The researchers based their study on Sweden’s two highest hockey divisions for men — the SHL and Hockeyallsvenskan, and the women’s top league, SDHL. A total of 648 players, 180 of them women, completed the researchers’ online questionnaire. The focus of the questions was on alcohol consumption, mental health and concussion history.

A lot of research is undertaken in both Europe and the USA into the effects of concussions on mental health and well-being.

“However, we want to investigate more long-term consequences for Swedish top players — six months or more after a concussion. The players’ responses have provided important insights into the links between concussion and mental health effects,” says Mitchell Andersson, doctoral student in psychiatry at Lund University.

He is behind the study, which has now been published in the journal BMC Sports Science, Medicine and Rehabilitation, together with Anders Håkansson, consultant physician and professor of addiction medicine at Lund University. When Lund University researchers collated the reported psychiatric symptoms among players, the male players were shown to have significantly fewer symptoms of depression/anxiety and burnout than other men — whether that be elite athletes in other sports or the wider Swedish male workforce. Thirty percent of male hockey players did, however, report at-risk levels of alcohol consumption — far more than in the comparison groups.

For female hockey players, the picture was slightly different. The prevalence of depression/anxiety symptoms was comparable to that of the average Swedish woman. Burnout, however, was far more common: over 19 percent of the women reported living with clinical symptoms of burnout — almost double the rate among Swedish women on average. The female hockey players also reported that they drank a lot of alcohol. The percentage of respondents reporting that they reached the level of at-risk consumption was 36.4 percent — also far above average.

Concerning concussions, both female and male hockey players who reported more concussions were more likely to report elevations in various psychiatric symptoms (e.g., depression and anxiety). The correlation was clearest in both sexes after three or more concussions: the risk of developing symptoms of depression doubled, and the risk of burnout was three-and-a-half times higher. More than one in four male and almost one in five female players reported having suffered at least three concussions.

“Other studies have shown that women experience more short-term symptoms after a concussion than men, but it was interesting that the link between concussion and heightened prevalence of symptoms of depression, anxiety, and burnout was equally strong for both sexes. This might indicate that the long-term neuropsychiatric recovery process is more similar in men and women than the short-term process,” says Mitchell Andersson.

To meet the criteria for burnout, the individual is to have lived under stress for a least six months and to have developed a number of physical and psychiatric symptoms. According to Mitchell Andersson, however, it can sometimes be difficult to see what is what — long-term symptoms after a concussion are often similar to those of burnout, such as cognitive impairment, irritability, difficulty concentrating and sleep problems.

The results of the study suggest several lines to follow up, argues Mitchell Andersson. One is to dig into why alcohol consumption among elite players is so high.

“Hockey players are physically slightly larger and are perhaps able to drink a little more. Their own view of themselves, and that of others, maybe that they are a bit tougher than others. There can be a sense of pride in being part of such a subculture. Romanticizing alcohol can be a part of it, for both men and women,” Mitchell Andersson speculates. He played hockey at a non-elite level.

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This same self-assumed toughness might contribute to male players actually underreporting possible mental health issues. The fact that such a high proportion of women report burnout symptoms even without concussion might point to a recurring pattern within women’s sport at the highest level: Their salaries are lower than the men’s. They are more likely to have to combine hockey with another job or academic studies. Juggling their responsibilities with late-night matches, often far from home, can be an impossible equation.

“Swedish hockey players at elite level need to know where and how they can get help. There is help available aimed at this target group. Imagine that you are an elite athlete who trains regularly, eats healthily, and earns good money from the sport you love — and yet you are still struggling. Can you imagine how frightening and isolating that must feel? Not having to feel alone in your state of mind is important,” concludes Mitchell Andersson.

This is a press release from Lund Unversity.* 

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They all filed into Charleston Coliseum and Convention Center last Thursday to hear from a neurosurgeon and other doctors about head injuries, following the death of Cohen Craddock after taking a hard hit during practice a few weeks ago.

A recent report from WCHS-TV in West Virginia detailed the ‘concussion discussion’. Below is an excerpt from the WCHS-TV story.

“The Craddock family deserves so much respect and support in this tough time and the fact they’ve gone forward to try to change the climate, if you will, with provisions of extra protection is noteworthy,” Kyle said.

Those in the audience heard the doctors discuss the common symptoms to look out for like dizziness, mood change, headache and confusion.

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Caden Tellier was part of the John T. Morgan Academy football program. He was rushed to a nearby hospital on Friday evening, before passing away from his injuries, according to the private school’s Facebook page.

A recent story from KY3.com detailed the death of the Alabama student-athlete. Below is an excerpt from the KY3.com story.

Tellier was known for “his kindness, generosity and love,” according to a GoFundMe set up for his family. His organs will be donated.

“True to his nature, he is giving of himself one more time to save the lives of others through the donation of his organs. His legacy will live on forever, and we thank God that we had the opportunity to love him and be loved by him,” the GoFundMe reads.

The Alabama Independent School Association, of which Morgan Academy is a part, released a statement earlier Saturday regarding Tellier’s injury.

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“We ask that our entire AISA family and the people of Alabama join us in prayer for peace and comfort for Caden’s family and the Morgan Academy community as they navigate this difficult time,” said Michael McLendon, the AISA’s executive director.

To read the full story from KY3.com about the Alabam high school athlete, click here. 

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The study found that football athletes were more likely to suffer a concussion on natural grass than on artificial turf.

Artificial turf has come a long way over the years from a thin layer of fake grass over concrete.

A recent story from KERA News discussed the study with lead author Dr. Munro Cullum, a clinical neuropsychologist at UT Southwestern Medical Center. Below is an excerpt from the KERA News interview.

Does this study suggest that artificial turf is safer?

I think that might be a little preliminary to make that conclusion. But the results did find that the symptoms were lower and less severe on the turf compared to grass. Now, just like with artificial turf, grass obviously varies tremendously from field to field, so that may play a role as well.

Why is natural grass a problem?

It’s quite variable in terms of how well it’s kept. How many bare spots are there? What is the nature of the soil beneath? Is it more clay? Is it more soft? Has it been watered recently? Is it hard? So, just like with artificial turf, there are a lot of variables that go into differences in grass fields as well. But again, that’s something, that probably merits some further study.

So, what then, should schools take away from this study?

It suggests the nature of the football field should be looked at. And they should probably be evaluated for how new the surfaces are, and how hard the surfaces are. And review that periodically if a school has turf that’s very, very old. Maybe it’s time to look at a renewed surface that might be somewhat more pliable and softer.

And for concussion assessments, I think it suggests that we need to pay attention to what they hit their heads on and look for the possibility of greater symptoms when they are playing on a grass surface. Although, as noted, the results are preliminary with a pretty small sample.

You’ve been studying concussions for years. Are schools more mindful today about this than before?

Schools are definitely, and school personnel are definitely, more mindful about concussions. The information has definitely gotten out over the last ten, 15 years, about taking concussions seriously.

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To read the full story from KERA News, click here. 

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“Increased time spent in the classroom, participating in some after-school activities or working a job was associated in our study with faster symptom resolution, especially for participants with lower post-acute symptom scores,” said lead author Jingzhen Ginger Yang, Ph.D., MPH, principal investigator in the Center for Injury Research and Policy of the Abigail Wexner Research Institute at Nationwide Children’s.

“However, when activities involved significant screen time—like surfing the internet or playing video/computer games—during the first-week post-injury, symptoms resolved more slowly.”

While some research on pediatric concussion has suggested an earlier introduction of physical activity promotes recovery, little is known about the intensity and duration of cognitive activity post-concussion and its potential influence on concussion recovery outcomes.

This new study, conducted by experts in Nationwide Children’s Center for Injury Research and Policy, division of Sports Medicine, Center for Biobehavioral Health, and division of Emergency Medicine evaluated the intensity and duration of daily cognitive activity reported by adolescents (age 11–17 years) following concussion and examined the connections between these activities and symptom duration.

Participants reported increases in low-intensity cognitive activities—such as listening to music, reading, watching television, and making or receiving phone calls—and total minutes of overall cognitive activities as their symptoms resolved.

Previous clinical guidelines for youth with concussions have recommended complete physical and mental rest until symptoms resolve to avoid re-injury and reduce the demands on injured tissue. However, recent clinical and experimental data have demonstrated that prolonged physical rest does little to improve functional outcomes, and the resulting isolation and withdrawal can have unintended physical, social and educational consequences.

“Children and teens should be encouraged to get back to their routines and take part in activities like clubs, jobs and homework after experiencing concussion, but keep in mind that for some patients, prolonged screen time in non-school activities such as gaming or internet scrolling can affect recovery if it is worsening their symptoms,” said co-author Thomas Pommering, DO, division chief and director of concussion clinics of Nationwide Children’s division of Sports Medicine.

“We recommend concussion patients pick their screen activity wisely, focusing on school demands first.”

According to the study, the average time children returned to school after a concussion was almost one week. Symptoms resolved more slowly when returning to school was delayed. Additionally, participating in club activities was associated with faster symptom resolution.

“Having a better understanding of the appropriate ‘dosing’ and timing of introducing cognitive activity is critically needed for our patients,” explains co-author James MacDonald, MD, MPH, sports medicine physician at Nationwide Children’s.

“Increased engagement in the classroom during the first week post-concussion, especially for youth with lower post-concussion symptom scores, can mean symptoms resolve faster and teens get back to normal life.”

The relationship between level of cognitive activity and symptom resolution may be bidirectional, with improving post-concussion symptoms prompting higher levels of cognitive activity and vice versa. Thus, controlling for current symptom levels when assessing associations between cognitive activity and symptom resolution, as this study did, is crucial.

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This study has several important clinical implications:

• Adolescents with concussion, especially those with relatively less severe post-acute symptoms, may benefit from moderate- to high-intensity cognitive activity as early as the first week post-injury.
• Limiting (but not prohibiting) moderate-intensity activities involving significant screen time (e.g., surfing the internet or video/computer gaming) during the first-week post-injury may help speed recovery.
• Early introduction of returning to school following concussion is an important consideration that may hasten timelines for recovery.

Families should collaborate with their child’s care team to develop a plan based on injury severity and recovery milestones.

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