When the Crows chase their third AFLW premiership on Saturday, captain Chelsea Randall will be watching from the sidelines.
A concussion from a collision during last week’s preliminary final left her ruled out of the match.
It’s a bitter sweet way to end a season — but as Sarah McCarthy knows, a concussion can have much longer consequences
In 2016, Sarah was the jammer for her Sydney roller derby team, skating at high speed in the league’s Grand Final, aiming to get past the opposition and score points.
“I was a few feet in front of the pack, looking over my shoulder,” she tells ABC RN’s Sporty.
As she skated, a competitor’s elbow hit Sarah’s neck and jaw hard and she crashed to the ground.
She doesn’t remember if she passed out or not, but recalls feeling briefly sick.
She got up, sat out for awhile, but later re-joined the bout, feeling reasonably ok.
It was Sarah’s second concussion that week, having had an earlier blow at training.
The next few months passed in a blur of sickness, dizziness and ringing ears.
“I could barely make it past lunch time without falling asleep. My head felt like it was in a vice 24 hours a day,” she says.
What was worse, says Sarah, was the memory loss, heightened emotions, and constant haze in her mind as she struggled to manage a big work project.
Sarah’s experience is not out of the ordinary. Experts say sportswomen are at higher risk of concussion than male athletes, and the effects of concussion in women tend to be more severe.
Almost five years on, Sarah continues to live with the implications of Post Concussion Syndrome.
“I struggled verbally, and I still do now if I have a poor night’s sleep,” Sarah says.
“It’s almost like I’m sitting on a chair in a room with a curtain around me and all of my vocabulary is just beyond the curtain. And I can’t reach it or I use the wrong words. I forget people’s name all the time,” she says.
“I’m fatigued every day. I still can’t exercise. I can’t handle stress, I can’t handle light, I can’t handle sounds.”
What happens when you’re concussed?
Dr Adrian Cohen, an emergency and trauma physician who researches concussion prevention, says concussion is not as simple as was once thought.
He says concussion results in less blood flow to the brain.
This means brain cells, called neurons, don’t get enough oxygen and glucose. They also suffer a “structural deformity”.
Basically, Dr Cohen says, the brain has a “metabolic crisis” and neurons stop working properly.
Why is concussion more common in women?
We don’t have enough data on the size of the problem, Dr Cohen says.
But research and scrutiny of concussion in women in sport is growing — largely in the wake of developments in elite men’s sport such as the AFL and NFL.
“Doctors like myself who work in this area are definitely seeing it more often and we’re seeing it with more severity,” Dr Cohen says.
He says women sustain more concussions than men in high-impact sports such as rugby league, rugby union and Australian rules football. Women also take longer to recover.
One possibility is that women may be more likely to report concussion.
But Dr Cohen says there are complex physiological factors at play.
“There are structural differences between men and women’s brains,” he says.
“They actually have a slightly faster metabolism than male brains, and they have slightly greater oxygen flow to the head.
“The cells themselves can be thought of as being slightly hungrier. So in the context of an injury that disrupts the supply of glucose and oxygen, it can help explain why they suffer more damage.”
He also says women are joining high impact sports without years of tackle training and have had less opportunity to build up the strong neck muscles crucial in protecting against impact.
Dr Cohen says these factors are not an argument for reducing women’s participation in contact sport — the benefits, he says, far outweigh the risks — but he is urging for new ways to minimise those risks.
“We have to outlaw illegal play that causes damage, we have to get people off the field when they have an injury, we have to recognise concussion,” he says.
He is part of a team developing a new device which he says can quickly and accurately assess a player for concussion.
“Instead of just asking somebody whether they’re okay, and putting [them] through a 10 minute test, which seems fundamentally flawed at the moment, we have got to put this in the field of objectivity.”
Concussion and migranes
Dr Rowena Mobbs, a Macquarie University neurologist who researches and treats the effects of concussion in sportspeople, says there is truth to suggestions that women experience concussion symptoms more severely.
“But there is this really important overlap of chronic migraine after trauma, and the term for this is post-traumatic headache,” she says.
“When we talk about migraine … they’re the same multitude of symptoms that can occur in concussion.
“So you can be dizzy and clouded in your thinking, lethargic and have double vision. And we know that women are at three times the risk of chronic migraine than men.”
She suggests there could be an association between chronic migraine syndrome and concussion, a kind of double whammy for women.
“It’s really a complex area,” Dr Mobbs says.
“It’s fairly new to research because, unfortunately, there’s been so much preferred research in men in sport, and we’re only just now approaching female concussion.”
In Australia, the Sports Brain Bank works on diseases such as chronic traumatic encephalopathy (CTE) and other brain disorders associated with previous concussions or head impacts.
Dr Cohen says there are several Australian sports women who’ve pledged to donate their brain to the Sports Brain Bank.
“But in general terms, these women won’t have been playing the games for as long, and at as high a level,” he says.
He says concussion and its long-term consequences “are a numbers game”.
“The more impacts to the head you have, the more likely you are to suffer short, medium and long-term consequences. Therefore, the more likely it is to show up as CTE. But we’re going to be seeing it in women unfortunately, in the not too distant future.”
Concussion rules are changing in Australian football codes — the rules that mandated Randall miss the AFLW grand final were brought in earlier this year.
Dr Mobbs welcomes these new rules, but hopes the conversation in elite sport will extend to how concussion is managed at training and in community sport.
In 2019, the Australian Institute of Sport released an updated set of concussion guidelines to improve player safety and address rising concerns in the community around the links between concussion and CTE, which has been linked to dementia and behavioural problems.
Dr Mobbs wants measures like restricting heading the ball in soccer training to be considered.
“We must look after people’s brains,” she says.
“We can preserve what we love about the sports, they can still be played hard, but it just means that we’ve got to all get together and think of ways we can preserve brain health for these players.”
Sarah McCarthy wishes she’d been stopped from returning to play in the 2016 grand final, and regrets not taking time to immediately rest after the injuries.
She has advice for other people who experience concussion.
“First and foremost, stop everything – stop,” she says.
“If you can, stay in a dark room, don’t do anything that’s too mentally taxing. Don’t exercise.
“If I had taken that four to six weeks to rest [and] not have too much mental and emotional stimulation, I think my recovery would have been a lot quicker.”