Teenage girls face almost double the risk of concussion playing football compared with teenage boys – and typically take two days longer to recover from these injuries, a landmark study has found.
Worryingly the research, which compared data from 40,000 female high school players in Michigan with a similar number of male footballers, also found that girls were 1.5 times less likely to be substituted if they suffered a potential concussion.
The study says it is unclear whether the higher concussion rates among teenage girls are more down to their being better at reporting symptoms or a consequence of physiological differences between male and female athletes.
However it notes that “female soccer athletes have lower neck strength and girth compared with male athletes, with these variables inversely associated with linear and rotational head acceleration after soccer ball heading”.
The paper, published in the Journal of the American Medical Association on Tuesday, warns: “As result of anthropometric and brain microstructural differences between the sexes, female athletes may be at greater risk than male athletes of diffuse axonal injury, the principal pathology underlying concussion.”
Intriguingly, whereas the most common cause of concussions in male athletes was contact with another player, in female athletes the most common mechanism was contact with an object, such as a ball.
The senior author of the study, Professor Willie Stewart, said that the evidence suggested a different approach to concussion may need to be taken for teenage girls.
“Given we know the importance of immediate removal from play for any athlete with suspected concussion, it is notable that ‘if in doubt, sit them out’ appears more likely to happen for boys than girls,” he said. “This, together with the finding that mechanism of injury appears different between boys and girls, suggests that there might be value in sex-specific approaches to concussion education and management in this age group.”
Stewart also led the research in 2019 which showed that former professional footballers were three and a half times more likely to die of dementia than the general population. It was unable to establish whether the cause of the higher levels of brain disease in footballers was due to concussions, heading heavier old leather footballs, or some other factor.
Dr Abigail Bretzin, lead author of the new study, said it was the first to look in such detail into concussion management and outcomes in teenage footballers. “Our findings add to research showing that female athletes are at increased concussion risk compared to male athletes, and highlight the importance of sex-specific research in this field,” she said.