Breakthrough research on the impact of concussion on female athletes

Most sports enthusiasts who follow team sports have probably at some point held their breath or looked away when the heads of two players collide in the heat of the moment, leaving both lying motionless. In recent years stories have emerged in the media about athletes struggling with long-term illnesses or symptoms following head injuries. But what are the effects of head injuries; especially concussion, on the health of those who experience them? A group of female scientists at the University of Iceland, Reykjavík University, and Landspítali University Hospital have been tackling this question in recent years, examining the specific effects of concussion on female athletes. Much evidence suggests that women may be more susceptible to the effects of concussion than men, but they have been less studied. The group has now produced short educational videos on the effects of concussions and head injuries on the body, as well as their research findings.

"The spark for the study is primarily our researchers' interest in sports and the fact that athletes often experience long-term symptoms following head injuries, or concussions in their sport, sometimes even having to quit sports altogether. Another significant concern is the effects of concussion on the hormonal function of the pituitary gland. It is thus important to identify factors that can be treated to shorten the progress of the situation and even heal it," says Helga Ágústa Sigurjónsdóttir, clinical professor at the University of Iceland and Landspítali University Hospital, and specialist in Internal Medicine and Endocrinology and metabolism.

Helga Ágústa Sigurjónsdóttir, clinical professor at the University of Iceland and Landspítali University Hospital, and specialist in Internal Medicine and Endocrinology and metabolism. image/Kristinn Ingvarsson

Breakthrough research on the impact of concussion on female athletes

She adds that the group's interest also focuses on identifying symptoms that can be treated following head injuries or concussion, whether they occur in sports or in other types of accidents. Could it be that individuals who become chronically ill after, for example, after a car accident, without any visible injuries, have symptoms of head injury/concussion that occurred during the accident?" asks Helga, adding that research has shown, among other things, that whiplash can cause dysfunction in the pituitary gland.

Concussion during sports: Incidence - Hafrún Kristjánsdóttir, professor at Reykjavík University

Helga Ágústa Sigurjónsdóttir, clinical professor at the University of Iceland and Landspítali University Hospital, and specialist in Internal Medicine and Endocrinology and metabolism.

The symptoms of a concussion can be various, such as memory loss, lack of focus, diminished sensation, depression, anxiety, fatigue and lack in stamina, indisposition, sleep deprivation and headache.

Study the psychological and neuropsychological impact of concussion

The research, funded in part by Rannís, is threefold. The first and second phases of the study were first and foremost in the hands of María K. Jónsdóttir and Hafrún Kristjánsdóttir, professors at Reykjavík University, and Ingunn S. Unnsteinsdóttir Kristensen, psychologist who did her doctoral thesis at Reykjavík University on the study. "There, among other things, the effects of concussion were examined in broad strokes using psychological and neuropsychological tests," says Helga. The knowledge of Icelandic female athletes on concussion was examined, how common it is, and the relationship between concussion and various factors such as sleep disturbances, depression, and cognitive function." 

The research findings are discussed in the following videos.

Concussion in sports - Background and consequences (phase 1) – Hafrún Kristjánsdóttir, professor at Reykjavík University

 

Concussion in sports - consequences (phase 2) – Ingunn S. Unnsteinsdóttir Kristensen, PhD from Reykjavík University in 2022

What effect does concussion have on the function of the pituitary gland?

In the third phase of the study, Helga and Lára Ósk Eggertsdóttir Claessen, a medical doctor and doctoral student in health sciences at the University of Iceland, examined the possible effects of concussion on the function of the pituitary gland. 

The pituitary gland is a very important organ, sitting 7-10 centimetres behind the nose, 'hanging down from the brain like a little Christmas bauble.  The pituitary gland controls nearly all of the body's hormones and their production in various organs. 

For a long time, there have been ideas that the pituitary gland can be damaged by head injuries and concussions, and results from specific studies related to accidents, brain haemorrhages and sports injuries support this," says Helga. This is, to the best of our knowledge, however, the only study of its kind and the only one where such a large group of women who have suffered head injuries or concussions in sports is examined," says Lára. In addition to her and Helga, and researchers within Reykjavik University, Sigrún Helga Lund, a professor of statistics at the University of Iceland, contributes to the study at all stages like they all do.

Concussion in sports - consequences (phase 3) - Helga Ágústa Sigurjónsdóttir

Furthermore, Helga points out that symptoms of headaches and concussion can be long-lasting and resemble symptoms of pituitary dysfunction. If pituitary dysfunction is the case, it may be possible to treat it, which can make a significant difference for the individual involved. It is thus important to examine whether pituitary dysfunction occurs as a result of head injuries/concussions in sports. We therefore measure all hormone axes of the pituitary gland and in women who have symptoms consistent with pituitary dysfunction we examine them further with more defined hormonal tests," explains Helga.

It is possible to treat pituitary dysfunction following a concussion.

Women in contact sports who were interested in participating signed up digitally for the study, and they turned out to be over 500. Then we worked on the definition of concussion to confirm whether each woman met the requirements for participation in the study," explains Lára. 

As before, various psychological and neuropsychological tests were conducted in the first and second phases of the study to identify what damage the female athletes may have experienced after a concussion. In phase 3, the women underwent thorough medical examinations and blood tests, where the hormones of all pituitary axes were measured. If the results of their hormone measurements repeatedly fell outside normal reference ranges, the women were further examined with more detailed tests on pituitary function.

Concussion in sports - consequences (phase 4) – Lára Ósk Eggertsdótir Claessen

The research group has already published results from all parts of the study, and it is clear that concussion leads to changes that appear in psychological tests, neuropsychological tests, and blood tests for pituitary hormones. It is therefore clear that concussion can cause dysfunction of the pituitary gland, which can be treated, thus improving the patient's quality of life," further explains Lára, who was awarded a special prize at Landspítali University Hosptial's Science Days this spring. 

There's no doubt about the importance of the research for female athletes, and Helga points out that the results should lead to changes in the treatment of individuals who experience head injuries or concussions in sports and even other accidents as well. Coaches, healthcare professionals, and the general public need to be familiar with the symptoms of head injuries and concussions. Hopefully, this will lead to changes in sports, both in terms of trying to prevent such injuries and in properly addressing those individuals who experience them," concludes Helga.