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    High school concussion stats hide the real stories of athletes like Brittni Souder



    George Perry - 6/1/21

    Asterisks are never a good thing in sports statistics. Shortened seasons, performance-enhancing drug use, deflated balls, reciprocal boycotts, titles, medals and trophies stripped... asterisks never draw your attention to something extra inspiring or noteworthy for its positivity. But at least they're honest. They alert you to the fact that there is more to the story than the numbers alone can tell you. Maybe Mark Twain would have been less damning of statistics if newspaper editors of his day had used more asterisks.

    High school concussion statistics could use a few more asterisks, if only to remind you that each data point is an athlete whose career and perhaps life will never be the same.

    It's no lie (in the statistical sense) that girls' soccer is the second most-concussed high school sport in the United States. But if all you know is 8.19 per 10,000 athlete exposures, behind boys' football 10.40 per 10,000 AE and ahead of boys' ice hockey 7.69 per 10kAE, you know nothing about any one of the female high school soccer players who suffered any of the 1,055 concussions that made their way into the November 2019 issue of Pediatrics.


    Nothing about which of those girls had recurring injuries, beyond knowing that girls had about 50% higher rates of recurrence than boys. Nothing about whether any of those athletes showed up or will show up in a subsequent study of NCAA concussion rates. Nothing about if any of those high school athletes suffered concussions in multiple sports. And certainly nothing about all the concussions that were not diagnosed.

    Which means you wouldn't know anything about Brittni Souder, even if the study had started a few years earlier.

    Everyone was talking about sports concussions except the doctors

    Johnson is preparing for his first season of IndyCar racing after 20 years in NASCAR. The design of the car - less than 50% the weight of a stock car, open-wheeled - means Johnson will be driving faster than ever. The course design will add to the magnitude of gravitational forces he experiences on turn, and the number of times his body experiences a surge in G's. And because IndyCar's do not have power steering the way NASCAR vehicles do, he will face greater demands on his arms and shoulders.

    Proving the point that even non-contact sports carry concussion risk, Brittni's first diagnosed concussion came as she crossed the finish line as the anchor leg of a 4 x 400m relay.

    Like 23 of the 65 young track & field athletes in the Pediatrics study who suffered a concussion while competing in track & field, Brittni's came from impacting the ground. Coming down the stretch, she pushed through an asthma attack and blacked out as she crossed the finish line, her head smacking onto the track. The emergency room doctor told her to stay home from school the next day and sit out practices and games until she felt better, then she'd be free to go back to sports.

    That was 2008. The following year, Dr. Robert Cantu of the Boston University School of Medicine testified in front of Congress and appeared on CNN and 60 Minutes to talk about concussions in football. 

    Credit The Knockout Project


    We can think of that as a "perfect hat trick" of concussions: equipment impact, player-to-player impact, accumulation.


    Unlike after her earlier concussions - those diagnosed and those not - this time the symptoms did not fade in the off-season. The headaches, dizziness, exercise intolerance and light sensitivity persisted. Whenever she felt good enough to go for a jog, the symptoms put her right back down.


    Her athletic trainers at Hood searched for a neurologist Brittni could visit. One neurologist told her that she was fine and ready to return to play. Clearly she wasn't, so the athletic trainers found another.


    We can think of that as a "perfect hat trick" of concussions: equipment impact, player-to-player impact, accumulation.

    Unlike after her earlier concussions - those diagnosed and those not - this time the symptoms did not fade in the off-season. The headaches, dizziness, exercise intolerance and light sensitivity persisted. Whenever she felt good enough to go for a jog, the symptoms put her right back down.


    Her athletic trainers at Hood searched for a neurologist Brittni could visit. One neurologist told her that she was fine and ready to return to play. Clearly she wasn't, so the athletic trainers found another.


    A brain and spine specialist in Baltimore diagnosed her with occipital neuralgia, treatable with steroid injections in the back of the head and surgery to remove scar tissue. She was cleared to train over the summer, and focused her training on her neck, upper body and cervical spine. Those muscle groups felt stronger and her movements improved - and the continued pain medication did its job - but whenever she tried running, the visual symptoms and dizziness returned. And when she attempted headers, the headaches and nausea came back as well.


    That same year, ESPN's Outside the Lines and PBS' Frontline collaborated on a series about concussions in the NFL.

    Repeated concussions build into the career-ending concussion

    Johnson is preparing for his first season of IndyCar racing after 20 years in NASCAR. The design of the car - less than 50% the weight of a stock car, open-wheeled - means Johnson will be driving faster than ever. The course design will add to the magnitude of gravitational forces he experiences on turn, and the number of times his body experiences a surge in G's. And because IndyCar's do not have power steering the way NASCAR vehicles do, he will face greater demands on his arms and shoulders.

    Determined to have a final season, and having been given no medical guidance to the contrary despite her ongoing symptoms, Brittni returned for her senior year on the team.


    In the last 10 seconds of a game, Brittni advanced off the defensive line to confront an opponent dribbling towards the top of the 18-yard area. Brittni stepped into the tackle as one of her teammates pushed the opponent from behind. The opposing player's arms instinctively went up and collided with Brittni's head, which then hit the ground as they both went down.


    Even though she walked off the pitch, this collision knocked her down for good. All the old symptoms were there, but were all-pervasive. Her body could not regulate its temperature, she struggled to keep track of day-to-day goings-on, basic mental or physical activities exhausted her.


    Migraines, the doctors said, even as "CTE" had become as much a part of the conversations on ESPN, Sports Illustrated and sports talk radio as "RBI" or "PAT."

    Dr. Ted Carrick and functional neurology: Giving concussions the treatment they deserve

    Brittni's friends, family and athletic trainers from Hood did the work that she couldn't and her doctors wouldn't. One of them read about how, way back during Brittni's freshman year at Hood College, Pittsburgh Penguins' star Sidney Crosby had found a way back to the ice after working with Dr. Ted Carrick. Brittni traveled to what was then the Carrick Brain Center in Georgia to meet with one of Dr. Carrick's partners.


    Her examination at the Carrick Brain Center was as exhausting as any training session. Whereas every other doctor she had visited gave her the standard experience of a 30-minute appointment, of which she'd have maybe 10-15 minutes of face time with the doctor, Carrick's evaluation was an all-day event. Blood tests, visual tracking tests, balance and motor control tests... Carrick had pioneered a field, and Brittni was finally in it.


    What was going on with her was pretty obvious to the medical staff from the outset, but they were going to find the way forward.

    Brittni's recovery plan included personalized nutritional recommendations to eliminate any food-sensitivity reactions revealed by the blood work; arm and leg exercises that are part of Carrick's functional neurology battery; and vision therapy - "horrible but helpful," in Brittni's telling.

    Coaching youth soccer to minimize risk and severity of concussions

    Johnson is preparing for his first season of IndyCar racing after 20 years in NASCAR. The design of the car - less than 50% the weight of a stock car, open-wheeled - means Johnson will be driving faster than ever. The course design will add to the magnitude of gravitational forces he experiences on turn, and the number of times his body experiences a surge in G's. And because IndyCar's do not have power steering the way NASCAR vehicles do, he will face greater demands on his arms and shoulders.

    The team at Dr. Carrick's institute had one other recommendation: a graduate program. Having finished her undergraduate degree remotely years before remote college was a nationwide thing, Brittni completed her master's in Exercise Science with dual concentrations in Performance Enhancement and Injury Prevention, and Sports Psychology, from California University of Pennsylvania. Quite a logical combination, given her history.


    Brittni coaches youth club soccer and individual soccer players, and is also a board member of Pink Concussions, an advocacy group for women and girls with brain injuries.


    Brittni's story is a key part of both endeavors. "Knowing my story is a mandate for the parents and kids I work with. Scaring the crap out of them is a requirement!"


    She takes a proactive stance on head safety with her coaching. Obviously, if she suspects that a young athlete has a concussion, she tells the parent immediately and the kid is done until they are appropriately cleared by a doctor. "They all know this, and there's no discussion. You can't bulls--t a bulls--tter!"


    A current conversation in soccer is whether younger age groups should be allowed to head the ball, what restrictions should be set and how they should be implemented. Brittni thinks current policies are a good but flawed start.

    "I remember being 8 years old and I loved to head the ball. I'd have my mom throw the ball to me and I'd head the ball over and over. Kids want to head the ball, but they have to learn how, and they have to learn how the right way. I teach headers because it's safer for me to teach them how to do it properly than to think they're never going to do it on their own or in a game.


    "You can teach technique without using a fully inflated ball with an 8-year old. Use a foam ball, a volleyball, an underinflated soccer ball - anything that involves less impact, while also teaching the technique. They need to know the technique before they try actual heading, and you teach the technique in a way that brings them to where they can safely do it in a game."


    Some of Brittni's technique coaching doesn't involve a ball at all. Brittni uses the Iron Neck to teach young soccer players how to head with their whole body. Rather than originate the heading movement with a forceful contraction of the shoulder and neck musculature, she wants the head and neck simply to transmit and direct force generated in the lower body.


    "It's a good way to feel all of the muscles in the neck and the core. Just standing with your feet slightly staggered with the Iron Neck on and going through a heading motion, you feel it from your legs to your core to your neck. That's proper technique - it's the whole body. Especially when I'm training a lanky young athlete, the kind who doesn't have good control of their limbs, you need to teach them the technique for controlling the upper shoulders and cervical spine.


    "I just wish I could use it more, where every athlete can get 10 minutes on it at each session."

    If the NFL was late to the concussion issue, what is soccer's excuse?

    Johnson is preparing for his first season of IndyCar racing after 20 years in NASCAR. The design of the car - less than 50% the weight of a stock car, open-wheeled - means Johnson will be driving faster than ever. The course design will add to the magnitude of gravitational forces he experiences on turn, and the number of times his body experiences a surge in G's. And because IndyCar's do not have power steering the way NASCAR vehicles do, he will face greater demands on his arms and shoulders.

    All the lifestyle modifications we've listed thus far are a great start, and we highly encourage you to incorporate all three of these into your life. As the NFL and college football make concussion safety a major priority, and the NHL refines their concussion protocols after nearly losing Sidney Crosby to concussions, soccer at all levels is not much better than when Brittni was on the pitch. 


    "Both men's and women's soccer are kinda sucking," she says. "You see blood on a player's head and they stay on the field. The men's game is far worse than football. The announcers have gotten better - sometimes! Sometimes they'll say it's a knock to the head and they should be evaluated, but other times they'll say something really stupid about 'mental strength' and 'getting back out there.' Limit your technology use, take frequent breaks throughout the day, and constantly monitor/adjust your posture as needed.

    "It drives me crazy because you know all the kids are watching. Especially the US Women's National Team and now the NWSL, you know kids are watching it. " 

    Credit Graham Cullen / Frederick News Post


    The concussion study in Pediatrics covered four years, and that four-year block ended three years ago. Girls soccer has continued to grow in that time with no significant steps towards reducing concussion rates, which means roughly 1,000 more young athletes are where Brittni was 12 years ago.


    Considering the progress in sports, athletic performance and medicine, that's a lot of asterisks that soccer could have avoided having on their stats sheet.