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Newsday (New York)
High school girls soccer, which has surged in popularity over the last 25 years, trailed only football for the highest number of suspected concussions on Long Island for the 2015-16 school year.
Newsday analyzed concussion reports it received under the Freedom of Information Law for nine sports at more than 100 Long Island public high schools, and obtained the participation numbers for all public high schools on Long Island from the state's governing body for high school sports.
Among the findings:
- There were 116 suspected concussions in girls soccer among more than 4,700 players, or one per 40.7 players. Boys soccer had 66, or one per 85.7 players.
- Football had 383 suspected concussions, one per 22.6 players.
- Four girls sports - soccer, lacrosse, basketball and softball - had a combined 278 suspected concussions, or one for every 56.7 players. The four comparable boys sports - soccer, lacrosse, basketball and baseball - combined for 169 suspected concussions, or one for every 118.5 players. Experts said the higher rate of suspected concussions among girls is consistent with national trends.
- Baseball had the fewest suspected concussions with 12, one per 399.6 players.
Soccer thought of as safer alternative
"People don't realize how physical soccer is," said Syosset goalkeeper Erica Bulzomi, a senior who said she suffered two concussions. "Some of my guy friends who play football, they will say, 'Oh, soccer is barely even a contact sport, you guys don't get hit as much.' But all you have to do is look at the bumps and bruises on any girl that plays soccer, any boy that plays soccer, and you'll see how physical the game is."
Soccer has long been viewed as a safer alternative to football or lacrosse, but experts said the sport has been slow to recognize the risk of concussion.
"We've known this for years, but parents are oblivious," said Tim McGuine, a sports medicine researcher at the University of Wisconsin School of Medicine and Public Health. "I hear parents say without batting an eye that they won't let their kid play football, and I always ask them, 'But will you let your daughter play soccer?' "
In a game where hitting the ball with your head is commonplace, trying to make the game safer has proved to be a challenge, McGuine said.
"A lot of people pay lip service to soccer, but parents, coaches and kids, they're not really focused on it. It's sad because it has to change. People are really focused on football right now, but soccer is the next big thing."
Number of girls playing soccer has soared
The number of girls playing high school soccer has grown by 236 percent nationally over 25 years, according to the National Federation of State High School Associations. There were 375,681 players in 2014-15, compared with 111,711 in 1989-90. No other sport has experienced an increase nearly as great.
Experts said the heightened popularity has led to bigger, faster athletes who play and train year-round. That has resulted in more physical play, which increases the likelihood of injury.
"The kids we're working with today are bigger, faster and stronger than what they were in the '60s and '70s, because they're training more today," said Nassau County high school girls soccer coordinator Denise Kiernan, who also is Glen Cove High School's athletic director. "They're getting much more training than just the high school experience, which makes them more physical and more aggressive going after the ball."
In soccer, with the exception of goaltenders, players can touch the ball with any part of their body except their hands and arms. Players rely mostly on their feet, legs and head to control, pass and shoot the ball.
A properly executed "header" - when a player uses her head to hit a ball that is in the air - is not considered a serious risk for concussion because "you can put more force on the ball than the ball puts on you and then there's no energy transfer into the brain," according to Kevin Crutchfield, a neurologist who works with the National Football League's Baltimore Ravens, Major League Soccer's D.C. United and Major League Baseball's Baltimore Orioles.
The danger comes from the physical contact and collisions that take place in the battle to get to the ball.
"You can get hit in the face, you can go head to head, your head can get hit on the ground, the goalkeeper can punch you when they're trying to make a save," said Cari Roccaro, former standout at East Islip High School who now plays for the Houston Dash of the National Women's Soccer League. "There are so many different ways in soccer, which is why it's such a big deal now."
Dawn Comstock, an epidemiology professor at the University of Colorado who has been tracking high school athletes' concussions nationally since 2006, said her research shows that most concussions in soccer occur from player-to-player contact.
Comstock published a 2015 paper in the Journal of the American Medical Association Pediatrics that concluded that in high school girls soccer, concussions were caused most commonly by contact with another athlete (51.3 percent). Second was contact with the ball or goalpost (29 percent). Third was contact with playing surface (19.2 percent).
Researcher 'astounded' by number of ER visits
A study on soccer-related injuries published in October in the American Academy of Pediatrics journal found that emergency room visits for concussions by soccer players under the age of 19 rose by nearly 1,600 percent between 1990 and 2014.
The study's author, Huiyun Xiang, director of the Center for Pediatric Trauma Research at Columbus, Ohio-based Nationwide Children's Hospital, said he was "astounded" by that number, even taking into account the rise in the sport's popularity and in concussion awareness.
"I have never seen such a dramatic increase in other sports or other injuries," he said.
"What's the best way to prevent this?" Xiang said. "I think we're still trying to figure that out."
Coaches and administrators said a reason for the high number of girls soccer concussions is the increased awareness about brain injuries, saying that has led to a rise in reporting cases that would have fallen under the radar before.
"When I played, if you got hit in the head, it was like, 'OK, you're fine, you can go back in,' unless you were knocked out," said St. Anthony's High School girls soccer coach Sue Alber, a star player who graduated from Islip High School in 2004.
Soccer groups ban headers by children
The U.S. Soccer Federation, the game's national governing body, and four youth soccer associations resolved a class-action concussion lawsuit last year by banning headers for children under 11 and placing a limit on headers in practice for children between the ages of 11 and 13.
On Long Island, there are hundreds of youth soccer teams, many of which are not under the authority of these organizations. U.S. Soccer said in a statement that it "strongly urges" that all youth programs follow these recommendations. The role of enforcing the recommendations falls on the coaches and officials at each level.
Briana Scurry, goalkeeper for the U.S. gold-medal winning Olympic teams in 1996 and 2004, said the "header" ban is "putting a Band-Aid on the situation." Scurry said soccer's concussion-prevention efforts are behind those of the NFL, which has received widespread criticism for its handling of head injuries.
Scurry wants players who are suspected of suffering a head injury removed from the field immediately for an evaluation. She said this needs to happen at the highest levels of the game - the Olympics, the World Cup - for lower levels to follow suit.
"Soccer doesn't want to be labeled as a dangerous sport," said Scurry, whose career ended in 2010 because of a concussion. "That's what the people who are at the higher levels are concerned with."
Scurry, who speaks to youth soccer groups about the dangers of concussions, and several of her former Olympic teammates - including Brandi Chastain and Abby Wambach - announced in the spring their intentions to posthumously donate their brains to research chronic traumatic encephalopathy, or CTE, which is a degenerative brain disease found in athletes who have experienced repetitive brain trauma. CTE has been most commonly associated with former football players.
"For a long time people heard concussions and they thought big NFL hits," she said. "They thought big strong men, football warriors. That's what their picture of concussions was."
State requires athlete be removed from play
New York State's concussion management act of 2011 mandated that any public school athlete suspected of suffering a concussion must be removed from play and cannot return until cleared by a physician.
There are no state requirements regarding medical personnel on the sideline at soccer games. In many cases that responsibility falls on the coaches, who the state requires to have taken several medical courses, including one for concussion awareness.
On Long Island, the majority of school districts employ a certified athletic trainer, who is required to have a bachelor's degree from an athletic training program. But the degree to which athletic trainers are present varies by district. Some schools have two full-time athletic trainers while others employ them on a contract basis only to attend football games.
James Pierre-Glaude, an athletic training professor at Stony Brook University, believes sports such as soccer do not receive the necessary attention from athletic trainers because the sport takes place at the same time as football.
"There's so much emphasis nationally and locally on football that resources may be pulled away from other sports, I would say that without a doubt," he said. "Also especially when you're talking about districts that have part-time athletic trainers or per diem athletic trainers. The big thing then becomes, 'Just make sure that football is covered.' That happens a lot."
In recent years football has tried to reduce the number of head injuries through a greater emphasis on teaching proper tackling methods, adding limitations on how often teams can hit in practice and upgrading to helmets that researchers say are best at reducing the risk of concussion.
Has to skip championship game
Emma Baumbusch, a defender at Islip High School, suffered a concussion as a junior in the final seconds of her team's 2015 state tournament semifinal.
With about 10 seconds left in the game, she said a teammate tried to clear the ball, attempting to kick it as far and as hard as she could. But Baumbusch stepped in front of the ball just after it was kicked, and the ball hit her on the left side of her face from no more than a few feet away.
Baumbusch said that while she remained conscious, she immediately got dizzy and her head was "throbbing."
"I was in shock," she said. "The ball hit me so hard."
After undergoing a common concussion test that night, Baumbusch was told by the team's athletic trainer that she couldn't play in the championship game the next day.
Baumbusch watched from the sidelines as her teammates won the state title, 1-0. She doesn't remember much of what happened.
"It's kind of blurry," she said. "It was hard to focus. I couldn't really see much."
She said it took about a month for the symptoms to subside. She missed the first few weeks of the basketball season and returned to play soccer in her senior year. Baumbusch will play soccer at King's College in Wilkes-Barre, Pennsylvania.
Diagnosed the next day
Alexa Russell, a sophomore midfielder at Sacred Heart High School in Hempstead, isn't surprised to learn that girls soccer had the second-highest number of concussions on Long Island.
"Girls soccer is such a contact sport now, so I can see why," she said, "because it's so physical."
In an Oct. 3 game against Kellenberg High School, Russell was in front of her own goal when a shot was launched. In the scrum of players fighting for position, Russell was shoved from behind, fell forward and was kneed in the head by the goaltender.
Russell said she felt dizzy but didn't think it was enough to leave the game. After about 10 minutes, the dizziness remained and she decided to take herself out.
That night while doing her homework, she knew something was wrong. "I couldn't focus at all," she said. "I was writing an essay, and I was on one sentence for at least 15 minutes."
She was diagnosed with a concussion the next day and missed the rest of the week of school. It took another two weeks for the symptoms to subside, she said.
She returned to practice Oct. 31 and scored two goals in her first game back, a 7-0 win in the Catholic High School Athletic Association state AA girls soccer semifinal game Nov. 6.
During the Nov. 12 championship game, Russell was hit in the head by a ball after a teammate tried to clear it. Russell said she was standing only about five yards away.
"I was so scared I had another one," she said. "I came out of the game and stayed out. It ended up I didn't have another concussion, but I just wanted to play it safe."
Russell said she plans to continue playing soccer because she has played the game her entire life and is not overly concerned about suffering another concussion.
Disagreement on higher rate among girls
More than 100 Long Island high schools with athletic programs supplied concussion reports to Newsday from the 2015-16 school year. Private schools are not required by law to provide the information. Only two private schools of 13 on Long Island agreed to do so.
Newsday also obtained participation numbers broken down by sport and region from the New York State Public High School Athletic Association, which is the state's governing body for public high school sports. NYSPHSAA surveys schools every year to compile the number of athletes that competed in each sport in each county.
There were 4,723 girls playing high school soccer on 233 teams on Long Island last year. There were 5,656 boys soccer players on 247 teams. The girls game resulted in nearly twice as many concussions as the boys game.
While experts say they are not surprised by that disparity, citing national studies with similar concussion rates, they are divided on the reasons.
"We think of concussions as a boys problem, but if you look at the rate of concussions, we have been seeing this tendency for the girls sports to be higher," said Christopher Giza, a pediatric neurology professor at UCLA. "And there is no definitive answer yet as to why that is."
One theory commonly cited, Giza said, is neck strength. Giza said teenage girls often have thinner and weaker necks than boys, which hinders their ability to brace their heads for an impact - such as when two players collide midair while trying for a header.
Giza said researchers also are looking into whether a female's brain composition and the presence of female hormones such as estrogen make them more susceptible to concussions than males.
Pierre-Glaude, the athletic training professor at Stony Brook University, said studies have shown that the landing mechanics of boys and girls also play a role. He said boys instinctively land in a squat position, removing much of the force of impact, whereas girls tends to land with stiffer knees and hips, which he said disperses the impact throughout the body, including possibly the brain.
Others suggest a less scientific reason behind the uptick in concussions of girls versus boys.
Comstock, the University of Colorado epidemiology professor, said teenage girls may be more willing to self-report concussion symptoms than boys because there may be less of a negative stigma attached to doing so.
But not everyone agrees with that theory.
Rosemarie Moser, director of Sports Concussion Center of New Jersey, called it "archaic." She added, "That does not have a lot of substantiation because, as we've seen in women's sports, women might be just as fierce and competitive as men. And they don't want to leave the game either."
Hard-shell helmets aren't allowed
Another hurdle facing the game is the lack of equipment that can help prevent head injuries.
Hard-shell helmets - such as the ones used in football, boys lacrosse, baseball and softball - are not allowed in either boys or girls soccer. There are several headbands and soft-shell headgear options that are marketed to reduce soccer concussions. They are permitted to be worn in high school, but researchers said studies have yet to show whether they work.
Bulzomi, the Syosset goalkeeper, has worn a soft, padded helmet for the last two years that covers her entire head and is attached under her chin. Bulzomi said she started wearing the helmet after suffering two concussions in the span of 11 months. She said she missed two weeks after her first concussion. Her symptoms - nausea and headaches - were more severe after her second concussion, she said, and so was the recovery time. She said she missed nearly two months of soccer recovering from that concussion and has worn the helmet ever since.
The helmet manufacturer - Miami-based Barnett Sports - markets it as headgear designed for rugby or flag football.
"Being in goal, sometimes you get clocked in the head with a knee or somebody picks up their cleat and hits you in the back of the head," she said. "But I haven't had any issues since I have been wearing the helmet."
Bulzomi, who plans to continue her soccer career next year at Goucher College in Maryland, said the helmet draws a lot of attention because it's such rare sight. She said referees, opposing coaches and players have asked her about it.
"It looks a little funny," she said, "but I've gotten over that."
McGuine, the sports medicine researcher at the Wisconsin medical school, said there is no evidence yet that soccer headgear makes a difference. He is in the early stages of a two-year study testing the headgear in high school soccer.
"We're trying to figure out whether someone's concussion risk goes down with soccer headgear, or does it go up?" McGuine said. "We don't know."
In the meantime, McGuine is concerned that coaches, leagues and high school associations might respond to concussion concerns by mandating headgear. Such a move could cause players to have a false sense of security and play even more aggressively.
Experts said the best way to reduce the risk of concussion is for officials to be more stringent deterring physical play. But they warn that a culture change takes time, and that's not often a popular solution for those concerned with head safety.
"I feel like something drastic would have to change to really limit or get rid of concussion in the sport," Roccaro said. "We'd have to have everyone run around with helmets, which is ridiculous."
Suspected concussions during the 2015-16 school year on Long Island:
SportConcussionsNo. of playersConcussions per player
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