Elite kite foiler Lucy Bilger recalls her head cracking sideways during a collision with her training partner in July.
“I actually didn’t even hit him. I just hit the water super hard.”
She was in the lead-up to her World Championships, on the pathway towards her 2028 Olympic campaign, when she was concussed.
“I just felt it was quite a lot of pain – like I winded myself, I couldn’t breathe. I was a little bit like dizzy.”
Symptoms started developing within an hour, but it wasn’t until the next day, when her headache was causing her so much pain it made her nauseous, that she got the concussion diagnosis.
A couple of weeks later, she joined the Auckland University of Technology’s Women’s Health and Neuroscience Research Programme.
The worst of her symptoms were over by then, but having never had concussion before, she wanted to gain more insight into what she was going through.
“To have a reason to why you’re feeling a certain way and the symptoms you’re experiencing, I think that’s really important.”
The research programme aims to look at the connection between hormones and concussion outcomes, using blood biomarkers to improve concussion diagnosis and recovery tracking, with the hopes of helping female athletes optimise their performance.
With a target of approximately 1000 study participants in the first couple of years, Professor of Human Performance at AUT Millennium, Patria Hume, emphasises the need for more participants, particularly in areas where they are lacking.
“What we still need is a lot more women, particularly Māori and Pasifika, because when we do the analysis by the hormonal stages, we want to ensure that we’ve got enough people in each of those stages.”
Sammy Bentley was one of the first participants back in May. The study’s sample group had grown to 447 participants by early December.
Most of these participants, like Bentley, are a part of the control group. That’s people who have not had a recent concussion.
Their data will be used to identify the baseline normative levels for the two brain proteins and 15 other markers being tracked over the next couple of years.
Bentley was drawn to participate in the study due to it being female-based.
“I thought it was really interesting that they were focusing on female athletes this time because I know that in the past it’s been more like male-dominated in this kind of research.”
She was also motivated by seeing teammates affected by concussions during her years playing water polo.
“I think it’s really cool that they’re trying to figure out ways to see how we develop afterwards and how we heal.”
Respiratory physio, Abby Stewart, another control group participant, deals with concussion recovery often in her field of work. She also felt that the nature of the study being female-based drew her to do her part.
“It only just takes looking at some of our higher quality RCTs and randomised control trials to spot that there is this, like, missing piece of the puzzle. Which is just that women’s physiology are so underrepresented in the research.”
The baseline level findings will be important for athletes, as they are often cleared to return to play after symptoms have resolved. Potentially before the brain has fully recovered, says Hume.
“We know that symptoms will often resolve within that three weeks, but our physiology doesn’t. So, those brain biomarkers and things won’t have returned to normal. What we’re interested in seeing is how long does it actually take to get back to what normal might be.”
Concussed participants are being tracked from when they enter the study up until seven months after their injury.
For Bilger, it took three months for her to be medically cleared to return to sport.
“That feeling that I don’t know if I’m going to get better or not – that was the biggest thing: [Having] no idea how long this recovery process is going to take.”
The what-ifs regarding her sports career were also on her mind.
“I was really worried if I didn’t get cleared, then that would ... put me at a severe disadvantage against the rest of the girls who are competing”
She found she struggled with the invisible symptoms more than the physical pain.
“Your brain almost couldn’t process all the information that was being chucked at you. That was really scary, and I just had this overwhelming feeling that I wasn’t myself.”
That’s a feeling many concussion sufferers will resonate with, and a key question asked during the study.
Working with medical clinicians, scientists and people who have experienced traumatic brain injuries, AUT designed a survey to reflect the subjective side of a concussion.
It utilises both a 1-5 and a 1-10 scaling system to assess questions related to a participant’s current symptoms.
Control group participants should find the questions relatively easy to answer; however, when concussed participants first arrive, they aren’t necessarily thinking straight, so they may struggle to gauge their position within the range relative to their symptoms.
“Sometimes, 1-to-10 is quite a big range at times, and I found that really hard to determine what number exactly correlates to the symptom that I’m feeling. But now I’ve recovered, the questions are quite easy to answer.”
The blood analysis side of the study enables a more objective look into what’s happening inside the body and the brain during a concussion.
Eventually, it’s hoped the survey and the blood analysis will be used in unison to provide a more accurate concussion diagnosis and recovery path.
But for now, the study is monitoring how the physiological changes found in the blood track with the symptoms a patient is experiencing.
As Bilger nears the end of her involvement with AUT’s research programme, she highlights her excitement around the awareness it brings to concussion and how it will improve the current diagnosis process.
“Concussions, from my experience, they’re quite hard to diagnose and define whether they’re moderate, mild or severe.
“It was quite interesting going through that process and being diagnosed. It seemed quite wishy-washy rather than actually finding something in your blood.”
This innovation of being able to look at objective markers is also close to Stewart’s heart when it comes to treating her own concussion patients.
“Suddenly, we’re able to look at something objectively within our bodies and say: ‘Oh, well, this actually links into concussion.’ And not only that, but it’s giving us a little bit of insight into your biomarker profile and actually the severity of your concussion. And most importantly, how can that help to optimise treatment outcomes and kind of individualise treatment pathways.”