5 Sport concussions and the female athlete

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The image shows action from a rugby match. One player is being tackled by two players from the opposition. The player being tacked is falling head first towards the ground.

Concussion is a brain injury that is caused by a blow to the head, or the head being shaken violently. They are particularly prevalent in contact sports such as rugby, hockey and football but are also present in sports where the head can collide with the ground after a fall, such as horse racing and gymnastics.

Research shows that female athletes are almost twice as likely to experience a sport-related concussion than male athletes (Bretzin et al., 2021), sustain more serious concussions, have worse symptoms, and take longer to recover (McGroarty, Brown and Mulcahy, 2020). While we are starting to understand why this is the case, research is in its early stages and we are only starting to see a fuller picture.

Activity 3 Introduction to concussions in sport

Timing: Allow about 10 minutes

Listen to the audio clip about what causes a concussion, and the short and longer symptoms of concussion. Then answer the following questions:

1. What immediate symptoms may you experience from a blow to the head?
2. What longer term effects might you feel from a concussion?

Download this audio clip.Audio player: sfps_1_session6_act3.mp3

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Transcript

PRESENTER

So what exactly is a concussion? For a start, you don’t have to have been knocked out to sustain one. In fact only 10% of people who are concussed lose consciousness. It’s a brain injury but there’s no blood clot or fracture. The brain’s hardware isn’t damaged but the software is so the brain stops functioning properly and, depending on the individual and the level of damage, it takes time to heal.

TONY BELLI

Typically if you have been concussed there will be a few minutes of feeling dazed and confused. Perhaps if you are playing a game you don’t know who you’re playing, what the score is. You typically have balance problems initially so bit of lack of co-ordination. These symptoms can be very transient so they may be there just for a matter of seconds or a few minutes and they can be easily missed on a pitch.

PRESENTER

Tony Belli is professor of trauma neurosurgery at the University of Birmingham and a consultant at the Queen Elizabeth Hospital in Birmingham. He’s one of the country’s leading experts in head injury.

TONY BELLI

And then typically athletes and people in general who have been concussed start complaining of fatigue and dizziness. Headache is a very common symptom as well. They may realise that actually cognitively they’re not quite right. So they may have problems with their memory, concentration, attention and some people can feel quite nauseated as well

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Discussion

1. Concussion injuries are caused by a blow to the head and this blow does not necessarily result in a loss of consciousness. However, it may leave you feeling dazed and confused about where you are and what you are doing. You may also find balancing difficult and be lacking coordination. Because it is the brain tissue that is injured you may not see typical signs of injury, such as bleeding or bruising, but that does not mean that these injuries are potentially very serious.
2. Long-term dizziness and headaches are tell-tale signs of a concussion. Fatigue, memory loss and nausea are also common symptoms.

Further information about signs and symptoms of concussion and what to do about them can be found on the NHS website [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] .

For female athletes, concussions can also cause a disruption to the menstrual cycle, including amenorrhea, which is the loss of periods (McGroarty, Brown and Mulcahy, 2020). This is because the menstrual cycle is controlled by the hypothalamus in the brain and its function is disrupted by head injuries. Earlier research by Wunderle et al. (2014) showed that women who experienced concussion during the second half of their menstrual cycle (when progesterone levels are high), suffered worse outcomes than those women experiencing head injury during the first half of their cycle.

These differences are attributed to the disruption to the brain-ovary axis causing progesterone levels to fall rapidly. Research into the menstrual cycle and concussion is still emerging, but tracking when concussions occur in the cycle might be helpful information in the complex evaluation of brain injuries.