Gender Differences in Concussion

The lack of attention to gender differences has been a problem in the medical field. This difference needs be taken into consideration when working with athletes recovering from traumatic brain injury because of physiological and chemical differences which impacts how you should manage concussions. Improper management of concussion may result in serious long-term or lifelong disability, risk of coma, or in extreme cases death.

 

Traumatic brain injury (TBI) commonly occurs in high-contact sports for both male and female athletes. However, when comparing the research between male and female athletes, female athletes suffer more concussions than men. Even in sports where the rules are the same for both sexes, such as basketball or soccer, female athletes experience or report a greater number and severity of symptoms and a longer duration of recovery than male athletes. A 2007 study of college athletic injuries shows that female softball players experience concussions at twice the rate of their male baseball counterparts. In some sports, such as women’s hockey where intentional body checking is prohibited for women, they still experience more concussions.

 

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Game concussion rate by gender. The figure compares game concussion injury rates in basketball and soccer (similar rules and equipment) and ice hockey (similar equipment but different rules—no body checking allowed in women’s game). In all three activities, the women’s sports showed absolute rate values that were higher than their male counterparts and in two cases, (basketball and soccer), these rates were statistically higher.

 

At first this difference was attributed to women being more honest or forthcoming about their injuries to their medical staff. However, view of female athletes being more culturally accepting of injury is slowly being reconsidered as studies prove that women are not just more vocal about their pain, but are being injured in sports at higher rates than men. Based on research, there are two reasons for this occurrence:

    1. Biomechanical Differences: Differences in the musculature in the cervical spine and less developed neck muscles. Studies have shown that neck size and strength may play a role in determining concussion rates and the comparatively weaker neck muscles in women may be causing less head stability in females during an impact of fall.
    2. Physiological Differences:Hormonal differences in women and men. Studies have shown that estrogen appears to be a protective factor in male, but it exacerbates the injury in female. Moreover,  the menstrual cycle is a predictor of the outcomes after a concussion. Women who are injured during the luteal phase, the last two weeks of the cycle, are more vulnerable to concussions and have worse symptoms than women who are injured during the follicular phase.

Although female athletes may face more concussions than male athletes, there are simple things that can be done to help reduce the rates of concussion. Pre-season testing and erring on the side of caution both after an impact and during return to play will help reduce second impact syndrome. Strength training, especially focused on the neck muscles may contribute to reducing the forces experienced by the head. With proper concussion management, an athlete can recover from a concussion and be able to return to play and life functions.

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