Concussion: are women more at risk? *H&H VIP*

  • Women are likely to experience greater symptoms of concussion than men, according to a recent study.

    Research carried out by the University of Michigan found that concussion does not have different effects on men than on women. However, it did find that women experienced concussion symptoms more severely than men at preseason testing.

    This is particularly relevant to equestrianism because women currently represent 74% of the riding population, according to the British Equestrian Trade Association (BETA).

    The study was presented at a sports concussion conference in Denver on 24-26 July, which was hosted by the American Academy of Neurology.

    Researchers tested 148 college athletes from 11 different sports at the university. Of these, 45% were women, 51% played contact sport and 24% had experienced a concussion.

    Women reported, on average, one-and-a-half times more symptoms and scored three points higher on severity than men.

    On clinical reaction time, women were 19 milliseconds slower to react than men.

    On tasks assessing processing speed, attention and working memory speed, women scored on average 7% below men.

    “The difference in performance between genders should be of great interest to athletes, coaches, athletic trainers and doctors who utilise baseline assessments to aide recovery protocols,” said study author Kathryn O’Connor of the University of Michigan and a member of the American Academy of Neurology.

    Making progress

    Steps are being made to see if wearable devices could help detect head trauma in sports where athletes are at a high risk.

    Last season, Saracen Rugby Club trialled a device called the xPatch, which measures blows to the head.

    The information is transmitted via a secure database to an app on authorised mobile devices, such as a smartphone.

    This means trainers and medical staff can see real-time information about injuries sustained during competition.

    A mouth guard aimed at detecting concussion is also currently in development at the University of Florida.

    The aim is to create something that could measure the strength of a blow to the head, which in turn would give doctors early warnings about head injuries.

    According to researchers at University College Dublin, the chance of jockeys in Ireland, France and Britain sustaining a concussion in a fall is 15%.

    Dr Jerry Hill, the British Horseracing Authority’s (BHA) chief medical adviser, said force detectors and gum shields are interesting developments, but unlike in other sports where the injury may not be apparent, in equestrianism it is.

    “If you fall off a horse, whether you hit your head or not, concussion must be considered,” he told H&H.

    “In the future it would be very useful to have a blood, urine or breath test to detect chemicals released during brain injury, which would give an objective measure of the presence and severity of concussion.

    “These are under development but are still some way off. Refining skull cap design to help dissipate impact forces is another area of ongoing research.”

    Racing was the first non-team sport in the world to operate a standardised concussion management programme.

    Rules require all professional jockeys to undergo yearly baseline neuropsychological screening in regional centres before receiving a licence.

    If a jockey is diagnosed with concussion at a meeting, they are immediately stood down for at least six days.

    Following this, they undergo more tests, which are compared to their baseline, a separate neurologist assesses the rider, and they may also have a brain scan.

    Only when the results of these assessments have come back normal is the jockey allowed to return to race-riding.

    “Our approach to concussion aims to prevent jockeys with reduced cognitive [brain] function riding and putting themselves, horses and colleagues at risk of injury,” Dr Hill added.

    “This is akin to not letting someone who has been drinking alcohol drive before they have completely sobered up.

    “Prevention of long-term health issues is another target, but we do not yet have the data to give a definitive answer on this.”

    How is it dealt with?

    Protocol varies across the different equestrian governing bodies.

    British Eventing (BE) has a compulsory 21-day ban for all riders who suffer a concussion at one of its events.

    This rule was introduced last year.

    Previously, riders could be given a seven-day suspension if symptoms resolved within 15 minutes.

    But there are exceptions to the current rules, which can allow riders to return after seven or 10 days — subject to medical assessment or a pre-season “baseline test”.

    “We are kept informed of developments around concussion by our chief medical officers on a regular basis, and of course alter rules accordingly,” BE’s national safety advisor Jonathan Clissold told H&H.

    The British Showjumping (BS) and British Dressage (BD) rules are less clear.

    The BS rulebook states that “any rider under a medical suspension may not compete in another equestrian discipline without the permission of the appropriate governing body”.

    Medical suspensions are not directly referred to in the BD or BS rulebooks.

    Heightened risk

    David Davies is a neurosurgery research registrar to the National Institute of Health Research (NIHR) specialising in traumatic brain injury, and also provides medical cover at equestrian events.

    He said that once an individual has a concussion, the risk of another injury may be increased by up to seven times.

    “The key to safe concussion management is to rest until the symptoms have completely resolved and then start a gradual return to training,” he said.

    If symptoms return, more physical and mental rest should be taken.

    “In riding there is no doubt that wearing a helmet is essential and has prevented many serious injuries,” he added.

    However, the evidence to support concussion guidelines in sport is surprisingly sparse. “Research is increasing and with luck in the near future more robust protocols will be formed.”

    Leading by example

    The University of Birmingham and the NIHR Surgical Reconstruction and Microbiology Centre are currently running a leading European study into recurrent concussive injury in sport.

    Mr Davies said he is “concerned” by some top riders’ attitudes towards wearing helmets at major events, such as when the helmet is removed for the lap of honour.

    “In our opinion no professional or role model rider should be seen on horseback without protective head gear at a competition,” he told H&H.

    Charity Headway — the brain injury association, which works to improve life after brain injury — welcomed the studies.

    Supporters of the charity include top jockey Hayley Turner, who suffered a serious head injury during a fall on Newmarket’s gallops in 2009.

    Charity spokesman Luke Griggs said it is positive that the public is becoming more aware of the consequences of head injuries.

    “There are numerous trials taking place for products that can help identify the impact and potential damage caused by a blow to the head, but far more research and work is needed before they can be relied upon as accurate diagnostic tools,” Mr Griggs told H&H.

    “Concussion is an evolving injury that can be notoriously difficult to diagnose.

    “It is therefore vital people seek medical attention after a blow to the head and do not take any chances.”

    Ref: Horse & Hound; 17 September 2015