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Girls suffer sports concussions at a higher rate than boys. Why is that overlooked?

In a study of collegiate athletes, the highest rate of concussions was reported not by male football players, but by female ice hockey players.

Female ice hockey players are highly susceptible to concussions, though many leagues forbid intentional body checking. (ALEXANDER NEMENOV/Getty Images)

The flood of media attention highlighting damaged brains, dementia and suicides in retired NFL players has made concussions synonymous with football. That attention was greatly needed; the debilitating consequences of brain injuries in football players of all ages has been severely overlooked. But the focus of this controversy has been far too narrow. It’s true that young players need better equipment and stricter safety standards on the gridiron. But in many of the most popular sports, boys aren’t the ones most likely to be afflicted by concussions. Girls are.

Recent studies of high school and collegiate athletes have shown that girls and women suffer from concussions at higher rates than boys and men in similar sports — often significantly higher. For instance, in a recent analysis of college athletic injuries, female softball players experienced concussions at double the rate of male baseball players. Women also experienced higher rates of concussions than men in basketball and soccer. Across all sports in the study, the highest rate of concussions was reported not by male football players, but by female ice hockey players. In that sport, a woman experienced a concussion once every 1,100 games or practices — nearly three times the rate experienced in football. The gender disparity exists in high school sports, too. One study, analyzing concussion data for athletes in 25 high schools, found that in soccer, girls experienced concussions at twice the rate of boys.

So why aren’t girls getting as much attention? For one, female athletes haven’t taken up the charge to the degree that professional football players have. More female role models need to share their stories and speak out on this issue, to put pressure on schools and leagues to make sports safer for girls and women. Congress also can drive more action, by setting national guidelines on managing concussions in young athletes.

We also need more and better science on the gender differences in concussions. There is painfully little research on why female athletes are so susceptible to athletic brain injuries and how to better protect them. For instance, helmets are mandated in boys’ lacrosse, but not in girls’. Without better science, debate rages over whether helmets would make girls less susceptible to concussions, or simply encourage them to be more aggressive on the field, making them more susceptible. And in ice hockey, it’s hard to explain why girls are suffering a higher rate of concussions than boys even though intentional body checking is prohibited in the girls’ game.

There are many possible explanations for why female athletes experience higher rates of concussions. The greatest attention has been directed to their head and neck size and musculature; researchers speculate that girls have smaller, weaker necks than boys, making their heads more susceptible to trauma. Hormones also could play a role. If a woman suffers a concussion in the premenstrual phase, when progesterone levels are high, there’s an abrupt drop in the hormone. That could cause a kind of withdrawal that either contributes to or worsens symptoms like headache, nausea, dizziness and trouble concentrating. This may be why women have more severe or longer-lasting symptoms than men, who have low pre-injury levels of progesterone. It’s also possible that, if girls feel the effects of concussions more severely, they are simply more likely to report them and doctors more easily diagnose them than in male patients. But for all of these theories, there is little consensus on how they actually play into the mechanism of brain injuries in girls and women.

This makes it difficult to know the best way to prevent concussions in girls and women. Do female athletes need better equipment, more neck strength training, better referee calls, or stricter rules to prevent dangerous play? Hockey and lacrosse leagues have taken the latter approach, placing limits on body checking for young players and banning checking to the head and neck area at all levels. There are other sports that can institute similar protections. A great example is girls soccer. We know that girls’ neck muscles are not fully developed until age 14. If heading were eliminated for girls below that age, that would prevent concussion without negatively affecting later elite competition prospects. Some schools have begun instituting such rules, and more should follow suit.

But there’s a lot of dispute over rule changes, and we need more action now to protect female athletes. First, we need more public awareness about this problem. The Women’s Sports Foundation has made this a priority, holding a congressional briefing with athletes and medical experts last week. In the way that Super Bowl champion Ben Utecht and Christopher Nowinski have spoken up on the need for better safety for male athletes, we need champion female athletes to do the same for girls and women in sports.

The federal government must play a role in this national issue, as well. Congress has failed to act on childhood concussions, allowing the much-needed ConTACT Act (Concussion Treatment and Care Tools Act) to languish for six years without a vote into law.  The ConTACT Act calls for the Centers for Disease Control and Prevention to adopt national guidelines for identifying possible concussions in young athletes, and strict rules about when and under what circumstances injured players should participate in practices and games. This way, all schools would be held to the same high standards to ensure student athletes receive proper care for concussions. We need to build a culture of support that centers on athlete safety rather than winning the game or a college scholarship.

These rules appropriately would apply to all players, regardless of gender. But we need to go a step further. We have some evidence that the brains of female athletes are more susceptible — or, at least, react differently — to injury compared to their male counterparts. We should stop assuming that concussions are a men’s issue. We shouldn’t simply accept that the best practices for boys’ and men’s sports will protect girls and women in the same way. The bodies of female athletes are different and their brains deserve just as much attention.​

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