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Br J Sports Med. 2019 Dec;53(24):1539-1551. doi: 10.1136/bjsports-2018-099571. Epub 2018 Oct 15.

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.

Author information

The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.
Duke University School of Medicine, Durham, North Carolina, USA.
University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Boston Biostatistics Research Foundation, Framingham, Massachusetts, USA.



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.


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.


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.


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

[Indexed for MEDLINE]

Conflict of interest statement

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.

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