HSS Researchers Find For Certain Sports, Concussion Rates Are Higher in Female Athletes than Males
Many female athletes encounter higher concussion rates than their male counterparts, according to two studies conducted by researchers at Hospital for Special Surgery (HSS).
The researchers conclude their findings demonstrate a need for further interventions to reduce concussion rates, such as the required use of protective head equipment in women’s sports, the adoption of neck-strengthening exercises and other prevention training, and greater enforcement of rules to decrease levels of contact in men’s sports.
Concussions can occur in a wide range of sports, affecting not only professional athletes but youth athletes as well. There are approximately 1.7 million to 3.8 million sports concussions reported in the nation each year1,2,3 as well as 1.1 million to 1.9 million pediatric recreation-related concussions.4
For the first paper, "Sex-Based Differences in the Incidence of Sports-Related Concussion: Systematic Review and Meta-analysis," first published on September 30, 2019, in the journal Sports Health, senior author Daphne Ling, PhD, MPH, a sports medicine epidemiologist at HSS, and colleagues conducted a meta-analysis of sex-based differences in concussion incidence in lacrosse, soccer, baseball/softball, basketball, track and field and swimming/diving. They found that the concussion incidence rates for females were statistically significantly higher compared to males in both soccer and basketball.
“While the causes are unknown, we suspect this sex difference in concussion incidence in soccer and basketball might be attributed to females having decreased head and neck strength, greater peak angular acceleration and increased angular displacement compared to males. Female athletes are also more likely to disclose their symptoms to coaches and parents. This is important for physicians to consider when treating patients who participate in these sports,” concluded Dr. Ling.
For the second paper, "Women Are at Risk for Concussions Due to Ball or Equipment Contact in Soccer and Lacrosse," published online ahead of print on October 17, 2019, in the journal Clinical Orthopaedics and Related Research (CORR), senior author Ellen Casey, MD, a sports medicine physician with the Women’s Sports Medicine Center at HSS, and colleagues conducted a meta-analysis of 10 studies published from January 2000 to December 2018. The studies reported concussion incidence for both male and female athletes who participated in the following sports: ice hockey, soccer, basketball, baseball/softball and lacrosse. The objective was to identify in which sports female athletes were less likely to experience concussions from player contact versus ball or equipment contact.
In female athletes, the main cause of concussions was contact with the ball or equipment in lacrosse, and heading the ball in soccer. Additionally, female hockey players were more likely than male players to experience concussions after contact with the ice surface. The researchers found no differences between male baseball and female softball players for ball/equipment-induced concussions. Similarly, there was no difference observed between male and female basketball players for surface or ball contact.
Furthermore, the pattern of the underlying concussion-causing mechanism was the same regardless of differences between the male and female versions of the sport. It is suggested that sex hormones; decreased neck strength in female athletes, which reduces their ability to withstand external forces; and increased neck and torso strength in male athletes, which allows them to better absorb impact in the upper body versus in the head alone, may play a role in the sex differences in concussion incidence.
To reduce their risk of concussion, Dr. Casey advises women to participate in exercises to enhance neck strength, stiffness and neuromuscular control, as females tend to have deficits in these areas relative to males. “Depending on the sport, exercises and training to optimize technique with high-risk movements, such as heading the ball in soccer, are also critical in reducing concussion risk."
Dr. Casey concluded, "If we truly want to reduce the impact of sports concussions, more research is needed on what causes concussions so that prevention measures can be put in place as well as better reporting of sex and gender differences across sports.”
Jennifer Cheng, PhD, Brittany Ammerman, BA, Kristen Santiago, BA, Bridget Jivanelli, MLIS, all from HSS, were co-authors for both manuscripts. Jo A. Hannafin, MD, PhD, and Emerald Lin, MD, from HSS were co-authors for the CORR and Sports Health publications, respectively.
1) Daneshvar DH, Nowinski CJ, McKee AC, Cantu RC. The epidemiology of sport related concussion. Clin Sports Med. 2011;30:1-17.
2) Harmon KG, Drezner JA, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 2013;47:15-26.
3) Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21:375-378.
4) Bryan MA, Rowhani-Rahbar A, Comstock RD, Rivara F; Seattle Sports Concussion Research Collaborative. Sports- and recreation-related concussions in US youth. Pediatrics. 2016;138:e20154635.
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the tenth consecutive year), No. 3 in rheumatology by U.S. News & World Report (2019-2020), and named a leader in pediatric orthopedics by U.S. News & World Report “Best Children’s Hospitals” list (2019-2020). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 130 countries. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.