November 08, 2008
The 15-year-old seemed fine until, two days later, she fainted while walking home from school and ended up in Sunnybrook's emergency ward.
"I thought it was nothing," said the midget `A' forward of that big hit and who, three weeks later, is slowly working her way back into practices and games.
"I had no idea I had a concussion."
And she's not alone, since head trauma is a poorly understood part of female hockey.
Balmer is one of hockey's broken daughters, a growing group of players who are sustaining concussions in a virtual vacuum, unaware that other girls and women – from novices to Olympic champions like Jennifer Botterill, playing for Canada in tomorrow's Four Nations Cup final – are being hurt.
NCAA studies show female varsity hockey players are sustaining concussions at twice the rate of their male counterparts, making head trauma the No.1 injury in the women's collegiate game. With many Canadian women competing in the NCAA loop – and 77,000 female players registered here – these disturbing numbers should raise questions across the hockey community, such as:
Why are concussions occurring in a hockey discipline that prohibits bodychecking? How can they be prevented? And why is the larger hockey community unaware that female players are suffering brain injuries on a worrisome scale?
"Because there's no bodychecking, people just don't think girls are going to get concussions and, honestly, that's what I thought too," said Toronto's Kim McCullough, director of the training program Total Female Hockey and a victim of two concussions while playing NCAA hockey at Dartmouth.
"But I had a coach from a peewee `C' team email me to say, `I had three concussions on my girls' team last year.' ... To know that it's not just restricted to the highest levels of hockey, to know that it's happening with our 9- and 10-year-old girls, it's definitely a red flag."
There is little female-focused head injury data in Canada, partly because concussions are not as easily spotted as, for instance, broken limbs, and symptoms must be reported by the athlete to medical staff. One Canadian study – now eight years old – by University of Calgary researchers compared six men's and six women's university hockey teams in the western provinces and found that over one season, concussion rates were similar.
That's why the NCAA concussion numbers, compiled annually as part of a comprehensive injury analysis of 15 varsity sports, are arguably the best indication of a serious trend in women's hockey.
The NCAA's results found no athletes were getting their bells rung like female shinny players. Concussions were the leading cause of their injuries at 18.3 per cent, outpacing men's hockey (at 7.9 per cent), men's football (6 per cent) and men's lacrosse (5.6 per cent). It should be noted this NCAA study, released last year, was based on team medical reports from the 1988-89 through the 2003-04 seasons. Recording women's hockey injuries began in the 2000-01 season.
However, there is cutting-edge research underway at the BrainFit lab (within the University of Toronto's occupational science and occupational therapy department) that studies the effects of hockey-related concussions in male and female youth players. BrainFit is run by Dr. Michelle Keightley, a neuropsychologist whose work shows that boys and girls are at similar risk.
"From our experiences working with male and female youth hockey teams, concussions are happening at approximately equivalent rates, regardless of gender," said Nick Reed, an occupational therapist and grad student who works with Keightley.
"The lack of bodychecking makes people assume that the contacts necessary to elicit a concussive episode aren't present in the female game. This simply isn't true. From our work and from the limited research (and) data out there, concussion is real in women's hockey."
Dr. Robert Cantu, the chief of neurosurgery and sports medicine director at Emerson Hospital in Concord, Mass., attended an international concussion conference in Zurich, Switzerland, last week at which the NCAA results were debated. He said while the women's hockey statistics are a relatively small sample, he was emphatic that the head injury frequency demands more research.
"For girls to be coming up with a higher incidence of concussion than guys in hockey, it lends credence to the fact that maybe girls are more easily concussed than guys," Cantu said.
"Certainly, statistically they are. But what are the possible reasons for that?"
Those reasons are varied, ranging from what sounds like sexist science – that women are more willing to consult medical staff than men – to weaker neck muscles to rigid, upright skating positions that compromise their balance. In a similar trend, the NCAA study also found female basketball and soccer players sustained concussion rates higher than those of their male counterparts, but less than those of female hockey players.
"Women are more honest in reporting concussions than men and that may be a major aspect to those (high) numbers," said Dr. Charles Tator, a renowned spinal cord injury research pioneer and concussion expert. The Toronto neurosurgeon added male hockey players are notorious for "under-reporting" concussion symptoms at elite and pro levels.
But it's a mistake to call women wimps.
Carmen Baker, a 17-year-old goalie for Leaside's second midget `A' team, said she would not leave an important game if she suspected she had a head injury.
"I'm very competitive, I would want to finish my own game," said Baker, who was concussed in grade school while playing outdoor shinny without a helmet.
"It's like any athlete; it's `Tape me up coach, I want to keep going.' So, if it's your head, your leg, your knee, you just want to keep playing."
Opinions also differ regarding a female's susceptibility to concussions and prevention. Cantu believes women should develop their neck muscles as men do.
"Your neck is your shock absorber, at least when you see a hit coming," Cantu said.
McCullough, who trains the Team Ontario under-18 girls squad, believes proper skating position – bent knees, hips forward, strong core muscles – must be drilled into players learning the game for balance and stability to help prevent awkward falls. She also wonders if bodychecking should become part of the game, so girls would be taught how to take a hit at an early age.
Though there's no bodychecking, there's body contact – lots of it.
University of Ottawa Gee-Gees winger Cass Breukelman was concussed twice last season. The first resulted from a hit from behind, which drove her face into the glass as she battled for the puck behind the net. Breukelman said that kind of physical force is not uncommon.
"We have tempers too and it can get really rough in the corners," said the second-year nursing student from Thunder Bay.
"It's do or die, almost. You go into the corner, you want the puck and you're going to give all you have to get the puck. Sometimes, girls just go too far."
But if girls go too far and there's a chance of head trauma, why do players like Breukelman, whose second concussion happened when she tripped in practice, risk brain injury for hockey?
"Hockey is pretty much my life," said Breukelman. "Ever since I was young, I wanted to go away to university and live the dream. I couldn't live without it. It's part of my life and that's why I'm scared now; I realize I have to take better care of myself and I want to finish my university hockey career."
