Girls soccer has highest rate of concussions: How Vermont players and teams are cutting the risk – Burlington Free Press

Addison Cook dovefor the ball in a full extension save during pressure training at a soccer camp thesummer before her sophomore year in high school. As sheflew through the air, she was struck to the head by a cleat and then landed with her head hitting the ground hard.

"I immediatelyknew something was wrong when I went to stand up," she said of the incident at Northfield Mount Hermon School in Massachusetts. "I was nauseous, shaking, and my head was pounding."

The North Country Union High School goalkeeper and captainhad just suffered a concussion.

Addison Cook goes up for a save(Photo: Addison Cook)

After going to the emergency room and having a CAT scan, Cook spent the next two weeks in darkened rooms with no phone andno activity while her brainhealed. She had to take abreak from the sport she loves.

This experience is all too common. In fact, girls soccer has the highest concussion rate in U.S. high school sports, according to a 10-year studyby the American Academy of Orthopaedic Surgeonspublished in 2017. As the sport of soccer continues to grapple with mitigating the risk, Vermont teams are putting more resources into protecting their players.

Many people still think of football, rugby, wrestling and hockey as posing the greatest risks for concussion. ButVermont soccer coacheslike Cory Payson of South Burlington High School know the serious risks concussions pose to their female soccer players.

"I have been coaching girls for the past 10 years and I think I have seen at least a concussion within the high school program every year," Payson said. "I have coached boys soccer and basketball as well and have not seen the frequency in those sports, so the findings make sense."

Lindsay Austin-Hawley,anassistant varsity girls soccer coach at South Burlington High School and anUnder 16 Far Post coach, saidshe has seen a shift in style of play in high school soccer over the years that may be contributing to more injury.

"Its becoming more of afast-pacedgame and amorephysical game," she said.

Concussion research is just beginning to address data that suggests "in gender matched sports, girls experienced significantly higher concussion rates than boys."So far, it is unclear why.

Katie O'Hara heads the ball during South Burlington High soccer practice October 21, 2019.(Photo: APRIL BARTON/FREE PRESS)

Developingresearch has started to make a connection between heading the ball, a regular soccer skill, and brain injury. National awareness has been driving conversations about changes in the sport.

Former and current U.S. Women's National Team playershave announced they are participating in studies about chronic traumatic encephalopathy(CTE, the brain condition most often associated with football). Michelle Akers and Brandi Chastain are part of a long-term study about the cognitive effects of headers and collisions; Abby Wambach and Megan Rapinoe have said they are dedicating their brains to CTE research after they die.

Astudylast yearcomparedfrequent heading to collision concussions and foundfrequent heading of the ball to be worseon cognitive function.

Payson has changed his approach to heading as a result.

Head Coach Cory Payson presides over South Burlington High School girls soccer practice on October 21, 2019.(Photo: APRIL BARTON/FREE PRESS)

"As a coach, I limit the frequency and the force that my players have to head with," Payson said. "Soft tosses are used, and I don't do heading every week."

Still, the coaches interviewed for this article all agree heading contributes to only a very small number of concussions they have seen. Most occur from a collision between two people or with the ground.

Soccer is changing andis having to adapt to keep players in the sport. In some cases, a player who has sustained a high number of concussions may not be able to gettheir doctor or trainer's permission to continue playing.

Awareness and concussion data are driving changes to the way head injuries are treated and prevented in youth soccer.All soccer coaches in Vermont are required to take the Center for Disease Control's HEADS Up concussion course, a two-yearcertification, that presents and tests coaches' knowledge about concussion recognition and treatment.

Significant changes in heading policies have been made to protect the most vulnerable from injury. InJanuary of 2016, following a class action lawsuit, the U.S. Soccer Associationamended its heading rules for youth players. Players aged 10 and younger cannot be taught the skill of heading and if they deliberately head the ball in a game, the opposing team gets a free kick. At 11 and 12 years old, players can head in competition but can only practice heading up to30 minutes a week.

Newer rules require refereesto stop the game, call the coach on the field and have the player evaluated if there is a suspected head injury. The referee is not allowed to let the player resume play until a health care professional has cleared them.

Grace Johnson and Katie O'Hara vie for the ball during South Burlington High soccer practice on October 21, 2019.(Photo: APRIL BARTON/FREE PRESS)

Payson, who says his daughter has had five concussions unrelated to soccer, advises other parents to "be vigilant to watch for any of the warning signs after a head injury." He added that the effects can be felt days after the injury and that it is important to not rush back into play because there is the potential for a more serious long term problem.

The coaches at SBHS and Champlain Valley Union High School say they take any head issues seriously. Their trainers are up to date on best practices and researchand put concussed players through a multi-step process of evaluation and slowly increased activity before returning to the sport.

Austin-Hawley said coaches also take responsibility for knowing their players' regular behavior patterns so that if something is amiss, they will recognize it. Shealso suggested referees play a role in how physical eachgame is allowed to get.

Butnot all the responsibility lies with coaches and referees. "I think it is important that players are also educated about concussions and that they understand the importance of being open and honest about how they are feeling," said Stan Williams, CVUvarsity girls soccer coach.

In addition to policy changes, treatmentrecommendations continueto evolve.Recovery can varyfrom one player to the next so treatment often takesa trial and error approach.

"I had to listen to my body immenselyduring my slow periodof coming back," Cook said,"I couldn't run too much or dive too intenselyor I would begin to feel sick and have to step out for the rest of the day."

Cook said she also foundprevention through Olympic weightlifting. There are studies to suggest strengthening neck muscles as a way to mitigate concussion risk.

One of the issues players face in recovery isdifferences in approach to treatment within the medical community.

Janette, the mother of a Division I high school soccer player, said her daughter "got hammered in the side of the head" by a kicked ballduring a coed game and was out of play for three-and-a-half months.

Janette agreed to share her daughter's story on the condition that the Free Press not use her full name or her daughter's name, for fear her daughter'sconcussion could adversely affect her college recruitment chances. The Burlington Free Press editorschose to include the interview because of its value to the reader's understanding ofconcussions.

More: Editor's note: How the Free Press handled a request for privacy

After trying to act tough in the moment, Janette's daughter finally told her family she thought she was suffering a concussion. In their first few weeks of treatment they saw multiple doctors, whoall had differing approaches to home care.

Erin Heslop at South Burlington High soccer practice on October 21, 2019.(Photo: APRIL BARTON/FREE PRESS)

"By the third or fourth time, I think I lost my mind and said I need some consistency," Janette said.

Janette and her daughter eventually ended up going to a University of Vermont Medical Center concussion specialist where they realized one of the daughter's eyes was off track and her distance vision had been impaired. Recovery was a long process with occupational therapy, physical therapy, eye exercises with an optometrist and increasingly complex logic problems.

Janette said that in the end, establishing a baseline was most helpful. Baseline, consistent pain, was not cause for worry. But, when her daughter's pain increased by two points on the pain scale, they knew to decrease heractivity.

"If you askher, she says that she still feels the effects of that concussion and its been over a year," Janette said.

With all of the research and medical data about concussions and sports, does soccer pose too greata risk to players?

Local coaches didn't think so,and neither have many players and parents, as evidenced by their continuing to come back after concussions and knowing those who have had a concussion.

Janette still gets scared seeing her daughter in the free kick line, a wall of players blocking a shot. She still feels soccer is a safe sportbut,in hindsight, would not have allowedcoed play.

For Cook, the good outweighs the bad. "Soccer is my passion, what drives me to be the best person I can be, and what makes me happiest," she said. "When I am playing soccer there is no place I would rather be."

Contact April Barton, abarton@freepressmedia.com or 802-338-0642.

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Girls soccer has highest rate of concussions: How Vermont players and teams are cutting the risk - Burlington Free Press