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Altered brain microstructure in association with repetitive subconcussive head impacts and the potential protective effect of jugular vein compression: a longitudinal study of female soccer athletes
  1. Gregory D Myer1,2,3,4,
  2. Kim Barber Foss1,
  3. Staci Thomas1,
  4. Ryan Galloway1,5,
  5. Christopher A DiCesare1,
  6. Jonathan Dudley6,
  7. Brooke Gadd1,
  8. James Leach7,
  9. David Smith1,
  10. Paul Gubanich1,
  11. William P Meehan III3,
  12. Mekibib Altaye8,
  13. Philip Lavin9,
  14. Weihong Yuan5,6
  1. 1 The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2 Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
  3. 3 The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
  4. 4 Duke University School of Medicine, Durham, North Carolina, USA
  5. 5 University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
  6. 6 Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  7. 7 Division of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  8. 8 Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  9. 9 Boston Biostatistics Research Foundation, Framingham, Massachusetts, USA
  1. Correspondence to Dr Gregory D Myer, Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA; greg.myer{at}cchmc.org

Abstract

Purpose To (1) quantify white matter (WM) alterations in female high school athletes during a soccer season and characterise the potential for normalisation during the off-season rest period, (2) determine the association between WM alterations and exposure to repetitive subconcussive head impacts, and (3) evaluate the efficacy of a jugular vein compression collar to prevent WM alterations associated with head impact exposure.

Methods Diffusion tensor imaging (DTI) data were prospectively collected from high school female soccer participants (14–18 years) at up to three time points over 9 months. Head impacts were monitored using accelerometers during all practices and games. Participants were assigned to a collar (n=24) or non-collar group (n=22). The Tract-Based Spatial Statistics approach was used in the analysis of within-group longitudinal change and between-group comparisons.

Results DTI analyses revealed significant pre-season to post-season WM changes in the non-collar group in mean diffusivity (2.83%±2.46%), axial diffusivity (2.58%±2.34%) and radial diffusivity (3.52%±2.60%), but there was no significant change in the collar group despite similar head impact exposure. Significant correlation was found between head impact exposure and pre-season to post-season DTI changes in the non-collar group. WM changes in the non-collar group partially resolved at 3 months off-season follow-up.

Discussion Microstructural changes in WM occurred during a season of female high school soccer among athletes who did not wear the collar device. In comparison, there were no changes in players who wore the collar, suggesting a potential prophylactic effect of the collar device in preventing changes associated with repetitive head impacts. In those without collar use, the microstructural changes showed a reversal towards normal over time in the off-season follow-up period.

  • concussion
  • injury prevention
  • soccer

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Footnotes

  • Twitter @gregmyer11

  • Contributors GDM contributed to the conception and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, obtaining funding and supervision. KDBF contributed to acquisition of data, drafting of the manuscript, and administrative, technical or material support. ST contributed to acquisition of data, drafting of the manuscript, and administrative, technical or material support. RG contributed to acquisition of data, drafting of the manuscript, and administrative, technical or material support. CDC contributed to acquisition of data, drafting of the manuscript, and administrative, technical or material support. JD contributed to acquisition of data, drafting of the manuscript, and administrative, technical or material support. BG contributed to acquisition of data, drafting of the manuscript, and administrative, technical or material support. JL contributed to conception and design, critical revision of the manuscript for important intellectual content, and analysis and interpretation of data. DS contributed to conception and design, drafting of the manuscript and material support. PG contributed to conception and design, critical revision of the manuscript for important intellectual content, and analysis and interpretation of data. WPMIII contributed to conception and design, critical revision of the manuscript for important intellectual content, and analysis and interpretation of data. MA contributed to the analysis and interpretation of data, critical revision of the manuscript for important intellectual content, and statistical analysis. PL contributed to the analysis and interpretation of data, critical revision of the manuscript for important intellectual content, and statistical analysis. WY contributed to conception and design, critical revision of the manuscript for important intellectual content, and analysis and interpretation of data.

  • Funding The authors acknowledge funding support from The Heidt Family Foundation, Robert S Heidt Sr Wellington Foundation and Q30 Sports Sciences, LLC.

  • Competing interests DS is the inventor of the Q-Collar approach and has financial interest in the results of the current research. One author (GDM) consults for Q30 Innovations to support applications with the US Food and Drug Administration but has no financial interest in the commercialization of the Q-Collar. Q30 Sports Sciences has financial interests in the development of the Q-Collar.

  • Patient consent Obtained.

  • Ethics approval Cincinnati Children’s Hospital Medical Center IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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