What Is Post-Concussion Syndrome?

The World Health Organisation’s (WHO) definition includes the presence of three or more of the following symptoms:

  • Headache
  • Fatigue
  • Difficulty concentrating & performing mental tasks
  • Dizziness
  • Irritability
  • Memory impairment
  • Insomnia
  • Reduced tolerance to stress, alcohol, emotional excitement

Is there a difference in Concussion rates & recovery between Males and Females?

  • Recent research has suggested that females are more likely to sustain a concussion compared to males and they take longer to recover from a concussion.
  • It is also known that when both male and females play sports, females have a higher incidence of concussion compared to males. Bretzin found that female high school athletes are 1.56 times more likely to sustain a sports related concussion compared to males when playing a sport with similar rules such as football, basketball, baseball/softball.  
  • Females report more symptoms which are more severe in nature
  • In 2017 The NZ Herald published an article based on research by The American Academy of Orthopaedic Surgeons stating that female football players are 12.1% more likely to sustain a concussion compared to boys
  • In basketball concussion accounted for 8.8% of boys’ injuries but 25.6 % of girls’ injuries.

Why is there a difference between the sexes?

  • Neck strength: females generally have a reduced head-neck strength compared to males. Their heads go through greater acceleration and increased angular displacement during the impact, thus predisposing them to the force required to produce a concussion
  • Hormones: theories have been put forward which suggest that if a concussion is sustained during the luteal phase of the menstrual cycle, females have a longer recovery rate compared with those who are on the birth control pill or women who experience a concussion in the 2 weeks after their period.
  • Reporting Rates: research suggests that females maybe more ‘honest’ leading to a higher incidence of reporting compared to males.It is also suggested that females also take longer to present to clinics which lead to increased chronicity.

Neck Strengthening

A promising form of prevention may come from a cervical muscle strengthening program. It is known that poor neck strength is a predictor of concussion, and for each additional pound of strength a player had, the overall risk of sports related concussion was reduced by 5%. Improved neck strength, as well as the ability to anticipate and activate the neck muscles, was found to reduce the kinematic forces from head impact.

References

ACC https://www.acc.co.nz/assets/provider/1bf15d391c/tbi-strategy-action-plan.pdf

American Academy of Orthopaedic Surgeons. https://www.nzherald.co.nz/sport/news/article.cfm?c_id=4&objectid=11826758

Bretzin AC, Covassin T, Fox ME, Petit KM, Savage JL, Walker LF, et al. Sex Differences in the Clinical Incidence of Concussions, Missed School Days, and Time Loss in High School Student-Athletes: Part 1. The American Journal of Sports Medicine. 2nd ed. 2018 May 23;46(9):2263–9

Dixon, S. (2015). The Employment and Income Effects of Eight Chronic and Acute Health Conditions. New Zealand Treasury Working Paper 15/15. Wellington New Zealand Government.

Feigin, V. L., Theadom, A., Barker-Collo, S., Starkey, N., McPherson, K., Kahan, M., Ameratunga, S. (2013). Incidence of traumatic brain injury in New Zealand: a population-based study The Lancet Neurology, 12(1), 53-64. doi:10.1016/S1474-4422(12)70262-4.

Grool AM, Aglipay M, Momoli F, Meehan WP III, Freedman SB, Yeates KO, et al. Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. JAMA. 2016 Dec 20;316(23):2504.

Lawrence DW, Richards D, Comper P, Hutchison MG. Earlier time to aerobic exercise is associated with faster recovery following acute sport concussion. Janigro D, editor. PLoS ONE. 2018 Apr 18;13(4):e0196062.

https://pediatrics.aappublications.org/content/142/6/e20183074


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