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Reasons Female Athletes At Higher Risk For Concussions Than Males Hard To Explain, Says Dr. Robert Cantu

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A study in the Winter 2007-2008 edition of Journal of Athletic Training reports a number of surprising findings about girls and concussions:

  • Girls playing high school soccer suffer concussions 68 percent more often than boys playing the same sport;
  • Girls appear more susceptible to concussions in sports like soccer and basketball than boys;
  • Concussion rates in high school basketball were almost 3 times higher for girls than for boys;
  • Girls took much longer than boys for concussion symptoms to resolve and return to play

Flying under the radar

The findings "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 Dawn Comstock, study co-author and assistant professor at the Ohio State University College of Medicine in Columbus.

"Generally speaking, the medical profession does not do a very good job in recognizing that female athletes sustain concussions at an equal or even higher rate as males," said MomsTeam expert Dr. Robert Cantu of Brigham and Women’s Hospital in Boston in an interview with The New York Times. "It’s flying under the radar. And, as a result, looking for concussions in women is not pursued with the same diligence, and it’s setting girls up for a worse result."

Explained by anatomy?

The reasons the concussion rates are consistently higher for girls than boys in same sports are unclear, but one reason, says Dr. Cantu, may be anatomical: girls may be at higher risk prone to concussions because their heads are smaller (one study of collegiate soccer players found that females had 26% less total mass in their head and neck than males) and/or because their neck muscles are less developed than boys and not as good as boys at absorbing shock of impact.

Or culture?

The second possible reason for the higher concussion rate in girls may be cultural.

  • Girls get more attention? The study's authors surmise that athletic trainers may pay more attention to girls’ injuries than boys because “society has tended to be more protective of female athletes." "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,” says Comstock. Coaches, athletic trainers and parents tend to be more cautious about letting girls return to play than boys. “Coaches and parents may be more sensitive to injury to the female head,” says Christopher Ingersoll, the journal’s editor-in-chief and a professor of sports medicine at the University of Virginia.
  • Girls more likely to self-report? Girls may self-report at higher rate than boys (but, like boys, probably under-report either because they don't want to lose their spot on the team or out of ignorance of risk). "Women may just be a bit more honest than men in terms of honestly admitting that they've had post-concussion symptoms,” suggests Dr. Cantu, a sentiment echoed by Ingersoll, who speculates that, “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 them.

Some strongly dispute this theory. As high school soccer coach, Gary Lynch, told The Baltimore Sun: "These kids are players. If you get to [be one of] the top soccer players, if you think they want to come out of the game, they're like the boys. You've got to tell them they have a concussion. They are not going to come over and tell you... It doesn't work that way. It sounds like an easy excuse, an easy reason to make up why there's more girls than boys, and I don't buy it."

Education & Proper Management Are Key

Regardless of the reason, Comstock hopes the article will “lead coaches, athletic trainers, and parents to treat head injuries in female athletes more seriously or to delay their return to play."

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 an entire season or longer,"advises Dr. Jean Ogborn, a pediatric emergency medicine specialist at Johns Hopkins Children's Center, in an interview with ABC News.

"What is very important about this article is that it points out that concussions can 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," Ogborn says.