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The Telegraph

Girls twice more likely of sustaining brain injury from heading a football than boys, research shows

Teenage girls are at twice the risk of a brain injury than boys from heading the ball, the largest ever study into sex-associated differences in football concussion has found. Adolescent girls who suffer a head injury are also less likely to be removed from play, despite taking on average at least two days longer to recover than their male counterparts. In what is likely to raise fresh questions over sex-specific management of concussion, the most common cause of a brain injury among girls was contact with equipment, such as heading the ball or collision with a goalpost. Boys, meanwhile, were more likely to sustain a head injury by colliding with another player and were 1.5 times more likely to be removed from the pitch than girls. “We may have to think about whether girls should be heading the ball at all in their adolescent years, or should they be cutting back on it as much as possible?” said Dr Willie Stewart, the Glasgow neuropathologist who proved the link between dementia and football and who led the study. “I know that’s a controversial thing to suggest, but to be honest, when you’re talking about brain injury, girls are getting brain injuries twice as often as boys and taking at least a couple days longer to recover. These are significant injuries that shouldn’t be passed off lightly.” The study – which was partly funded by the Football Association and Professional Footballers Association and based on injury data from around 80,0000 Michigan High School athletes between the ages of 14 and 18 – also underlines alarming differences in how brain injuries were handled. Despite the increased risk to females, boys who sustained a head injury were 1.5 times more likely to be removed from play than girls due to the increased likelihood of a physio being present at their matches, pointing to an increased need for gender-specific approaches in concussion management. “It may be that girls are suffering with symptoms for longer because they’re not being removed as effectively as they should be,” said Dr Stewart. “It also takes girls longer to get back playing again and yet the return to play guidance is the same for males and females, so I think this suggests to me that the sport should be looking at it differently. “We need to think about different rehabilitation for female athletes and that could mean, instead of a 24-hour step between recovery time, and maybe look at a 48-hour step between recovery time more generally for female athletes than males.” The findings tally with a growing body of evidence which has identified sex differences in concussion risk, with differences in male and female physiology thought to play a role. “If I were to go back and design this study from the ground up, then we would ask the girls where they are in their menstrual cycle,” said Dr Stewart. “What we do know is that in the second half of the menstrual cycle, the risk of concussion is greater and symptom severity can be longer, we think that’s because of a sudden loss of [the sex hormone] progesterone in the second half of the cycle. That’s the problem, we’re treating women as just another version of a male because that’s all the research that’s been done.” An FA spokesperson welcomed the study as “an important piece of research” but stopped short of implementing sex-specific approaches in its concussion protocols, instead pointing to the same-sex heading guidance the body updated last year for youth age groups. The guidance classes heading as a “low priority” between the ages of 14 and 16 and advises one session a week with a maximum of 10 headers. At under-18 level, heading drills should be “reduced as far as possible, taking into consideration the heading exposure in matches”. The spokesperson added: “The FA is committed to supporting further research in the future to better understand the impact of head injuries and concussion in the women’s and girl’s game, as there is currently limited information available. “The FA’s medical team continues to work with key stakeholders across the game to build a greater understanding and an accurate picture of the medical demands in the women’s and girls’ game.” ‘The impact of heading the ball in my career is scary’ By Fiona Tomas Julie Hemsley, former England international, says that losing hearing in one ear as a result of heading throughout her career changed her outlook and encouraged her to treat it with extreme caution in her new role as a youth football coach in Florida. The US Soccer Federation banned children under the age of 10 from heading the ball in 2015, and followed a lawsuit against the organisation calling for action to be taken after nearly 50,000 concussions were recorded among high school football players in 2010. The measures also included restricting the number of headers in practice for 11 to 13 year-olds – and Hemsley believes it is for the greater good of female football. “Our game is better played on the ground, it really is,” insisted Hemsley. “Women don’t have the physique sometimes to head the ball and we’re not making natural headers of the ball any more because we can’t teach it at a young age. It makes sense to enjoy the game a bit more with the ball on the ground. “There’s got to be a different way of training players to coach with aerial balls. For women, too, chesting the ball isn’t always a good idea. I’ve seen kids over here get the ball in their neck – and that can’t be good. I’m not against heading, but if we want to play a better game, it may help it, especially for the women’s game.” Hemsley, who hails from a generation of women’s football pioneers that included Gill Coultard, the first woman to earn 100 caps for England, says heading was an “integral” part of her 26-year career. The former central midfielder remembers one particular occasion when she “saw stars” after heading a ball when playing in Sweden. “It was freezing, and the balls would get so hard with the cold. Heading one of them really hurt,” said Hemsley. “Heading was my thing, because I could time it, but the impact it may have is a little scary actually.” It was during a club game in the 1980s when she “got smashed” in a collision with former England and Arsenal midfielder Debbie Bampton, after which she endured “12 weeks of hell.” “It was from a corner. I beat Deb in the air with the ball – she was a bigger player than me – and I paid for it,” she said. “I felt a tremor all through my body from the impact, I went to flick the ball away, but the impact of her head hit mine, and threw my brain to my forehead. I went to bed and I was too scared to fall asleep, in case I never woke up.” The collision left Hemsley with a twisted vertebrae in her neck and made her 70 per cent deaf in her right ear. It wasn’t until 20 years later, after relocating to the US, where she had an operation to fix her anvil, the small bone in the middle ear. The procedure restored her hearing, but she still suffers from the effects today. “If the temperature changes, or the atmospheric pressure changes with bad storms, I can feel the pressure and tightness in my ear, which becomes sore,” said Hemsley. Taylor denies being ‘asleep at the wheel’ over dementia crisis By Tom Morgan