Female athletes have been underrepresented in concussion studies, with some studies including no female participants. As a result, concussion protocols and treatment have largely focused on male athletes and may not adequately address the needs of female athletes. Several recent studies found that females have higher concussion rates than males in some sports, experience more severe symptoms, and have worse outcomes. However, females remain an understudied population. Including more female athletes in concussion research is needed to develop gender-specific guidelines and improve treatment for all athletes.

1. Critical Issues in Sports
JRN 589
Concussions II
Prof. Hanley

2. Concussions II
• A recent study female athletes
have been “vastly”
underrepresented in concussion
studies.
• Many studies – and hence most
concussion protocols and
treatment – focus on male
athletes in football, ice hockey
and soccer.

3. Concussions II
• Some 40% of studies cited in the
most prominent consensus and
position papers regarding
concussions include no female
participants at all.

4. Concussions II
• Each year, between 1.6 and 3.8
million Americans are diagnosed
with sports-related concussions.
• Ironically, most of these
concussions occur in
recreational sports.

5. Concussions II
• Studies by the National Athletic
Trainers Association, the
American Medical Society for
Sports Training, and
International Consensus Confer-
ence on Concussion in Sport all
produced reports or updated
reports between 2014-2019.
• Females were underrepresented
in each study.

6. Concussions II
• This is significant because these
studies lead to the protocols of
concussion identification and
treatment.

7. Concussions II
• “Clinicians rely on these
documents to guide their
medical practice, but they may
be based on scientific evidence
that is not sufficiently
representative of female
athletes. This disparity may lead
to inequitable treatment of
female athletes who suffer
concussions,” wrote Christopher
D’Lauro et al in 2022.

8. Concussions II
• As funding for concussion
research grows, this disparity
widen, the authors conclude.
• “ … financial support and
logistical assistance for
concussion research originating
from heavily male sports
organizations may continue to
influence the concussion
research gender composition,”
the study concluded.

9. Concussions II
• The authors conclude that
“concerted inclusion efforts
must be made to sample athlete
populations in a way that allows
an equitable representation of
diverse athletes in concussion
research.

10. Concussions II
• “Better female and non-binary
athlete-focused concussion
research data will narrow the
knowledge gap between male
and female athletes and
ultimately allow better data-
driven care for all athletes.”

11. Concussions II
• The number of female athletes
in the U.S. is growing
substantially.
• Some 3.2 million girls compete
in high school, according to the
National High School Sports
Federation.

12. Concussions II
• In terms of injuries stemming
from high school sports, football
accounted for 44%, followed by
girls soccer.
• The head was the most site most
injured.
• Concussions accounted for 22%
of all injuries in high school
sports.

13. Concussions II
• In college, the number of males
stands at around 293,000, or
56% of all college athletes, a
figure somewhat skewed by
large college football rosters.
• The number of females is
approximately 230,000.

14. Concussions II
• At the NCAA level, sports-
reported concussion (SRC)
rates per 10,000 athlete
exposures are highest in men’s
ice hockey (7.91), women’s ice
hockey (7.5), football (6.71),
and women’s soccer (6.31).
• Note that half of concussion
rates happen in women’s
sports.

15. Concussions II
• Ironically, even though body-
checking is not allowed in
women’s hockey female hockey
players sustain nearly
equivalent rates of concussion
relative to male hockey players.

16. Concussions II
• “Female athletes are more
susceptible to sport-related
concussions (SRCs) and
experience worse outcomes
compared with male athletes,”
according to a July 2020 article
published in the Orthopaedic
Journal of Sports Medicine.

17. Concussions II
• “Female athletes appear to
sustain more severe
concussions than male
athletes, due in part to a lower
biomechanical threshold
tolerance for head impacts.
Additionally, concussions may
alter the hypothalamic-
pituitary-ovarian axis,
resulting in worse symptoms
and amenorrhea.

18. Concussions II
• “Although females are more
likely to report concussions
than males, underreporting
still exists and may result in
concussions going untreated,”
the authors led by Dr. Neil K.
McGroarty concluded.

19. Concussions II
• When combined with the study
that showed female athletes
are not wholly included in
concussions studies, it means
that “female athletes remain an
understudied population,
resulting in lack of sex-specific
treatment guidelines for female
athletes postinjury,” the journal
article authors concluded.

20. Concussions II
• “An abundance of research is
available related to
concussions in male-
dominated sports (e.g., football
and hockey),” reported
McGroarty.

21. Concussions II
• “However, there is a paucity of
literature regarding the
specific factors that predispose
female athletes to higher
incidence rates and worse
outcomes after concussions.”

22. Concussions II
• “Research also suggests that
female athletes have more
prolonged concussion-related
symptoms than their male
counterparts,” according to a
study published in a 2009 issue
of the American Journal of
Sports Medicine.

23. Concussions II
• The solution is obvious:
include more female athletes in
concussion studies to address
the imbalance in gender that
emerges in study after study.
• In that way, protocols and
treatment based on the unique
characteristics of female can be
established.