March 22, 2023 – Layla Blitzer, a 17-year-old highschool student from New York City, was playing field hockey for her school last October and was hit hard by a ball just above her eye.
She suffered a severe concussion. She has also had neck problems and headaches for the past 4 months. “They are so bad that I still need physical therapy,” she said.
At first, staff on the opposing highschool where she played didn't realize she had a concussion. “Even the referee said, 'You're not throwing up, so you're OK,'” said Allison Blitzer, Layla's mother.
It soon became clear that Layla was “not feeling well.” She consulted a neurologist referred by the varsity, who diagnosed the concussion.
Similar symptoms, various severity
David Wang, MD, lead team physician at Quinnipiac University in Hamden, CT, said the symptoms of a concussion – akin to headache, dizziness, visual disturbances, sensitivity to light and sound, mood and cognitive problems, fatigue and nausea – are similar in adolescents and adults.
“But symptom levels and severity are higher in adolescents than in younger children and adults,” he said.
In addition, the recovery time is longer.
“The effects of a concussion in adults, especially men, can last about seven days, but in teenagers, three to four weeks is not uncommon, and in teenage girls it can be even longer,” said Wang, director of Comprehensive Sports Medicine in Connecticut.
The severity of symptoms and the way long they last in teenagers “depends on their stage of life, because adolescents are going through puberty and are biologically in a period of rapid development, but neurologically they are not yet mature,” he said. “The changes in their bodies can make them more vulnerable to the effects of a concussion compared to younger children and adults.”
Similar to adult women versus men, girls are likely to have more severe symptoms and an extended recovery time in comparison with boys – a finding that surprised Allison Blitzer. Her older son had suffered two concussions while playing sports in highschool, but after a number of weeks, “he was fine and able to participate again.” Layla's symptoms were more severe and lasted longer.
One of the possible reasons for the gender differences in concussions is that ladies generally have weaker neck muscles, Wang said. Weaker neck muscles allow the pinnacle to speed up more after a blow, leading to greater forces on the brain.
Dealing with a young person’s recovery time
Layla tried to go to highschool three days after the concussion, but “it didn't go well,” she said. The shiny lights within the classroom were bothering her eyes. And most classes were digital, on a pc or projector, and an excessive amount of time in front of a screen causes eyestrain and headaches after a concussion.
“I couldn't look up and do any of the work my class was doing,” Layla said. The noise within the lobbies, cafeteria and elsewhere was also overwhelming, so she stopped going to highschool after two weeks.
Since Layla has several siblings, it was not all the time quiet at home and he or she isolated herself in her room.
“I fell behind on work,” Layla said, despite the assistance of a concussion specialist who arranged with the varsity to offer Layla less work, take breaks and have more time to finish assignments and tests.
Even after several months, Layla was unable to maintain up along with her schoolwork. The school was “super supportive,” she said, but she still didn't understand how long her recovery time would take.
“It seemed like I would recover much faster. And although I have made progress, it has been almost five months since my injury and we are in the middle of midterms, but I cannot take them because I am still behind on my work,” said Layla.
In addition to the headaches and memory problems, Layla suffered from persistent fatigue, which was made worse by insomnia. The neurologist gave her sleeping pills, which relieved the fatigue, however the headaches remained.
Finally, Layla consulted one other specialist who was capable of pinpoint the explanation for her headaches. He prescribed targeted physiotherapy, which Layla attended twice every week.
“Physical therapy has helped me the most and I am finally starting to catch up, even though I am still behind,” she says.
A current analysis of eight studies (with nearly 200 participants) examined the effectiveness of physical therapy on post-concussion symptoms (akin to headaches) in adolescents.
The researchers found evidence that physical therapy is effective in treating adolescents and young adults after a concussion and will result in faster recovery than the traditionally prescribed complete physical and cognitive rest.
Returning to sport can't be rushed, Wang said, not only since the person continues to be recovering and might not be “at their best,” but in addition because a second injury through the recovery period could cause greater damage.
“We call it 'overlapping concussion syndrome,'” he said. “The concussion is partially resolved and the kid is functional enough to play a little bit again, but then he gets hit again. That complicates the situation and delays recovery even more.”
“Academic quicksand”
Adolescence is a “difficult time,” Wang said. Teenagers are learning about themselves on the planet, in class and of their social environment. Interrupting this process can disrupt the method and make it even tougher.
“What we've seen with teens who have missed two years of school because of COVID is that they're often not well-adjusted and not ready for the college environment,” Wang said. “These are critical maturation years. If a teen misses school or social activities because of a concussion, that adds to the stress as well.”
Wang compares this to “academic quicksand,” saying, “The more teenagers struggle, the deeper they sink, because the struggle itself can be so exhausting.”
Layla can confirm this.
“The stress of falling behind, especially in a very competitive academic environment, has definitely caused me a lot of anxiety,” she said. “I see everyone in my class moving up, and I'm still catching up on old math units, doing an old unit that the class finished a long time ago, as well as the one that everyone is working on right now.”
Her mother said it was hard for Layla to look at her friends exit on weekends, knowing that wherever they went would probably be too loud and shiny for her while she was still recovering.
“It's an invisible injury and it's hard to quantify or show someone else how much a person is suffering. So it's very isolating,” she said.
Lobbying
Layla is an intern at PINK Concussions, a nonprofit organization focused on concussions in women, where she advocates for other teens who've suffered concussions.
When she played field hockey, “we didn’t wear goggles or helmets because the hockey league felt there wasn’t enough evidence to support the idea that girls should wear protective gear,” Layla said.
Now she is working along with her school's athletic director and directors of other private schools to alter her league's rules to require protective equipment at field hockey games.
“I think my concussion could have been prevented if I had been better protected,” she said.
She also advocates for a more realistic protocol for returning to highschool.
“Some teachers may fear that students with concussions could delay their return to school,” said Katherine Snedaker, a licensed clinical social employee and founding father of PINK Concussions. “But our research found that students want to go back to school so badly that they downplay their symptoms in order to return to school/sports before they are ready. Students did not use their concussion as an excuse to stay away longer.”
Layla said teachers “should be prepared for children who have suffered a concussion to be unable to keep up with work for some time. Some teachers may not realize that recovery may be different for girls and boys. And they should know how to help a student get back to school successfully.”