A bop in the head here, a blow to the knee there — getting knocked with balls, sticks and body parts was par for the course for Natalie Katz, a high school lacrosse player in New York City. So when Katz was nailed in the head with a metal lacrosse stick during a game her sophomore year, she kept playing.
But that night she couldn’t complete her homework and collapsed into bed early. Back at school the next day, she couldn’t handle the bright lights and noises, and she wasn’t able to finish her math test. She even tried to go to lacrosse practice, but had uncharacteristically forgotten her gear. “I wasn’t functional,” she remembers.
[See: 9 Sports Injuries That Sideline Kids.]
Her mom and trainer suspected she had a concussion, and a pediatrician soon confirmed it. Since she’d seen other athletes recover from concussions in a few weeks, Katz figured her plans would remain the same: take finals, train all summer and be recruited to play lacrosse in college.
That didn’t happen. Instead, she postponed finals, spent the summer working with neurologists, physical therapists and other head injury specialists, and won’t play lacrosse in college — or ever again. “All of a sudden,” Katz says, “the way I defined myself was completely gone.”
An Overlooked Population
When most people think and talk about concussions, men come to mind. Fair enough: Boys and men are at higher risk for concussions, but that seems to be because sports with the highest risk of concussion tend to be male-dominated. Plus, boys and men are more likely to engage in the types of risk-taking behaviors (think speeding or substance-abusing their way into car accidents or getting into fistfights) that can cause brain injuries, says Dr. Douglas Smith, the director of the Penn Center for Brain Injury and Repair and a professor of neurosurgery at the University of Pennsylvania’s Perelman School of Medicine.
But studies comparing male and female athletes in the same sport (think soccer or basketball) have found that girls and women are as much as 50 percent more likely than men to suffer concussions. They also seem to take longer to recover — something Dr. John Neidecker, an osteopathic physician and sports concussion specialist in Raleigh, North Carolina, noticed in his practice. His recent study supported it: In it, he and colleagues compared the medical records of 110 male athletes and 102 female athletes, all of whom had endured a single sports-related concussion. They found that the median number of days female athletes had symptoms was 28, while for male athletes, it was 11. (Since a few people fell on extreme ends of the spectrum, researchers looked at the median, not average, to paint the most accurate picture.)
The researchers suspect that part of the difference in recovery times can be attributed to the fact that girls are at higher risk for pre-existing conditions like migraines that seem to prolong recovery. Why one person of either gender recovers quickly or not “is very multifactorial,” Neidecker says. “Sometimes it’s severity of injury, sometimes genetics play a role, but … more and more research is feeling that pre-existing conditions play a significant role in recovery.”
[See: Seemingly Innocent Symptoms You Shouldn’t Ignore.]
Other recent research using rat and human neuronal cells points to the wiring of female brains as a reason women and girls seem more susceptible to concussions in the first place. The research team, led by Smith at the Penn Center for Brain Injury, found that female axons — or nerve fibers involved in cell communication — were thinner and had smaller microtubules, or “the train tracks that are used to transport protein across the brain,” Smith says. So, when researchers applied force to simulate a traumatic brain injury, the female axons were more likely to break. “If you damage the train tracks, you end up dumping all the cargo,” Smith says. That cargo buildup not only disrupts communication, but can grow large enough to cause disconnection of the axons, contributing to long-lasting concussion symptoms.
Hormones also seem to affect concussion severity for women and girls. Some research out of the University of Rochester Medical Center has shown, for example, that women who suffer a head injury in the two weeks before their periods — when the hormone progesterone is highest — fare worse in a number of ways including mobility, pain and emotional health, compared with women at low-progesterone phases of their cycles. That may be because a sudden drop in progesterone aggravates post-concussive symptoms like headache, nausea, dizziness and brain fog, the study authors suggest.
Despite the mounting evidence that female brain injuries are certainly different, and quite likely more serious, than male’s, the vast majority of concussion and brain injury research involves boys, men and male brains. In fact, there’s almost no postmortem brain tissue available for research, and early research on brain injuries spared female rats due to their menstrual cycles’ effect on outcomes, says Katherine Snedaker, the executive director of PINK Concussions, a nonprofit dedicated to female brain injury. As a result, treatment protocols, clinicians’ knowledge and even women’s, girls’, parents’ and coaches’ expectations are often misguided for women and girls.
“This is brain injury’s time to wake up to women’s health,” says Snedaker, who launched #PINKBrainPledge in December, a partnership with the National PTSD Brain Bank that recruits women to pledge to donate their brains to participate in research about traumatic brain injury, post-traumatic stress disorder or both. A deeper understanding of what makes female and male brains and injuries different, she believes, “could result in [better] treatment for men, too.”
Life as a Lady With Post-Concussive Syndrome
When Katz returned to school her senior year, her concussion treatment appointments had ended, but her symptoms had not. Instead of nailing tests, she’d need more time. Instead of socializing during lunch, she avoided the cafeteria’s bright lights and loud noises. Instead of feeling energetic and healthy, she suffered fatigue and head pressure and pain. Instead of emotional stability, she felt crippled by waves of anxiety and sadness. And worst of all, she couldn’t find the words to articulate it all. “I didn’t have a way to describe [my symptoms] and I didn’t have a way to validate that they were real,” she says. “People reacted like I’m just being an emotional girl.”
Katz’s experience is unfortunately common among women with head injuries, finds Snedaker, who runs a Facebook support group that includes close to 3,000 women with head injuries, like those who sustained them in the military, as victims of domestic violence and in accidents. Sometimes these women face such gender-related judgment not only from peers, but also from medical professionals, she says. Snedaker’s message to the women is not inspirational, she says, it’s simple: “I tell them they’re not bad, stupid, crazy or malingering.”
One of the women listening — and now advocating alongside Snedaker — is Colleen Slaton, a pediatric occupational therapist who suffered 10 blows to the brain seven years ago at the hand’s of a client, a 15-year-old with autism. She still deals with fatigue, brain fog, short-term memory loss and light and sound sensitivity — especially when she hasn’t gotten sufficient sleep. “Don’t be intimidated or afraid to advocate,” says Slaton, 29, who lives outside of Lancaster, Pennsylvania. “Don’t be afraid to say what you’re really experiencing, because it’s an invisible injury.”
For Katz, now an ambassador for PINK Concussions like Slaton, advocating means pushing for health care professionals — including neurologists, physical therapists and mental health professionals — to better coordinate care for brain injury patients, and to develop better long-term care plans after their formal treatment ends. That includes social, emotional and psychological support. “To look at the physical symptoms would be to ignore the most crippling part,” she says.
[See: 10 Lessons From Empowered Patients.]
Still, Katz sees a silver lining in her experience: The time she gained when she lost lacrosse allowed her to explore other interests. This fall, she’ll be a freshman at Duke University, where she plans to study digital media and entrepreneurship. “It brought me to this place where I could channel the energy into something positive,” she says.
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Why Aren’t We Talking More About Women With Concussions? originally appeared on usnews.com
