Gender Variables in Sports Concussions

"There are several possible explanations [respecting why girls take longer than boys to recover from concussions]."
"Boys have a greater neck musculature than females. So, during the mechanism of injury that causes the concussion, girls' necks and heads may whiplash more than boys'. The greater these accelerations and decelerations [especially the rotational aspect], the greater the strain on the brain."
Dr. Roger Zemek, concussion specialist, Children's Hospital of Eastern Ontario, Ottawa

"In the twelve years I've been doing this [studying and treating concussions in children], you do see a bit of that bravado [typical of boys' behaviour], girls saying they can play through a concussion and not report the symptoms."
Dr. Kristian Goulet, concussion specialist, Children's Hospital of Eastern Ontario

"We have known for at least the last decade that females who participate in similar sports as males have higher rates of concussion."

"Boys and girls likely have different recovery courses, but we have to treat each concussion individually."

"Adult coaches need to create an environment and culture for their players that stresses that a concussion is an important injury to not downplay and encourage the reporting of symptoms."

Dr. Mark Halstead, director of the Sports Concussion Clinic at St. Louis Children’s Hospital

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"More females had preexisting migraines and mental illness which may be very important and more so than inherent biological differences."

"Larger studies that specifically examine sex biology are needed to understand the effect of sex on recovery trajectory after concussion."

Dr. Monica Vavilala, director, Harborview Injury Prevention and Research Center (HIPRC), University of Washington, Seattle

"First and foremost, the current findings highlight the importance of seeking proper care following a concussion."

"There are a lot of treatment interventions from behavioral management to vestibular and vision therapy that help athletes recover from concussions. "
"However, a large number - estimates are as high as 55 to 60 percent - of young athletes with concussions do not receive clinical care beyond the initial diagnosis."

Anthony Kontos, research director, Sports Medicine Concussion Program, University of Pittsburgh 

Photo: Consumer Reports

A study was published in the Journal of the American Medical Association (JAMA) in 2016 of which Dr. Zemek was the lead researcher. This was a comprehensive bit of research where over three thousand children, both boys and girls between the ages of five and 18 were part of the study, although over 8,000 children had been screened to gather data from five centres. Girls were involved in close to half of the concussions studied. The study concluded that girls and boys experience concussion rates matching the sport involved.

Other studies predating this one were cited along with the data gleaned for this study, all concluding that girls are at a much higher risk in lengthier recovery time than are boys. They are consequently more susceptible to post-concussion syndrome that takes a longer period of time to surmount. Basically it is a matter of anatomical and physiological differences between the genders, although it was also postulated by Dr. Zemek and other researchers as well, that hormone-specific differences could also factor into the duration and intensity of concussions.

Historically, however, females are also recognized as being more open about symptoms of physical harm and stress, reporting when physical contact of a violent nature has resulted in injury. Boys, on the other hand, tend to downplay injury, unwilling to appear to their peers as unable to take a knock. That kind of reaction and suppression of injury is also typical of the masculine character, the stiff upper lip to prove you're a 'man', and can 'take it'. Things are changing, however, in the world of sports with the growing awareness of the serious harm done by suffering concussions.

Data out of a 2015 study published in the British Journal of Sports Medicine pointed out higher rates of concussions for females playing soccer, and alternately, higher concussion rates for males in lacrosse and basketball. Scientific American earlier in the month highlighted a report revolving around a study of over 200 boys and girls in middle and high school in the U.S. The 110 boys and 102 girls had suffered their first concussions playing football, field hockey and wrestling.

The average recovery time from concussions for the boys in the study turned out to be eleven days, while the girls required 28 days for recovery. At a presentation for a symposium by the Concussion Legacy Foundation and the University of Ottawa brain and mind research institute, Dr. Zemek spoke of a prototypical case of concussion where he presented a hypothetical 14-year-old girl in a soccer collision who recalls what had occurred, didn't lose consciousness and didn't suffer amnesia.

"She was unsteady on her feet when evaluated. She was slow to answer questions. She has a headache, and feels foggy", he went on of the imaginary girl's first bout with a concussion with a background of never having suffered migraine headaches. The purpose of the example was to emphasize that what might at first reckoning appear to be a low-risk situation -- no concussion history, no loss of consciousness -- might in fact reflect someone at high risk for lingering concussion symptoms.

About one thousand concussion cases are seen and treated annually at the Children's Hospital of Eastern Ontario, a number that has quadrupled over the past ten years, as a result of increased public awareness of the prevalence and danger of concussions, all the more so if they're simply dismissed out of hand. From 2011 forward the number of reported instances of concussion doubled in the following year. And according to Dr. Zemek, one in five Canadians have had, or will suffer a concussive event.

"It wasn't necessarily a change in diagnosis, or a change in how we code it when we present to the emergency department. It was because of a high profile person -- and I think most of us in Canada know who that is [Sidney Crosby], and he missed the playoffs that year because of a concussion. The silver lining? His injury impacted awareness", concluded Dr. Zemek.