Gender-specific concussion management is required for soccer players


Dr. William Stewart

An extensive study of teenage footballers in Michigan revealed key differences in concussion injury metrics between men and women, emphasizing the need to develop gender-specific approaches to managing sports injuries.

Sport-related concussion (SRC) is a specific concern in young female athletes, according to study authors Abigail C. Bretzin, PhD, and colleagues. appears inside JAMA network open. Previous surveillance studies on SRC in high school and college have reported higher injury risk rates and longer recovery outcomes in female soccer athletes. Deepening these trends, the researchers explored whether there were sex-associated differences in SRC, addressing the mechanics, management, and recovery of SRC.

“This is an area that has not been remarkably investigated,” William Stewart, MBChB, PhD, corresponding author of the study, said in an interview. Previous studies of males and females have shown that female axons are thinner, with fewer microtubules or internal scaffolds than male axons. This may increase the risk of shear injuries in females. Limited research has also cited differences in the risk of concussion throughout the menstrual cycle in women athletes.

The reporting system targets four areas of injury

Investigators conducted a high school injury injury project on 43,741 male and 39,637 female soccer athletes participating in the Michigan High School Athletic Association (MHSAA) Head injury Reporting system. The study included students from 9th to 12th grade, ranging from the start of the 2016-2017 academic year to the end of the 2018-2019 academic year. Since 2015, the state has forced high schools to send data to MHSAA.

MHSAA captures data on four categories: person-to-person contact, person-to-object contact, person-to-reproduction surface contact, or uncertainty about the cause of the event. The results of the study included details on the mechanism of injury, immediate management, and time to return to play for each documented SRC.

The researchers reported notable differences between players and players. The documented risk of SRC was 1.88 times higher among adolescents than boys in all academic years (RR, 1.88; 95% CI, 1.69-2.09; Pg <.001). They also cited inconsistencies in the distribution of injury mechanisms between the sexes. Women were more likely to suffer injuries from contact with the team, such as directing a ball (41.9%), while male players tended to maintain SRC from contact with another player (48.4%). The authors suggested that "female soccer athletes have lower neck strength and circumference, compared to male athletes, with these variables inversely associated with linear and rotating head acceleration after directing the soccer ball." .

Boys were more likely to retire immediately from the game and also returned to the sport two days earlier than girls. “There is, therefore, the possibility that this longer recovery time may, in part, reflect our observed differences in immediate attention, in particular the elimination of the game,” the authors wrote. Immediate elimination from the game was also more common in cases where an athletic coach played a role in the evaluation of SRC players.

Removal of the One-Size-Fits-All approach

The current management of concussions is based on a “for all” model, Stewart said. Male and female athletes are treated following a common concussion management protocol, which covers concussion detection up to rehabilitation. “This management model is based on virtually exclusive research into male athletes.”

What the study showed is that this one-size-fits-all approach can be flawed, which drops female athletes. “We should study more research on sexual differences in concussion and, most importantly, put them into practice in gender-specific concussion management protocols,” he suggested.

Future studies should also look at the effects of athletic coaching employment on SRC metrics. “While this was a statewide comprehensive epidemiological study of SRC reported in adolescent soccer athletes, including high schools with and without access to athletic coaches, the Head Injury Reporting System did not include information on whether there were athletic coaching services available at each school, including specific athletic training services for football, ”the researchers wrote, citing the limitations of the study.

Girls report symptoms more often

“Researchers should be commended for taking a forward-looking approach to addressing this common observation in high school sports,” said Keith J. Loud, MD, MSc, FAAP, sports pediatrician at Dartmouth Children’s Hospital -Hitchcock in Manchester, NH. the results are “completely credible,” said Loud, who was not affiliated with the study. “We have long postulated differences in neurophysiology, neck strength, style of play and a tendency to report as explanations for the observation that high school girls in football are diagnosed with more concussions than boys. “.

The findings suggest the boys play more aggressively, but maintain fewer concussions, he added. Meanwhile, girls are more likely to talk about their injury.

“The diagnosis of concussion still relies heavily on the athlete to report symptoms, which is one of our hypotheses about why girls seem to suffer more concussions: they report symptoms more often. It could also be that they have a long recovery. ” he offered aloud. The main limitation of this study is that it cannot overcome this information bias.

Loud was also concerned that the girls were less likely to be removed from the game, although they apparently suffered more concussions. “Maybe it’s because their injuries are less obvious on the field and they’re diagnosed when they report after games.”

Stewart reported that he received grants from the Football Association and the National Health Service Research Scotland during the study. He also served as an unpaid member of the International Football Association Independent Football Concussion Advisory Group and the Football Association Expert Panel on Concussions and Head Injuries in Football. None of the other authors made disclosure.

This article originally appeared on, which is part of the Medscape professional network.

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