Girls More Likely To Suffer Concussions in Sports Than Boys

Higher rates ...

Girls suffer concussions at a higher rate than boys in similar sports.

• Soccer: 
  • A 2007 study ¹ found that the concussion rate for girls was 68 percent higher than boys;  
  • A 2011 study² found that the concussion rate for girls in high school soccer (0.35 per 1000 participations by an athlete in a practice or competition or athlete-exposures (AEs) was double that of boys (.017 per 1000 AEs)
• Basketball:
  • The 2007 study found the concussion rates in high school basketball were almost 3 times higher for girls than boys.¹
  • The 2011 study reported that the concussion rate for girls was 1.7 times higher than for boys.

... but not longer recovery?

Whether girls take longer than boys for symptoms to resolve and return to play, however, is unclear. 

• The 2007 study¹ found longer recovery times,
• A 2009 study³ found that girls with a previous history of concussions reported more and different concussion symptoms (particulary headache), although admitting to the possibility that male and female athletes may report symptoms differently due to psychological or personality factors not directly related to concussion. 
• The 2011 study,² however, reported no gender difference in concussion outcomes or severity, with high school girls and boys who suffer concussions in sports reporting the same number of symptoms, and taking the same time for their symptoms to clear and to return to play.  The one difference: girls reported symptoms more subtle and easily missed or attributed to causes other than concussion than those boys.

The findings "re-emphasizes the fact that concussions aren't just a concernfor high school football players; they can happen to athletes playingall types of sports," said Dawn Comstock, co-author of the 2007 study and assistant professor at the Ohio State University College of Medicine in Columbus.

"Generally speaking, the medical profession does not do a very good job in recognizing that female athletes sustain concussions at an equal or even higher rate as males," said MomsTeam.com expert Dr. Robert Cantu of Brigham and Women’sHospital in Boston in an interview with The New York Times. "It’s flying under the radar. And, as a result, looking for concussions inwomen is not pursued with the same diligence, and it’s setting girls upfor a worse result."

Explained by anatomy …

The reasons the concussion rates are consistently higher for girls than boys in same sports are unclear, but one reason may be anatomical: girls may be at higher risk prone to concussions because their heads are smaller (one study of collegiate soccer players foundthat females had 26% less total mass in their head and neck than males) and/or because their neck muscles are less developed than boys" and not as good as boys at absorbing shock of impact.

Or culture?

The second possible reason for the higher concussion rate in girls may be cultural.

• Girls get more attention? The 2007 study's authors surmise that athletic trainers may pay more attention to girls’ injuries than boys because “society has tended to be more protective of female athletes." "As a society, we protect girls more than boys. Boys have to be tough and learn to play through pain, so they will be less likely to report a concussion,” says Comstock. Coaches, athletic trainers and parents tend to be more cautious about letting girls return to play than boys. “Coaches and parents may be more sensitive to injury to the female head,” says Christopher Ingersoll, the journal’s editor-in-chief and a professor of sports medicine at the University of Virginia.
• Girls more likely to self-report? Girls may self-report at higher rate than boys (but, like boys, probably under-report either because they don't want to lose their spot on the team or out of ignorance of risk). "Women may just be a bit more honest than men in terms of honestly admitting that they've had post-concussion symptoms,” suggests Dr. Cantu, a sentiment echoed by Ingersoll, who speculates that, “Culturally, it may be OK for girls to talk about a concussion. Athletes who play tough, macho sports may not be as open” to talking about them.

Some strongly dispute this theory. As high school soccer coach, Gary Lynch, told The Baltimore  Sun: "These kids are players. If you get to [be one of] the top soccerplayers, if you think they want to come out of the game, they're likethe boys. You've got to tell them they have a concussion. They are not going to come over and tell you... It doesn't work that way. It soundslike an easy excuse, an easy reason to make up why there's more girlsthan boys, and I don't buy it."

Education & proper management needed

Regardless of the reason, Comstock hopes coaches, athletic trainers, and parents will treat head injuries infemale athletes more seriously or to delay their return to play. 

Parents and coaches and primary physicians should all know the definitions of concussion, the signs of continued post-concussion syndrome, the guidelines for return to normal activity and the signs that should keep an athlete out of play for an entireseason or longer," advises Dr. Jean Ogborn, a pediatric emergency medicine specialist at Johns Hopkins Children's Center, in an interview with ABC News.

"What is very important about this [[2007] article is that it points out that concussions can occur in girls' sports with significant frequency, and that girls and their parents need to be aware that these injuries must be carefully managed to prevent permanent damage," Ogborn says.

Should gender be a factor in concussion management?

The Consensus Statement on Concussion in Sport issued by the 3rd International Conference on Concussion held in Zurich in November 2008 "accepted that gender may be a risk factor for injury and/or influence injury severity" but did not list female gender as a possible modifier in the management of concussions because there was no "unanimous agreement that the current published research evidence is conclusive."   

1. Gessel LM. Fields SK. Collins CL. Dick RW. Comstock RD. Concussions among United States high school and collegiate athletes. J. Athl Train. 2007; 42(4): 495-503.

2. Frommer L, Gurka K, Cross K, Ingersoll C, Comstock R.D., Saliba S. "Sex Differences in Concussion Symptoms of High School Athletes" Journal Ath. Training 2011; 46(1):000-000.

3. Colvin AC, Mullen J, Lovell MR, West RV, Collins MW, Groh M. The Role ofConcussion History and Gender in Recovery from Soccer-Related Concussion.  Am. J. Sports Med. 2009; 37(9): 1699-1704.

Revised March 19, 2011