The frightening reality of women’s concussions

It’s a moment perhaps everyone who’s played rugby — or any contact sport — has experienced; your head hitting the turf, or accidental head-to-head contact. For some, the contact doesn’t cause any issues, maybe a bruise or a bit of short term pain. For me, it meant a concussion; throbbing headaches, nausea, ‘fogginess’, a struggle to concentrate and more. Just under three months after smacking the back of my head into the ground twice over six weeks playing rugby, I’m still struggling.

It’s been an eye-opening experience.

After 15 years of playing sport, including netball, cricket, touch football and rugby, it was during a sevens match that I stood flat footed in a tackle and was steam rolled by an opposition player, hitting my head on the turf and experiencing my first concussion.

Immediately I knew there was an issue. While there wasn’t a headache straight away, I’d hit my head so hard there was almost an audible thud as it struck the ground. Moments later when I dove over the line to score a try, I stood up and cried. There was no reason; I wasn’t in any pain and in fact I should have been celebrating as I’d no doubt sealed a win for my team. But as I walked off and over to my team bench I couldn’t help it with tears rolling down my face and gasping for breath as I practically sobbed. It was one of the first signs of my concussion. The symptom list would continue to grow as the day went on.

Over the years, and as more information and the lasting effects of minor traumatic brain injuries [MTBI] or concussions has come to light, sporting bodies have endeavored to make sports safer for their athletes.

Rugby has introduced new tackling height rules and the ‘blue card’ system in which players showing immediate signs of concussion are sent from the field and are unable to return to play. Rugby league has done similar, lowering the tackle height and doing away with the shoulder charge, while AFL has cracked down on head-high bumps and sling-tackles which leave players powerless to stop a head knock.

While all these measures have seen a decrease in concussions, it’s certainly almost impossible to eradicate concussions from contact sport – especially in the women’s game.

According to studies in the Orthopedic Journal of Sports Medicine, women are twice as likely as men, in like-for-like sports, to experience a concussion, symptoms are more severe for women and symptoms are likely to last longer for women in comparison to men.

Speaking to Dr Rowena Mobbs of Macquarie University’s National Repetitive Head Trauma Research Group, she hoped more work would be done to explain why women are at such high risk.

“The jury is still out a bit as to why that may be the case,” Mobbs told ESPN. “But it does seem that women are a group that appear more vulnerable to having more severe concussion symptoms and having a more prolonged concussion experience, or post-concussion syndrome, so that’s a really important field of research.

“Traditionally the research has been focused on men in these contact sports, but we’re seeing such a community shift with women now participating and I’d hope to see an equal amount of research for both men and women.”

According to Dr Mobbs, three times as many women compared to men suffer chronic migraines, an issue that can be exacerbated by concussion, while the anatomical differences between men and women around the head and neck may also play a role.

As the days following my concussion went on, the symptoms started to take hold. For a week I suffered headaches, while a fogginess overtook my brain and there was a constant feeling of pressure in the back of my head where I’d struck the ground. I took two weeks out of the gym, sat out rugby training and struggled to focus while working.

Only days after I suffered my first concussion, Steve Smith was withdrawn from Australia’s first ODI against England for a concussion. Three days later he passed a concussion test and was cleared to play in their second ODI. It was crazy to me. Here I was, sitting on the couch with an ongoing headache, unable to go to the gym or concentrate long enough to read a page of a book let alone face cricket balls being fired down a pitch at me.

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He was later withdrawn for the second ODI and was never named for the third.

For most people it takes close to two weeks to recover from concussion symptoms, while the rest enter post-concussion syndrome, which can last months or years if not treated properly.

“Over two thirds of people will recover within the first two weeks, but there are many people who don’t and go on into the post-concussion syndrome period,” Mobbs said. “We need to help follow up with athletes and make sure they’re fine over the longer term, because we do know that concussion symptoms can crop up weeks or months after you had the trauma.

“Symptoms of concussion do not necessarily indicate the degree of trouble in the brain. For example, we know with a lot of patients, even up to 30 percent, have abnormalities with some brain testing even though they feel fine.”

After two weeks and slight symptoms, I returned to the gym and training. I was too impatient and didn’t properly follow return-to-play protocols. Two weeks after returning to training, and four weeks after hitting my head, I made my return to the playing field.

Playing in my first sevens game for Gordon in Sydney’s club competition, I lasted less than a minute on the pitch before I jogged to the sideline afraid I was about to be sick. I sat on the bench, sucking down water with a hat on my head to keep the light out of my eyes before I took to the field again, despite my parents’ protests. On my first play, I caught the ball, slotted through the gap and went over for a try. Immediately I stood up and walked straight to the sideline. That’s how the remainder of my day went; play one or two minutes, make a tackle and come straight off.

You’ll sit there shaking your head at my stupidity, but I can easily say I’m not the only one. A teammate from my club’s women’s 15s team returned to play despite still suffering headaches, while girls in my own team admitted they’d suffered several concussions over the years and returned to play well before they were ready.

While I made it through my first sevens tournament relatively unscathed, I can’t say the same following my second tournament only a week later.

Playing in the second game of the day, I rolled away after making a tackle and hit my head on the turf again. It was tiny, barely a knock and any other time it would have caused no issues, but because I’d returned to play too early I’d just suffered my second concussion. All the previous symptoms returned and I needed a teammate to drive me home because I was too worried to get behind the wheel.

“It is critical that people fully recover,” Dr Mobbs told ESPN. “We need to discover ways and encourage players to come forward with their symptoms, but also help understand what the symptoms are; provide education and provide better testing to pick up on concussion symptoms.

“If people return too early and still have symptoms they are at risk of further concussions, not only because the brain is more sensitive, but also because they may not make good choices on the field and their skills may be less. We recognise we want to win in sport, but we’ve got to do it safely.”

Close to six weeks on, I’m still dealing with the repercussions of that second knock. For former W-League player Natasha Prior, those repeated head knocks eventually ended her career.

At just 21-years-old, Prior made the decision to quit football after she suffered her fifth concussion in less than six years and was informed by a specialist that continuing playing risked her developing dementia by her 40s.

“I’ve had a few concussions, but I think I had my first bad one around the age of 14,” Prior told ESPN. “I’ve managed to have one every year or so just through playing football, then I had my worst one and it pulled me out for a year or so.

“My last concussion it was all the stereotypical symptoms; depression, headaches — they were a big thing — up to about seven or eight months if I were to do heavy exercise in terms of weights or anything I’d get nosebleeds.

“After my last concussion I had to see a brain specialist and we had chats about the potential of Alzheimers at a young age and whether I wanted to continue playing, and it was taken much more seriously.”

Concussion symptoms can be so wide ranging. For me as well as the usual headache and nausea, I also suffered from irritability around loud noises and bright lights, and an inability to find words – while writing this piece I completely forgot Steve Smith’s first name. One awful side effect can also be depression. While I’ve never suffered from mental health issues, it’s something that impacted Prior.

“The main thing was probably the mental health side, not so much from leaving football because that wasn’t such a big thing, but it felt chemical to me, the depression that I had. I think only now coming out of that I can recognize that it was something kind of bigger than just a bit of a head knock, it actually had lasting repercussions,” she said.

“I’d always kind of suffered slightly from mental health issues, but I’d never really addressed it, then having this happen, I think that led onto other things. I feel it brought to light the issues I already had.”

Making her W-League debut in 2017, Prior played just two seasons of top flight Australian football before her retirement, in that time though she says she felt pressure to return to play earlier than recommended.

“I loved playing football but I think there was definitely an external pressure to come back and play quicker,” Prior said. “Not naming the club, but with my first bad concussion a few years ago, they tried to rule it off as just a jaw knock and that I didn’t actually get concussed.

“There was pressure, where it’s viewed more of a two-week issue before the coach comes to you and asks when you’re going to be able to play. It’s a bit awkward to say technically there isn’t really anything wrong but your brain’s had a bad knock.

“I had a bad one [concussion] the year before my last when I was playing in Newcastle. Not that it got swept under the rug, but I think given how short the W-League season is you deal with it much quicker than I guess if you assess the case properly.

“I feel pretty positive now, but it’s taken a year and a half to get through that journey and kind of accept what happened.”

While Prior made the decision to walk away from professional sport and continue working on her mental health, she still takes to the field with her friends every so often to play friendly matches where she avoids heading the ball and there’s no pressure to go in for hard tackles.

For me, rugby’s preseason training has already started, but I’ll be sitting out for a little while. Instead I’ll be seeing a concussion specialist to hopefully find some steps that’ll see me resolve these symptoms and give me a chance to return to the playing field.

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