Increased risk for concussion in female athletes.

Frank Hillary, Ph.D., Kessler Med. Rehab. Research and Educ. Corp.
Colleen Mann, Philip Schatz Ph.D.
Saint Joseph's University, Department of Psychology, Philadelphia PA.

The incidence of sports related concussion in high school and college athletes is high, with 34-97% of athletes reporting one or more previous concussion. Despite the growing sports-concussion literature, there has been greater emphasis on the incidence/prevalence of concussive injuries in male athletes. We analyzed 28 published studies on sports related concussion/mild TBI over the last 8 years. The incidence of concussion in female athletes was evaluated in less than half of these studies (13) and only 3 examined females exclusively. For those investigations analyzing concussions in both genders, the incidence per 1000 athletic exposures (AE) was greater in females (.348 per 1000 AE) as compared to males (.289 per 1000 AE). For those studies solely investigating concussions in soccer, the female-to-male concussion ratio was nearly identical (.382 and .364 per 1000 AE, respectively). However, when considering other sports (baseball/softball, basketball, and field hockey), the incidence of concussive injury was nearly double in females as compared to males (.293 versus .165 per 1000 AE). Considering these data, future investigators should not only include female athletes in their research, but should also focus on the factors associated with sports related concussion in female athletes. We offer two potential explanations for the increased incidence/risk of concussion in female athletes: the skeletomuscular and biomechanical differences between men and women result in greater risk for women to sustain brain injury, and a socio-psychological explanation describing the differences in how males and females approach athletics, and in particular contact athletics.