Concussion logs are based on research from mostly males. what about women

Lindsay Simpson still has questions about her concussions.

She got her first when she was 16, playing for a club soccer team in Atlanta, a promising high school goaltender with ambitions for a Division I scholarship and—her biggest dreams—a pro career.

“I jumped after the ball and my body thumped up weirdly. I hit the back of my head on the floor,” Simpson said. “You train very well not to do that, but mistakes happen.”

When she was injured in 2002, “concussion” wasn’t the common word it is today. For weeks, Simpson had mysterious symptoms and problems at school, leaving her and her parents wondering what was going on. “I had this horrible, unbearable headache. I couldn’t be in the bright lights. I just really wasn’t myself,” she said.

Her parents took her to one doctor after another, trying to understand what was wrong with her. She saw chiropractors, orthopedists, even an orthodontist.

Eventually they saw a neurologist who said it could be a concussion. “He said, ‘Have you had any hits to the head lately?'” Simpson recalled.

The field of concussion research has come a long way since the early 2000s. Greater awareness among the American public – who watch collegiate and professional footballers suffer concussion every weekend – may be why US teenagers are reporting concussions in increasing numbers.

But there are still many questions, especially when it comes to the differences between men and women. Some studies suggest that women and girls are more prone to concussions and may take longer to recover.

These differences are a topic researchers plan to discuss this week at the International Conference on Concussion in Sport. Some concussion experts are hoping the big Amsterdam meeting could result in a consensus statement that could improve research on how concussions affect women.

Concussions took them out of the game

Outside of American football, no high school sport is more likely to cause concussions than girls’ soccer.

Nine months after her first concussion, Simpson was able to return to the soccer field. But for the rest of her career — from high school through her days as an NCAA Division I player — Simpson suffered concussion after concussion, some mild, some more serious.

Finally, in the final game of her sophomore spring season at the University of Maryland, she ran out of the box to clear a ball and collided with a player on the opposing team. Simpson’s head hit the other player’s shoulder. The next thing she remembers is her teammate helping her off the field.

The symptoms – nausea, dizziness, sensitivity to light, memory problems – were so severe that she had to discontinue her courses.

After that, a neurologist told her that she would never play soccer again. All these years later, she said, “It still hurts, it still stings.”

Now at age 36, Simpson still has questions about the concussions that changed the course of her life.

“The million dollar question for me is why? Why did I get this impact and it affected me so much — and yet every Sunday on TV you see someone getting a stroke and they’re fine?” she said. “That’s the question I want answered in my lifetime.”

Many women get concussions, but studies have historically focused on men

Millions of Americans suffer concussions every year. In a 2017 CDC survey, 2.5 million high school students — 15% of all high school students nationwide — said they had suffered a concussion in the past year. More than 40% were girls.

But much of the most consequential concussion research has focused on men and boys, according to a new analysis published in the September issue of the British Journal of Sports Medicine.

Schools, teams and healthcare professionals nationwide rely on guidance from three major organizations — including the International Conference on Concussion in Sport — to help diagnose and record concussion.

Researchers examined the studies cited in these organizations’ influential concussion claims. They found that the participants were 80.1% male and only 19.9% ​​female.

“The amazing thing was how male it was,” said Julianne Schmidt, a concussion researcher at the University of Georgia and one of the study’s authors.

Worse, about 40% of the studies cited did not include women or girls at all. “By giving a number, it made it very clear that this is a huge imbalance and it’s going to take a lot of work to bring it back into balance,” she said.

Schmidt is in Amsterdam for the recent International Conference on Concussion in Sport, where a panel of experts will begin drafting a consensus statement reflecting the latest research on concussion to make recommendations on diagnosis and treatment.

The conference normally meets every four years. But due to delays in the pandemic, the latest statement is now from the 2016 meeting — a very long time for a rapidly evolving field that releases hundreds of studies each year.

Because the ICCS statement is so influential, it needs an update that reflects research imbalances, Schmidt said — even something as simple as recognizing the gender gap and calling for more research funding.

“The doctor who treats an NFL player on the sidelines uses the same statements and guidelines that a pediatrician uses to treat a 14-year-old female soccer player,” Schmidt said. “We can’t just assume that women are little men.”

What the research says about women and concussions

The gender imbalance stems from the origins of concussion research – studies of high-performance sports, namely American football and ice hockey, both of which are predominantly played by men.

Access to research was also a factor: Professional sports teams and high-level college programs have dedicated medical teams, making it easier to track and diagnose concussions in these athletes than in other populations.

The gender balance has improved over the past decade as researchers have looked at groups more diverse than just high-profile male athletes, said Dr. Christina Lin Master, pediatrician and concussion specialist at Children’s Hospital of Philadelphia and University of Pennsylvania.

Researchers know that women are more likely than men to report concussion symptoms after a head impact. Well, Master said, studies are needed to find out why.

“Is that because they have a more severe injury and more symptoms, or is it something to do with gendered behavior where they report more symptoms or reveal symptoms rather than hide them?” Meister said.

The differences could also be biological, she said. There are many hypotheses: One factor could be that men have stronger neck muscles than women. Another could be hormones – even menstrual cycles. It could be that women have more delicate axons, the thin fibers that connect neurons together.

“There’s probably a bit of ‘both and’ rather than ‘either or,'” Meister said. And some of that may not be related to the women themselves, but rather to the medical staff around them: A study she led suggested that the disparity in recovery times between male and female collegiate athletes is explained by access to medical training staff could.

That’s where influential groups — like the ICCS panel of experts — come in, she said. An updated consensus statement could help move the field towards answering these questions by highlighting the gaps. “If they make a statement about what research is needed, I think the funding agencies pay attention to that,” she said.

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