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Concussions in Sports: Does Gender Matter?

Active area of research, but remains murky, with general trends but few definitive answers

Possible explanations

The reasons concussion rates are higher for girls than boys in same sports are unclear.

One reason may be anatomical: girls may be at higher risk of concussions because their heads are smaller (one study of collegiate soccer players found that females had 26% less total mass in their head and neck than males [14] and/or because their neck muscles are less developed than boys and not as good as boys at absorbing shock of impact.

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

  • Girls get more attention? The authors of the 2007 study[1] 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,” observes 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 editor-in-chief of the American Journal of Sports Medicine 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[15] (but, like boys, probably significantly underreport concussions [17-20], 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. A 2012 study in the American Journal of Sports Medicine [4] reported on research from 2002 suggesting that "male athletes play though pain and try to hide and minimize their symptoms in an effort to avoid removal from sport, whereas female athletes tend to be more concerned about their future health."  In his 2012 book, Concussions and Our Kids,[16] Dr. Cantu speculates that the concussion rate for boys and girls may actually be the same but has been skewed in the studies by the fact that boys under-report concussions more than girls.  He wonders just "how different would the picture be if all concussions were counted, not just those that youth athletes report to coaches and trainers?"  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 like the 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 sounds like an easy excuse, an easy reason to make up why there's more girls than boys, and I don't buy it."
  • Hormones/metabolism/cerebral blood flow.[15] Animal studies have suggested that estrogen and progresterone may act to protect the brain after more severe traumatic brain injury (TBI), but a study of rats found that estrogen actually made TBI worse in female rats, but served as a protective factor in male rats.  Several researchers have suggested that women may have a greater rate of cerebral blood flow and an increased demand for glucose, with one study suggesting that, as a result, a concussion may exacerbate the neurometabolic cascade [13] after injury, resulting in further decreases in cerebral blood flow and increases in glycemic demands, which may lead concussed female athletes to exhibit prolonged neurocognitive impairments compared with male athletes.                                                                                                                                                                                               
  • Differences in training.  Some suggest that, girls aren't as accustomed as boys getting hit, citing, for example, the fact that in ice hockey, boys are allowed to body check after a certain age (currently age 12 or Bantam), while body checking in girl's hockey isn't allowed at any age, while no checking is allowed in girl's lacrosse but is, of course, allowed in boy's. So, the argument goes, girls aren't as prepared to handle contact. 

Education & proper management needed

Regardless of the reason, Comstock hopes coaches, athletic trainers, and parents will treat head injuries in female athletes more seriously and cautious about 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 entire season 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.