Detroit – A survey of Michigan high schools provides evidence that concussions and head injuries are more common among girls, and in the sports of football and ice hockey.
The third annual review by the Michigan High School Athletic Association also suggests a decline in reported concussions and head injuries since the 2015-16 academic year.
But officials caution some of the decline is likely do to different reporting methods used by schools, in the early years of the review.
“I think it’s important as an educational piece for our constituents, our parents, student athletes, coaches,” said Kathy Vruggink Westdorp, assistant director of the MHSAA.
“We can look further into these incidences of concussion in all our meetings.”
Doctors lauded the effort. But they caution that the surveys in Michigan and other states to not account for the repetitive, incidental trauma in sport that is a major contributor to long-term brain damage.
The routine jarring that occurs with blocks and tackles in football, body-checking in ice hockey or heading in soccer, repeated over the course of years, contributes greatly to causing the degenerative brain disease Chronic Traumatic Encephalopathy (CTE), doctors say.
However, the surveys provide essential information coaches, trainers, athletes and parents can used to help avoid and treat potentially serious injuries.
The results and trends will be clearer with each annual survey, Vruggink Westdorp said. And, the 99-percent compliance rate among high schools in the state encourages accuracy.
“According to the data we’ve compiled in this third year – and, our work, of course, is never done – but we have seen a trend, at this point in time, that concussion incidences are down,” she said.
“We continue to review that.”
The 2017-18 concussion report, released last week, found a 9.6-percent decrease in the number of confirmed concussions from the previous year.
But MHSAA officials said the specific rate of decline is less certain than the trend, especially with everyone getting used to the reporting requirements and refining the process.
Student-athletes suffered 3,580 head injuries – or 4.8 per school, compared to the 2016-17 average of 5.2.
Only 1.3 percent of participants experienced a head injury, a decline from 1.4 percent in 2016-17 and 1.6 percent in the first year of the study, 2015-16.
A total of 284,920 “athletes” participated, with one student counting as more than one, if they participated in multiple sports.
Doctors praised the work, but emphasized the insidious nature of brain trauma: What is most easily detected is not always the major concern.
And, special equipment is required to gauge the degree of brain trauma of the subtler blows that, repeated over time, are of considerable concern.
“The only way to get that data would be for people to wear accelerometers, whether it be a patch, or whatever, in their helmet or headband,” said Dr. Robert Cantu, medical director of the Concussion Legacy Foundation, a partner with the Boston University School of Medicine in the Center for the Study of CTE.
“All of our work at BU has suggested that it is total brain trauma, and that includes sub-concussive blows, as well as concussive blows.
“About 20 percent of our CTE, pathologically diagnosed cases, have no history of concussion,” said Cantu, a world-renown expert on concussion.
“There are in the last seven or eight years a number of studies that have followed athletes over the course of a season, especially in football and soccer, and with no recognized concussions they have been able to show structural, metabolic and functional changes in the brain just from the repetitive head trauma.”
In Michigan, girls reported significantly more concussions than boys in soccer, basketball and baseball/softball.
Girls reported more than double the concussions per 1,000 participants in soccer than boys, 25 to 12.
Girls also reported more than double the number of concussions per 1,000 participants in basketball than boys, 22 to 9.
Softball players reported seven concussions per 1,000 participants.
Contact sports again revealed the most head injuries, in the Michigan survey.
Football accounted for 41 head injuries per 1,000 participants. And, ice hockey repeated with the second-most injuries per 1,000, with 32.
Girls soccer and wrestling tied for third with 25 head injuries per 1,000 participants.
“That gives us some concrete information as to how to continue to address further issues,” Vruggink Westdorp said.
“There is still the gender difference question. Our research appears to support the conclusion that some of that could be anatomical or muscular.
“But, some of that could just be higher incidences of females reporting, at this time.”
Cantu said the experience in Massachusetts identifies other issues with the surveys.
“The schools that have one or more certified athletic trainers report up to eight times more concussions that schools that have no athletic trainers,” he said.
“And even if you have an athletic trainer, it is not perfect. Because concussions are missed.
“But, of course, the tracking is meritorious.”
Vruggink Westdorp said the MHSAA is already incorporating the survey in some of its work.
“This really solidifies the trends in terms of concussion and concussion care,” she said.