While concussions are on the rise among all young athletes in the United States, girls may run a higher risk of suffering concussions than their male counterparts engaging in the same sports, researchers say.
Concussions result from a blow to the head that causes the brain to slam against the inner wall of the skull. Bleeding or tearing of the nerve fibers causes symptoms such as headaches, dizziness, confusion, loss of consciousness and amnesia.
A new study to be published in the Journal of Athletic Training found that in high school soccer, girls sustained this type of head trauma 68 percent more often than boys did. Female concussion rates in high school basketball were almost three times higher, and girls took longer to recover and to return to play compared with boys.
Researchers at Ohio State University and Nationwide Hospital in Ohio obtained the findings using data from national high school and collegiate injury surveillance systems.
"This finding re-emphasizes the fact that concussions aren't just a concern for high school football players; they can happen to athletes playing all types of sports," says study co-author and assistant professor at the Ohio State University College of Medicine, Dawn Comstock.
Physicians not affiliated with the study agree that the issue of concussions in young female athletes needs more attention.
"What is very important about this article is that it points out that concussions occur in girls' sports with significant frequency, and that girls and their parents need to be aware that these injuries must be carefully managed to prevent permanent damage," says Dr. Jean Ogborn, a pediatric emergency medicine specialist at Johns Hopkins Children's Center.
Why Girls Bear the Brunt of Concussions
There are both physiological and sociocultural explanations for differences in concussion rates between males and females, including different styles of play, muscle strengths and cultural norms.
Increasing numbers of competitive female athletes may be one explanation.
"As more public attention and money flows toward girls' sports, they are becoming increasingly competitive, and girls are being pressured to increase their level of play and toughness," says Ogborn. "This may lead to more injury-prone activities in larger numbers of girls than ever before."
Differences in the game itself may be another reason for the difference. "The style of play in comparable sports is different," says Christopher Ingersoll, editor-in-chief of the Journal of Athletic Training and a professor of sports medicine at the University of Virginia.
"Look at baseball versus softball, for example. There are different ways of pitching," he says. "In lacrosse, there are different rules for men and women and different equipment. Men have to wear helmets with face masks; women don't."
Because the same sport is played differently by men and women, there are likely to be differences in injuries. In the study, researchers found that boys and girls playing the same sport sustained concussions from playing different positions.
In soccer, boys suffered concussions while goaltending, whereas girls tended to sustain concussions while defending. In basketball, more boys sustained concussions while rebounding and chasing loose balls, whereas more girls got concussions from defending and ball handling.
Differences in training may also be a factor. Ingersoll explains how in ice hockey, for example, men are allowed to body check opponents whereas women are not. As a result, men practice checking in scrimmages and become accustomed to that style of play. Women are less prepared to be smashed against the ice because it doesn't happen as often.
From an anatomical perspective, men have stronger and more developed neck muscles, allowing them to better absorb a blow to the head. "Because girls' neck muscles are not as developed, they may be at a higher risk and may suffer more serious concussions," says Comstock.
Cultural factors might also explain the differences in concussion rates. "Coaches and parents may be more sensitive to injury in the female head," says Ingersoll. "Culturally, it may be OK for girls to talk about a concussion. Athletes who play tough, macho sports may not be as open to talking about a concussion."
Comstock agrees. "As a society, we protect girls more than boys. Boys have to be tough and learn to play through pain, so they will be less likely to report a concussion."
Head Injuries on the Rise
Researchers were most concerned about the fact that concussion rates in general are increasing in high school sports.
"It appears that concussion rates are increasing in high school sports," says Comstock. "We found that they account for 9 percent of all high school athletic injuries. A decade ago, concussions caused only 5.5 percent of all sports-related injuries."
A couple of other factors may also explain the overall rise in concussions. It may be that high school kids are bigger, stronger and faster these days so that collisions between players are more forceful and dangerous.
It may also be that athletes and coaches are doing a better job of documenting them.
"More athletes, coaches and athletic trainers are more aware that concussions are a serious injury," says Comstock. "That's good news, because concussed athletes will be more likely to receive medical attention."
To further protect young athletes from serious injury, researchers recommend educational programs, improved protective equipment and better enforcement of rules.
"We need to make sure athletes, coaches and parents are aware that concussions are a serious injury," Comstock says.
Says Ogborn: "Parents and coaches and primary physicians should all know the definitions of concussion, the signs of continued post-concussion syndrome, the guidelines for return to normal activity ... and the signs that should keep an athlete out of play for the entire season or longer."
And although more research is needed, concussion prevention may eventually be tailored for different sports.
"The more we understand the differences between male and female sports, the more we can do to address them," says Ingersall. "We need to focus prevention efforts on a case by case basis. For example, in soccer, goalkeeping causes more concussions in men, whereas defending causes more concussions in women. We need to look at the rules, the training and the technique for these positions."