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Star Tribune (Minneapolis, MN)
McKenzie Gregoire suffered so many concussions playing soccer, doctors made her quit. She spent her senior season as Shakopee's team manager.
Sara Johnson's first soccer concussion came in eighth grade. Four years later, she suffered another one playing for Fridley, forcing her out of the game she loves.
Haley Ramberg blacked out from a soccer concussion two years ago for Blaine. She missed one month of school as her head and body healed, recovering as many student-athletes with these brain injuries do: resting in dark rooms and quiet places for weeks.
Blaine coach Scott Zachmann said the sight of Ramberg's collision haunts him to this day. His big fear used to be knee-ligament injuries.
"Now I find myself way more worried about a concussion," Zachmann said. "Anytime players collide, it's the first thing you think of."
State champions in girls' soccer will be crowned Thursday at U.S. Bank Stadium, ending a season in which concussion concerns escalated for many Minnesota high school coaches. Football owns the national conversation on concussions, but mounting evidence suggests girls' soccer deserves an equal share in that painful spotlight.
A Star Tribune survey of Twin Cities coaches, which drew 52 responses, showed that about 5 percent of varsity girls' soccer players suffered concussions the past two seasons. That's an increase from the 3 percent concussion rate girls' soccer showed in the 2014-15 school year, in a study published by the Minnesota Department of Health.
Several teams with rosters of about 20 players reported having three or four concussions this season. New Prague, St. Paul Johnson and St. Croix Lutheran were among the schools that have had at least six players suffer concussions over the past two seasons.
National studies show concussions are a significantly bigger threat for girls' soccer players than boys' soccer players, with the girls' game generating football-like brain injury numbers.
A study this year led by Northwestern orthopedist Wellington Hsu showed high school football produced 9.41 concussions for every 10,000 athlete exposures, with an exposure defined as one player participating in one practice or one game. Girls' soccer had the second-highest rate, at 9.10, with boys' soccer considerably lower, at 3.03.
That study also showed concussions make up 34.5 percent of all girls' soccer injuries, compared to 24.7 percent in football, and 18.9 percent in boys' soccer.
"It was quite surprising because [girls' soccer] is not a sport that we immediately associate with concussions," Hsu said. "Since we published, it's been very interesting to see all the people who've come out of the woodwork to explain this is a real problem."
The University of Wisconsin is conducting its own study to measure the effectiveness of headgear, working with 30 high schools in Wisconsin and three in Minnesota - Tartan, Stillwater and North St. Paul.
"I'm convinced there are more concussions in girls' soccer than there are in high school football," said Timothy McGuine, the Wisconsin scientist leading the study.
While football's concussion rate is higher, factoring in the year-round commitment for many club players, the soccer danger multiplies.
"With specialization, a lot of girls play 23 games for their high schools, and then they'll go on to play another 40-50 games for their clubs," McGuine said. "We have girls playing 80 soccer games a year. The average high school football player might play 40 games his whole career."
Brain 'felt slower'
Before becoming Shakopee's team manager, Gregoire had been a year-round player since age 10. She suffered two concussions by age 12 and two more by 15, including one playing basketball.
Her last one came the final game of her junior season. As a defender, she went to control a "50/50 ball" against Eagan, when the back of her head met an opponent's elbow. She missed one week of school, spending most of that time in the dark because her eyes were so sensitive to light.
She wanted to stay part of the team, so she became a manager.
"I definitely went through a super-tough time just realizing I wouldn't be able to play soccer, because it was such a big part of my life," Gregoire said.
Johnson said she had a "pretty aggressive playing style" for Fridley. After suffering her first soccer concussion just before ninth grade, she had another one the next year playing rugby.
The one that ended her career came as a senior, on a corner kick. Playing defense, she tried heading the speeding ball away from the net, only to have it hit her in the temple.
"My first two concussions affected me physically, but not mentally," Johnson said. "They scared me, but not as much as my third one. I was out of school for a month. My brain just kind of felt slower."
For Ramberg, the concussion that ended her sophomore season at Blaine came on a breakaway against Irondale. She was at full speed and collided with the goalie, jarring her head.
"I woke up feeling sick and had ringing in my ears," she said. "I missed about a month of school, and then I came back for half-days. It took about two, two-and-a-half months to feel back to 100 percent."
Why more girls?
Girls are diagnosed with concussions more frequently than boys. This is the case for basketball and hockey, too: The Minnesota Department of Health study from 2014-15 showed girls' hockey with a 6.85 percent concussion rate and boys' at 3.96; girls' basketball at 5.07, and boys' at 1.4.
But a clear reason for why girls seemingly suffered head injuries more often is elusive.
"Potentially, it's the difference in neck strength [between boys and girls]," said Dr. William Roberts, chairman of the Minnesota State High School League's sports medicine advisory committee. "When there's a blow to the head, if the neck strength isn't as high, more of the force can be transmitted to the head and brain.
"Another thing people have talked about is that girls may be more honest and actually report symptoms better than boys."
But not all coaches view female soccer concussions as a growing crisis.
Sixth-year Gophers soccer coach Stefanie Golan said she's never had a high school recruit get derailed by a concussion. "The injury we see most is ACLs," Golan said of anterior cruciate ligament injuries in the knee.
Orono coach Erin Murray, president of the Minnesota High School Soccer Coaches Association, said concussions have not been a hot topic at those board meetings. Minnesota law requires coaches in all sports to undergo regular concussion education courses.
"It seems like coaches are much more educated on concussions and when to pull a kid out," said Murray, whose team will play Mahtomedi for the Class A state championship Thursday.
Zachmann said having an athletic trainer at his team's games has helped. His concern is that once the season ends, players head for their club teams, where athletic trainers might not be present, leaving some concussions undiagnosed.
"I'm pretty convinced the summer coaches are missing them," Zachmann said. "The girls are going nonstop nowadays."
Brandi Chastain, whose winning goal gave Team USA the 1999 Women's World Cup title, has spent recent years advocating to make the sport safer.
"I don't think anyone below the age of 14 should head the ball," Chastain says in a video for the Safer Soccer Concussion Legacy Foundation. "They don't understand space and time and awareness, these things that really allow a professional player to make good decisions and protect themselves."
Heading the ball was the leading cause of concussions in girls' soccer during the 2014-15 school year, accounting for 39.3 percent of those injuries, according to the Center for Injury Research and Policy.
The Minnesota Youth Soccer Association, like organizations in other states, now prohibits heading the ball for all players under 11 years old. From ages 11-14, no player is allowed to head the ball more than 20 times each week.
Eastview coach David Herem said his team practices heading the ball far less than it used to. Three of his 17 varsity players suffered concussions this season.
"We are very concerned about their long-term health," Herem said. "We want the girls to have functioning brains in the future."
A handful of Twin Cities players now wears headgear designed to help reduce concussions. But in the Star Tribune survey, 44 of the 52 teams reported having no players who wear headgear.
One argument against wearing the headgear is it doesn't give players the same control and accuracy when heading the ball.
"Some people tell us it doesn't help, but I can't imagine it's not beneficial for head-to-head collisions," Zachmann said. "If it's going to protect the kids and change the game only slightly, then we need to look into it more."
Staff writer Mary Jo Webster contributed to this report. firstname.lastname@example.org 612-673-7844
Coaches from 52 Twin Cities girls' soccer programs responded to a Star Tribune survey regarding head injuries.
14 - Teams had multiple players who suffered a concussion this season.
111 - Total concussions reported during the past two seasons - more than two per team.
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