How does gender play a role in sports concussion? What the research shows

With the Superbowl coming up, we’d be remiss if we didn’t address the issue of sports-related concussions, which can have long-lasting impacts on cognitive function. It’s estimated that as many as 3.8 million concussions occur in the US each year during competitive sports and recreational activities, with the highest incidence occurring in football, hockey, rugby, soccer, and basketball.

Diving deeper into the difference between men and women, the largest number of sports concussions among men occurs during bicycling, football, and basketball games, while the largest number of sports concussions among women occurs during bicycling, playground activities, and horseback riding. And yes, gender does play a role in sports-related concussions. Read on to hear about the existing research. (And go forth and wear protective gear!)

Science shows men and women are impacted differently by sports concussions

Researchers Tracey Covassin, Jennifer Savage, and Abigail Bretzin out of Michigan State University and Meghan Fox out of Grand Valley State University recently did a literature review (they collected all of the available research and summarized it) on the differences between male and female sport-related concussions.  Male and female brains have different structures, functions, and strengths; so it makes sense that there would be differences in how those brains handle sports-related concussions. 

Scientists find six areas of research which may help explain differences 

PREVALENCE / FREQUENCY

• Research shows that women have an almost two times greater risk for a sports-related concussion than men do when playing soccer, basketball, and softball.
• Research also shows that women report more symptoms and that their neurocognitive function and physiological recoveries are more severe than men.

SYMPTOMS

• Not only do female high school athletes report more symptoms after a concussion, but they also take longer to recover.
• Types of symptoms also vary: men tend to report more amnesia and confusion while women report more drowsiness and sensitivity to light. Women also rate symptoms such as headaches, concentration difficulty, and feeling more emotional, irritable, and sad significantly higher than men.

NEUROCOGNITIVE FUNCTION

• Concussed female athletes are 1.7 times more cognitively impaired than male concussed athletes. Reaction time and visual memory tasks were noted to be harder for women post sports-related concussion, and overall, these symptoms take longer to resolve in women than in men.

VESTIBULAR AND OCULAR OUTCOMES

• The vestibular system helps you balance, maintain your posture, and head control, and in combination with your ocular system helps your eyes to track as they should when you turn your head.
• There isn’t much research in this area comparing genders following sports-related concussions (yet) – currently, it looks like there probably aren’t sex differences in this area, however, a few studies suggest there may be, so further research is needed.

ELECTROPHYSIOLOGY

• Electrophysiology is a measure of the electrical waves that our brains put out.
• This area also is lacking in research, so it’s not clear yet whether there is a sex difference here; however some studies of traumatic brain injury (a more severe head injury) have found differences in brain activation between the genders – more research is needed here, too.

NEUROIMAGING

• Functional magnetic resonance imaging (fMRI) is a really neat technology that allows scientists to look at how the blood moves in your brain in real-time – it’s like a video of your brain!  The system tracks blood oxygen dependent (BOLD) signals to see where the blood goes in your brain, often while you’re doing a language or cognitive task.
• Again, there’s not a lot of research specific to sports-related concussion here; the mild traumatic brain injury research isn’t conclusive, but it does suggest that women with mild TBI showed hypoactivation longer than men did and that a specific part of the brain (the uncinated fascicule) that may help to modify behavior and may be involved in memory was more impacted in women than men.
• Given these differences in mild traumatic brain injury, sex differences in neuroimaging results following sports-related concussion should also be investigated.

So what explains the difference in the genders?

Behavior may be a contributing factor – former male college athletes are over 2X more likely not to report their symptoms than former female college athletes. Estrogen may also impact female recovery or injury. And finally, some differences may be attributed to how male versus female brains are structured.

The big takeaways

In summary, we need more research in the area of sports-related concussions, specifically regarding gender differences. Existing research suggests that female athletes who have suffered from a sports-related concussion report more symptoms and take longer to recover than their male athlete counterparts. However, every patient who has had a sports-related concussion is different – their evaluation, management, and treatment should be individualized, and gender may play a role in that individualized approach to follow up a post-sports-related concussion.

Read the research

• Covassin, T., Savage, J.L., Bretzin, A.C., & Fox, M.E.  (2018). Sex differences in sport-related concussion long-term outcomes.  International Journal of Pyschophysiology, 132, p. 9-13.  Retrieved from http://dx.doi.org/10.1016/j.ijpsycho.2017.09.010.