Effects of Sex and Event Type on Head Impact in Collegiate Soccer

Reynolds, Bryson B.; Patrie, James T.; Henry, Erich J.; Goodkin, Howard P.; Broshek, Donna K.; Wintermark, Max; Druzgal, T. Jason

doi:10.1177/2325967117701708

Cited by 39 publications

(17 citation statements)

References 43 publications

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“…This suggests that women may be more sensitive than men to the effects of heading at the level of tissue microstructure. Our findings add to a growing body of evidence that men and women express distinct biologic responses to brain injury (7,21,(32)(33)(34). FA was the most prevalent indicator of microstructural alteration.…”

Section: Heading Exposure and Fasupporting

confidence: 64%

MRI-defined White Matter Microstructural Alteration Associated with Soccer Heading Is More Extensive in Women than Men

Rubin¹,

Catenaccio²,

Fleysher³

et al. 2018

Radiology

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Purpose To examine the role of sex in abnormal white matter microstructure after soccer heading as identified by using the diffusion-tensor imaging (DTI) metric fractional anisotropy (FA). Materials and Methods In this prospective cross-sectional study, 98 individuals who were enrolled in a larger prospective study of amateur soccer players (from 2013 to 2016) were matched 1:1 for age and history of soccer heading in the prior 12 months. Among the subjects, 49 men (mean age, 25.7 years; range, 18-50 years) and 49 women (mean age, 25.8 years; range, 18-50 years) with median total soccer headings per year of 487 and 469, respectively, underwent 3.0-T DTI. Images were registered to the Johns Hopkins University template. A voxelwise linear regression was fitted for FA with terms for the number of headings during the previous 12 months and its interaction with sex after controlling for the following potential confounders: age, years of education, number of lifetime concussions, and handedness. In the resulting statistical maps, P < .01 indicated a statistically significant difference, with a threshold cluster size larger than 100 mm. Results Among men, three regions were identified in which greater heading exposure was associated with lower FA; eight such regions were identified among women (>100 contiguous voxels, P < .01). In seven of the eight regions identified in women, the association between heading and FA was stronger in women than in men. There was no significant difference of heading with FA between the sexes for any region in which heading was associated with FA among men (P > .01, <100 contiguous voxels). Conclusion With similar exposure to heading, women exhibit more widespread evidence of microstructural white matter alteration than do men, suggesting preliminary support for a biologic divergence of brain response to repetitive trauma. © RSNA, 2018 Online supplemental material is available for this article.

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Section: Heading Exposure and Fasupporting

confidence: 64%

MRI-defined White Matter Microstructural Alteration Associated with Soccer Heading Is More Extensive in Women than Men

Rubin¹,

Catenaccio²,

Fleysher³

et al. 2018

Radiology

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“…However, a meta-analysis by Dougan et al (2014) presented evidence that more severe deficits in neuropsychological functioning was seen acutely post-concussion (1-10 days) in female athletes in comparison to males. Alternatively, the study by Reynolds et al (2017) found no differences in the number or severity of head impacts between males and females in collegiate soccer. Taken together, these studies suggest that potential sex related differences are likely due to a range of physiological and metabolic differences, and not necessarily differences in the number or severity of head impacts (Brook et al, 2016).…”

Section: N-acetyl Aspartate and Previous Studiesmentioning

confidence: 92%

Reduced brain glutamine in female varsity rugby athletes after concussion and in non‐concussed athletes after a season of play

Schranz

Manning

Dekaban

et al. 2017

Human Brain Mapping

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The purpose of this study was to use non-invasive proton magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) to monitor changes in prefrontal white matter metabolite levels and tissue microstructure in female rugby players with and without concussion (ages 18-23, n = 64). Evaluations including clinical tests and 3 T MRI were performed at the beginning of a season (in-season) and followed up at the end of the season (off-season). Concussed athletes were additionally evaluated 24-72 hr (n = 14), three months (n = 11), and six months (n = 8) post-concussion. Reduced glutamine at 24-72 hr and three months post-concussion, and reduced glutamine/creatine at three months post-concussion were observed. In non-concussed athletes (n = 46) both glutamine and glutamine/creatine were lower in the off-season compared to in-season. Within the MRS voxel, an increase in fractional anisotropy (FA) and decrease in radial diffusivity (RD) were also observed in the non-concussed athletes, and correlated with changes in glutamine and glutamine/creatine. Decreases in glutamine and glutamine/creatine suggest reduced oxidative metabolism. Changes in FA and RD may indicate neuroinflammation or re-myelination. The observed changes did not correlate with clinical test scores suggesting these imaging metrics may be more sensitive to brain injury and could aid in assessing recovery of brain injury from concussion.

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“…However, variability introduced by level of play, sensor choice, and sensor recording threshold has created a wide range of head impact rates: female soccer (0.4-3.3 impacts/AE), 30 , 33 , 38 , 42 , 44 , 45 male soccer (1.3-2.4 impacts/AE), 33 , 44 , 45 female lacrosse (0.1-0.3 impacts/AE), 8 , 13 , 25 and male lacrosse (0.7-1.9 impacts/AE). 7 , 13 , 25 , 35 , 51 Head impact rates were markedly lower than rates in sensor studies without video or visual reviewer techniques: female soccer (2.9-5.7 impacts/AE), 29 , 40 male soccer (31.1-39.5 impacts/AE), 39 , 40 female lacrosse (9.2 impacts/AE), 41 and male lacrosse (5.5-11.5 impacts/AE). 31 , 39 , 41 Generally, previous studies have found that soccer has higher impact rates than does lacrosse.…”

Section: Discussionmentioning

confidence: 81%

Sport- and Gender-Based Differences in Head Impact Exposure and Mechanism in High School Sports

Huber

Patton

McDonald

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Repeated head impacts sustained by athletes have been linked to short-term neurophysiologic deficits; thus, there is growing concern about the number of head impacts sustained in sports. Accurate head impact exposure data obtained via head impact sensors may help identify appropriate strategies across sports and between genders to mitigate repetitive head impacts. Purpose: To quantify sport- and gender-based differences in head impact rate and mechanism for adolescents. Study Design: Cohort study; Level of evidence, 2. Methods: High school female and male varsity soccer, basketball, lacrosse, and field hockey (female only) teams were instrumented with headband-mounted impact sensors during games over 2 seasons of soccer and 1 season of basketball, lacrosse, and field hockey. Video review was used to remove false-positive sensor-recorded events, and the head impact rate per athlete-exposure (AE) was calculated. Impact mechanism was categorized as equipment to head, fall, player to head, or head to ball (soccer only). Results: Male players had significantly higher head impact rates as compared with female players in soccer (3.08 vs 1.41 impacts/AE; rate ratio, 2.2 [95% CI, 1.8-2.6]), basketball (0.90 vs 0.25; 3.6 [2.6-4.6]), and lacrosse (0.83 vs 0.06; 12.9 [10.1-15.8]). Impact mechanism distributions were similar within sports between boys and girls. In soccer, head to ball represented 78% of impacts, whereas at least 88% in basketball were player-to-player contact. Conclusion: Across sports for boys and girls, soccer had the highest impact rate. Male high school soccer, basketball, and lacrosse teams had significantly higher head impact rates than did female teams of the same sport. For girls, basketball had a higher head impact rate than did lacrosse and field hockey, and for boys, basketball had a similar impact rate to lacrosse, a collision sport. Sport differences in the distribution of impact mechanisms create sport-specific targets for reducing head impact exposure.

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Effects of Sex and Event Type on Head Impact in Collegiate Soccer

Cited by 39 publications

References 43 publications

MRI-defined White Matter Microstructural Alteration Associated with Soccer Heading Is More Extensive in Women than Men

MRI-defined White Matter Microstructural Alteration Associated with Soccer Heading Is More Extensive in Women than Men

Reduced brain glutamine in female varsity rugby athletes after concussion and in non‐concussed athletes after a season of play

Sport- and Gender-Based Differences in Head Impact Exposure and Mechanism in High School Sports

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