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Vital Signs with Dr. Sanjay Gupta

The Likelihood and Severity of Concussions for Female Soccer Players Examined. Aired 2:30-3p ET

Aired February 13, 2016 - 14:30   ET


[14:30:26] DR. SANJAY GUPTA, CNN HOST & CHIEF MEDICAL CORRESPONDENT: Getting your bell rung, or seeing stars. Call it what want, but concussions are brain injuries, and it's time to start treating them that way. This is "Vital Signs." I'm Dr. Sanjay Gupta. Concussion comes from the Latin word which means to violently shake.

It's exactly what happens to the brain inside the skull after a blow to the head, neck, or body. The brain bounces off the skull, bruising and tearing membranes, sometimes resulting in irreversible damage. When it comes to sports with high concussion risks a few come to mind right away -- American football, and, of course, boxing or ice hockey. But what about the world's most popular game? It might be time to start including soccer on that list.



UNIDENTIFIED MALE: Two players down.

UNIDENTIFIED FEMALE: I think they hit heads.


GUPTA: You just dropped.

CINDY PARLOW CONE, FORMER U.S. WOMEN'S NATIONAL TEAM PLAYER: Yes. I think it was -- I was out in mid-air.

UNIDENTIFIED FEMALE: In the air, both trying to head it. No question about it, they absolutely clocked each other.

CONE: It's scary because in an instant, in that instant, my life changed.

GUPTA: Cindy Parlow Cone made a career out of heading the soccer ball. At nearly six feet tall, she was a target in the air, scoring countless goals with her head. For Cindy, the physical side of the game was one of the things she loved most about it.

CONE: Growing up with two brothers is a very physical childhood and you know, brothers are wrestling around all the time. So I was used to that. And then going out on to the soccer field, I loved the combative nature of it. I was fearless.

GUPTA: And that fearlessness was an asset on the field. At the age of 16, she found herself called up for a scrimmage with the U.S. women's national team, playing alongside stars like Mia Hamm, Judy Foudy, Kristine Lilly.

You're on the team for nine years. Then in 2006, you left. What was going on?

CONE: I think the first time I thought about leaving the team was in 2004. My concussion symptoms were just continuing to get worse, and it was kinds of the first time that I realized that something was wrong.

GUPTA: In soccer, heading is a big part of the game, but that very act is responsible for nearly a third of all concussions reported in youth soccer. Dr. Robert Cantu is a neurosurgeon who has spent over 30 years studying concussions in sports.

DR. ROBERT CANTU, CLINICAL PROFESSOR OF NEUROLOGY AND NEUROSURGERY, BOSTON UNIVERSITY: Of the sports at high-risk for concussion, soccer is right up there. And for girls it's right up at the top. If you focus on the head, it's not greatly safer in terms of concussion than football.

CONE: Yes. Not enough movement off of the ball, right?

GUPTA: Cindy had two diagnosed concussions in her career, though she says there have probably been more. Her first injury came in 2001.

CONE: My own teammate actually hit me in the side of the head and I was knocked out before I hit the ground.

UNIDENTIFIED MALE: She's woozy, though. You can see it.

CONE: I continued to play, and then I remember running up and down the field and, like, my -- my fingers weren't working. It didn't feel right and they were like tingly.

GUPTA: That's a brain injury. You had injuries to your brain.

CONE: Yes. Correct.

CANTU: The brain has some natural protection for sure. The obvious protection is the scalp and then the skull, the bone underneath it. But underneath that is a membrane and then a water bath, spinal fluid, before you get to the brain. So the brain, when you put it in motion, the head, actually sloshes back and forth in this water bath. But if you violently shake it, it bounces off parts of our inner surface of the skull.

GUPTA: Cindy's second diagnosed concussion came two years later in the 2003 World Cup consolation match. Again, she collided with other players and was briefly knocked unconscious. But it would be a scare a year later in 2004 that made Cindy realize these concussions were jeopardizing more than just her career.

CONE: Good. Set it up. I remember trying to tie my shoes, and my fingers weren't working

right. And that's the last thing I remember until waking up in the MRI machine, and I had just been diagnosed with a TIA, or mini stroke.

[14:35:01] GUPTA: You think about strokes in older people.

CONE: Right.

GUPTA: You're an athlete, 24 years old.

CONE: I mean, that was a really scary time for myself, my family, and, of course, my teammates. Just as quickly as things happened, I was, went through all of the stress tests and everything and was released to rejoin the exact same training camp a few days later.

GUPTA: In the end, doctors weren't sure that Cindy had had a mini stroke. But they were confident that whatever it was, was related to repeated concussions.

Did someone say at that point it to you, look, maybe it's time to stop playing?

CONE: Never. I mean, I think back now, and because I've educated myself so much more on the topic, it's scary of what could have happened, because I never have fully recovered from that concussion. I still have the exact same symptoms.

GUPTA: That's 14 years later?

CONE: Yes. I have symptoms every day. I have pretty much daily headaches. I have extreme fatigue. It's not related to normal things like working out and then feeling tired. That's why a part of this campaign called "Safer Soccer" to take heading out of the game up to the age of 14.

GUPTA: Safer soccer is an initiative started by the Concussion Legacy Foundation and Santa Clara Institute of Sports Law and Ethics. Cindy joined World Cup teammate Brandi Chastain as another face of the campaign last year. The aim is simple -- change the minimum age of heading the ball in youth soccer from 10 years old to 14. Doctor Cantu is one of the co-founders.

CANTU: The young brain, especially under the age of 12 or 13, is particularly vulnerable to trauma, compared with the adult brain. And then the other really important one is mostly between the ages of 10 and 12 the connectivity and the pruning of circuitry within the brain is at its highest amount.

GUPTA: Because of her post-concussion symptoms that continue to this day, Cindy Parlow Cone is no longer allowed to play soccer. But the sport is still a big part of her life.

CONE: Natalie, where do you need to be? OK, Tiana, look around --

GUPTA: She now coaches young girls, and you'll notice, no heading practice here. Well, I think a lot of the concern comes with the number of

repetitions that a lot of coaches have their kids do in practice. I mean, it's not uncommon for someone to go to a heading practice and to do 100 headers in a matter of 25, 30 minutes.

GUPTA: Cindy Parlow Cone retired after a successful career at the game's highest level. But there are some who won't get that chance, whose careers are over before they barely began.


[14:41:16] GUPTA: According to a study by the high school reporting index online, concussions have become the most common injury in American sports, rising from nine percent in 2005 to more than 24 percent in 2015, partly because of increased awareness. They've also found in the 2013-14 school year only football and boys' ice hockey reported more than concussion in competition than girls' soccer. In fact, concussions are more than twice as likely to happen to a girls' soccer player as compared to a boy. One possible reason is neck strength. Typically young girls' necks are going to be thinner and weaker, less able to absorb the impact of a hit to the head. While many players make a full recovery, others are not as lucky.

Wednesday morning in Memphis, Tennessee.

GRACIE HUSSEY: I'll be out at 2:30.

GUPTA: Sixteen-year-old Gracie Hussey and her older sister Katie are headed to school.

UNIDENTIFIED FEMALE: So take a look at the sign of this h.

GUPTA: First up for Gracie is algebra class. What used to come easy for this straight-A student is now more challenging. Two severe diagnosed concussions on the soccer field in the span of five years have left Gracie reeling. Along with her two older sisters, Gracie started playing soccer at a very young age.

HUSSEY: I remember I played for a team calmed the butterflies. We played against a boys' team and I made all the boys cry because, like, I was so competitive and I didn't back down to them.

GUPTA: On the soccer field she was tough, consistently playing on teams above her age level against girls who were bigger and stronger. Gracie was never afraid to challenge them for the ball, especially in the air.

HUSSEY: Well, right off the bat when I was introduced to heading I loved it immediately. I thought it was cool. And every practice I would say once a week a practice was dedicated to headers.

GUPTA: With much of the corn cushion conversation dominated by football, soccer seemed like a safer option. Gracie's mom Beth and her father Richard didn't see it as an inherently dangerous sport. But all that would change with Gracie. Her first diagnosed concussion came when she was just seven-years-old. BETH HUSSEY, GRACIE'S MOTHER: Gracie wept up to head the ball and the

girl's elbow caught her right in the forehead. And I saw it, and Gracie fell to the ground and jumped right back up and acted like it didn't happen.

GUPTA: Gracie just wanted to get back on the field as soon as possible. It wasn't long before doctors cleared her to return.

BETH HUSSEY: As a parent, this is why I guess I'm so passionate about getting the word out now. It's because thinking back, it just -- it just kills me remembering situations, and thinking that everything was OK.

GUPTA: This video is from 2011. Gracie is the goalkeeper in the orange jersey. You can see her colliding with another player and getting kicked in the face. She's disoriented and in tears, but she stays in the game. Most likely another brain injury, undiagnosed.

BETH HUSSEY: I think a lot of people who suffer concussions and who suffer the worst concussions over and over, are the athletes that can fight through pain and don't want to admit that they're hurt. I think it's also hard to communicate it as a child when no one can see it.

GUPTA: Gracie continued playing soccer and excelling at it. She was one of the stars of her club team, winning regional tournaments around the southern United States. But in 2012, that would all end.

HUSSEY: My main concussion that changed my whole life was September 25th.

[14:45:01] BETH HUSSEY: And Gracie was playing defender, and she had cleared the ball. And when she cleared the ball she was off balance. And someone came and just hit her. And she fell back and hit, fell back on her head, leaned on her shoulder, and she hit the turf really hard.

HUSSEY: And then I stood up and the whole field was spinning around me. And everybody was like, are you OK? And I remember that I was feeling so confused. And I just stayed in the game because there was about 30 seconds. I was like, I'm fine. Then I could barely make it to the bench. And after that I really don't remember much.

GUPTA: Gracie went to see a neurologist who diagnosed her with post- concussion syndrome. She missed a lot of school, and as the winter basketball season approached Gracie became restless. She told her parents she finally felt better, but she was hiding a secret.

HUSSEY: I was lying to myself and my parents. I really had a headache, but I was just so determined to get back to my sports that I lied, and I shouldn't have.

GUPTA: Among other symptoms like dizziness and nausea, Gracie had been suffering from a severe headache every day for months. At that point the decision was made to stop playing all contact sports, including soccer. HUSSEY: It was really tough. At first I didn't want to accept it. I

thought it was just going to be for a year, maybe. But then when I looked at it and realized that I was not going to be able to play for the rest of my life, I was so mad and frustrated because that's my personality.

GUPTA: Gracie suffered from two diagnosed concussions on the soccer field. But she and her family now think there may have been as many as four or five more that went undetected.

BETH HUSSEY: I didn't realize at the time that if a child's nauseous, has a headache, sees stars or things go black, the sky changes colors, that those are symptoms and signs of a concussion. It's not natural for the head to feel that way. Now I've learned just being a part of this for so long with Gracie through her journey, I've learned and I understand more.

GUPTA: Understanding more. It's what doctors and researchers are also trying to do when it comes to concussions and the brain. More and more, it appears technology will have a position on the playing field.

Next -- what tech is teaching us about brain injuries.


[14:50:36] GUPTA: One of the trickiest aspects of concussion is that everyone experiences one differently, and you don't always lose consciousness when suffering a concussion. That's a myth. A concussion does, however, change the way you perceive the world. Blurry vision, ringing in the ears, numbness in your arms, headaches, nausea, fatigue, those are all common physical symptoms. There can be cognitive issues such as difficulty with memory, concentration, even amnesia.

There are also emotional symptoms like irritability, depression, sleep disturbances. Complicating the diagnostics even further is the fact that there's still so much we need to learn about the brain itself before we can fully understand what happens when it is injured. That's where technology can help, and it's finding a home on the field of play.


GUPTA: It happens in a split second, the impact of a soccer ball on the head or head-to-head contact. A quick blow is all it takes.


GUPTA: Finding a way to measure that is what Chad Hollingsworth is working on.

HOLLINGSWORTH: A lot more people play soccer in this world than American football. So that was kind of the idea. Let's try to make a sensor that could work for non-helmet sports. GUPTA: He's the president of Connecticut-based Triax Technologists.

The company has developed a sensor worn in a headband to measure impacts to the head.

HOLLINGSWORTH: This is not a diagnostic tool, but it does give you an objective measure of what's going on a field in real-time.

CONE: The real goal of it is to provide objective data to medical professionals to be able to better detect concussions.

GUPTA: Cindy Parlow Cone agrees that technology has a place in sports. She's co-founded a company called Inver (ph) to develop a detection device.

CONE: Our device actually goes inside the ear so it sits on the bony part of the canal so it actually measure skull motion which, as you know, is important in detecting impacts to the head and skull movement.

GUPTA: Cindy says she wonders what might have been if more had been known about concussions when she was playing.

What is your sentiment or your, sort of emotional thinking about these headaches now?

CONE: I call it my new normal. I rationalize it that everyone has issues and I'm no different.

GUPTA: Gracie Hussey feels the same way. Her playing career ended three years ago at the age of 13.

HUSSEY: My morning pills are --

GUPTA: Now at 16 years old, she takes 11 pills a day to combat her symptoms.

HUSSEY: If I didn't take my pills I think I might be fainting every other hour, probably.

BETH HUSSEY: To see a child every morning and every evening have to take medicine, it's tough. And the goal is to get her off the medicine.

GUPTA: In the back of both Gracie's and Cindy's minds are questions about the future. More and more, chronic traumatic encephalopathy or CTE, has been in the spotlight. It's a degenerative cognitive disease that can only be diagnosed after death. In former NFL players, who had had concerns about CTE symptoms while still alive, it was found in 87 out of 91 examined brains. And it is also recently been found in soccer players. To help cut down on the number of blows to the head, the Safer Soccer Initiative hopes to raise the American mum age of heading the ball. But it is up to youth leagues to adopt the policy.

CONE: The main pushback that I've heard is that it changes the game, which is a legitimate pushback. It does change the game. But for me I think it changes it actually for the better because now the ball is on the ground more often. You're working on skills.

CANTU: There's no such thing as good head trauma, but let's not get paranoid about it. We're all going to take shots to the head, and as I've mentioned, we've got some pretty good protection. But it's not a good idea to seek it out.

GUPTA: In a statement to CNN, FIFA, soccer's international governing body, told us recent policy changes have led to a, quote, "significant decrease of concussions." FIFA says in 2014 a new protocol was approved for FIFA competitions. One of the main elements of this protocol is that only the team doctor can allow a player to return to play after suffering a head injury.



GUPTA: When you come out here nowadays and you're standing on a soccer field like this, does it take you back? I mean, do you have any of the -- the tough memories from years past where you got injured?

CONE: No. I really don't. I mean, when I look back over my career, it's with pride and joy.

Here we go. All you got to do is get a touch!

And now through my coaching and through my involvement in the company that I'm starting, I take great pride in trying to help make the sport I know and love as well as other contact sports safer for kids.

GUPTA: Making sports safer while still maintaining the integrity of the game, that's the challenge facing sports leagues all over the world. For parents and players, it's about weighing the benefits and the risks. We're not saying to never play football or soccer. There are big upsides to team sports like exercise, social engagement, and valuable life lessons, such as teamwork. But make sure it's happening as safely as possible. Talk to the coaches, trainers, parents, and players, so that everyone knows concussion awareness is a no-brainer.

For "Vital Signs," I'm Dr. Sanjay Gupta.