A Blast from the Past…and a look to the future.
A common theme in some of our previous blogs is the differences between sex when it comes to concussion. This is because these differences are an ever-increasing prominent topic of study in the scientific community. Today, we are going to briefly explain why we need to look at both sexes in relation to concussion and how this discussion about sex differences is nothing new by taking a look at a study published in 2003.
Male Centric View on Concussion
If we look at who is traditionally researched when it comes to concussion, it’s typically male professional sport athletes. We just have to look at the focus on male NHL and NFL players in relation to the risk of obtaining Chronic Traumatic Encephalopathy (CTE – a serious degenerative issue associated with repetitive hits to the head) to highlight this issue. The problem with this focus is that what we know about concussion is biased towards this male, pro sport demographic which means the insights gathered from years of research may not be applicable to other communities of athletes.
Identifying Vulnerable Communities
As with many health problems, it is important to look for groups that may be more at risk for sustaining concussion and try to take action to mitigate those actions. Fortunately, more and more studies are looking at youth athletes, amateur adult athletes, and college athletes of both sexes. This is why the topic of sex and why females seem to have an increased incident of concussions, more severe symptoms, and prolonged recovery are coming to the forefront of the concussion discussion.
Yet, this discussion is not necessarily new. In fact, there have been people studying the differences in sex in relation to concussion more than 20 years ago. One of those researchers, Tracey Covassin, actually was looking at the sex differences regarding the incidence of concussions amongst collegiate athletes in the U.S. between 1997-2000. In fact, she also re-examined this topic more recently, but that will be another blog post for another day!
The Study’s Details
This study, published in 2003, looked at female and male soccer, lacrosse, basketball, softball, baseball, and gymnastics athletes to see whether males or females were more at risk for sustaining concussion. As stated in the article: “it can be argued that male athletes may be at greater risk for concussions due to their aggressive nature or the faster pace of the sport, or both, while female athletes may be at greater risk due to their smaller size and weaker neck strength” (1). At this point, various studies had shown that males were more susceptible to concussion and other studies supported the opposite.
Collecting data from the NCAA’s Injury Surveillance System, the research team identified 14,591 total injuries and almost 6% were identified as concussion. Female athletes sustained 167 (3.6%) concussions during practices and 304 (9.5%) during games. Male athletes received 148 (5.2%) in practices and 254 (6.4%) in games.
A Breakdown of the Stats
The study found some interesting trends, briefly highlighted below.
- Athletes at the highest risk for suffering a concussion were:
- male and female lacrosse players,
- male and female soccer players, and
- female basketball players
- Athletes with the lower risk for suffering concussion were:
- baseball, and
- Female athletes were found to be at a greater risk for suffering a concussion during games than male athletes.
- Female soccer players had the highest rate of concussions in comparison to other female sports
- Female lacrosse players had the highest risk of sustaining a concussion during a game situation in comparison to other female sport.
- Female soccer and basketball players suffered concussions more often than male soccer and basketball players, respectively.
- Female soccer players suffered from concussions more often during games than male soccer players
What does this Mean?
Ultimately, this study’s findings showed that there are significant differences between incidences of concussion between male and female athletes for particular sports. Looking back at this study retrospectively, this study doesn’t show us anything we don’t already know now. But at the time, this was one of the first studies to look at sex differences in relation to concussion over a number of sports in game and practice scenarios for collegiate athletes. This study was building the foundation that we are using today to conduct research on the differences between males and females in concussion.
Some Points of Consideration
In saying that, this study has some limitations. Most importantly, the definition of concussion for this study was based on the grading scale of concussion which highlighted loss of consciousness and amnesia as the most telling signs of concussion (2). This, of course, has since been developed: there is no grading system now in diagnosing concussion and it is often stressed that most concussions do not result in a loss of consciousness. This difference makes it challenging to compare these results to current and future findings. For instance, due to the change in how concussion is defined and identified, it may be that more concussions are diagnosed but not that more concussions are occurring. Similarly, it may be that awareness has simply increased and not that more concussions are occurring in sport.
A final point of consideration to think about, is that when this study was completed and published it was hoped that knowing this information would help modify rules and create safeguards to protect these vulnerable groups of athletes (i.e. females). While some changes have occurred to the rules in various sports, we seem to be stuck on gathering more and more information in order to confirm that females (or other vulnerable groups) suffer more from concussions rather than make changes based on what is already known. In saying that, since we need to know more about what causes concussion and how to prevent concussion effectively, what changes could be made? But what this means – as with many of our past posts have highlighted – is that more research is definitely needed in order to appropriately manage this injury.
Rebecca Babcock graduated from the University of Otago in New Zealand with a Master’s in Bioethics and Health Law. Her thesis examined the ethical and legal issues surrounding concussion management. She currently spends her time assisting with marketing and communications development for Pure Motion, including helping to develop their concussion program. She also spends her time working at the Dahdaleh Institute for Global Health Research at York University as a research assistant where she is assisting with two projects: 1) The Ethics of Natural Language Processing in Humanitarian Needs Assessments; and 2) A Risk-Benefit Analysis of Digital Contact Tracing in the COVID-19 Pandemic.
- Barnes BC, Cooper L, Kirkendall DT, McDermott TP, Jordan BD, Garrett WE Jr. Concussion history in elite male and female soccer players. Am J Sports Med. 1998;26:433–438.
- Cantu RC. Guidelines for return to contact sports after a cerebral concussion. Physician Sportsmed. 1986;14(10):75–83.