Mild traumatic brain injuries, also known as concussions, can be sustained through various means, including sports injuries, falls, and car accidents. While any individual is susceptible to an mTBI, research has shown that women are twice as likely to incur a sports-related concussion than men.[1] [2] [3] The research also demonstrated that women appear to have worse symptom and treatment outcomes following a diagnosed concussion than their male counterparts do.[4]
But why are females at an increased risk of sports-related concussion? And equally as important, is the question of why females demonstrate worse outcomes following a sports-related concussion? One theory suggests weaker neck muscles may be a contributor, which increases susceptibility to head injuries due to less stability to protect against an impact.[5] Additionally, hormones (like estrogen and progesterone) and cerebral blood flow may play a role in how the brain responds to trauma and recover from injury.[6] While not yet published, our group has done both magnetic resonance imaging (MRI) and NeuroCatch® portable brain scans to show increased white matter neuroplasticity differences and increased attention and cognitive brain vital signs in females when compared to males. These too may point to important factors for future research in concussion in females.
So, let’s summarize. Females in sport appear to be more likely to sustain a concussion, experience more severe symptoms, and take longer to recover. Yet, most sports-related concussion protocols are based on research data collected from males. Consequently, there is a priority need for female brain research on concussion to fill the gap.
Like most research, medical studies have generally not included female participants, and male research data have been generalized to females. However, our preliminary NeuroCatch® results comparing high school female and male brain vital signs are confirming that such a generalization cannot be made. Similar to cardiovascular research, research focused on males receives much more attention for important conditions like coronary artery disease, despite the fact that the at-risk female group experience far higher rates of morbidity and death.[7] This gap represents a huge omission for females, such as delays in treatment, and inadequate or ineffective treatment.
While concussion prevention is important, such measures can only protect our female athletes so much. Females remain broadly under-represented in concussion research, resulting in real-life disadvantages. We need to better understand gender differences in concussion and extrapolate this to evidence-based management and treatment. Let’s close the gap in concussion.
Footnotes:
[1] Bretzin AC, Covassin T, Fox ME, et al. Sex differences in the clinical incidence of concussions, missed school days, and time loss in high school student-athletes: part 1. Am J Sports Med. 2018;46:2263-2269
[2] Schallmo MS, Weiner JA, Hsu WK. Sport and sex-specific reporting trends in the epidemiology of concussions sustained by high school athletes. J Bone Joint Surg Am. 2017;99:1314-1320
[3] Tsushima WT, Siu AM, Ahn HJ, Chang BL, Murata NM. Incidence and risk of concussions in youth athletes: comparisons of age, sex, concussion history, sport, and football position. Arch Clin Neuropsychol. 2019;34:60-69.
[4] McGroarty NK, Brown SM, Mulcahey MK. Sport-Related Concussion in Female Athletes: A Systematic Review. Orthop J Sports Med. 2020 Jul 16;8(7):2325967120932306. doi: 10.1177/2325967120932306. PMID: 32728590; PMCID: PMC7366411.
[5] Rowson S, Bland ML, Campolettano ET, Press JN, Rowson B, Smith JA, Sproule DW, Tyson AM, Duma SM. Biomechanical Perspectives on Concussion in Sport. Sports Med Arthrosc Rev. 2016 Sep;24(3):100-7. doi: 10.1097/JSA.0000000000000121. PMID: 27482775; PMCID: PMC4975525.
[6] Espinoza TR, Wright DW. The role of progesterone in traumatic brain injury. J Head Trauma Rehabil. 2011 Nov-Dec;26(6):497-9. doi: 10.1097/HTR.0b013e31823088fa. PMID: 22088981; PMCID: PMC6025750.
[7] Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Heart J. 2010 Dec;18(12):598-602. doi: 10.1007/s12471-010-0841-y. PMID: 21301622; PMCID: PMC3018605.
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