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Supporting female performance in sport and fitness
Supporting female performance in sport and fitness

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6 Why do females fare worse from sport concussions?

The image show a representation of the brain on a blue background. There are two circles around the brain and an ECG trace of the heart beat below it.

The reasons for the differences in how females and males experience concussion are complex. As Dr Emma Ross explained in Activity 1, females have smaller heads and weaker neck musculature for support (up to 47% weaker than males (Sanderson, 2021)). As a result their skulls when hit can be accelerated more quickly, potentially causing more damage to the brain.

Research by Elizabeth Williams, of Swansea University, has shown that more than 50% of the concussions sustained by female rugby players were due to their head making contact with the ground, while only 4% of concussions in male rugby players were caused in this way (Sanderson, 2021).

In football, female players were more likely to injure themselves while heading the ball, while for male players concussions were more likely to be caused by contact with other players (Bretzin et al., 2021). While male football and rugby players tend to be larger and may create more force it does not fully explain these significant gender differences, and Activity 4 looks into explanations for them.

Activity 4 Rates of concussion in female sports

Timing: Allow about 10 minutes

Watch the video in the link below where Elizabeth Williams presents the findings of her pioneering research into concussion in women’s rugby.

Rugby concussion: Swansea University study into protecting women [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)]

Then answer the following question:

  • What has this research shown and how may it be applied to training for contact sports?
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The research has shown several things. Perhaps most significant is the different ways that females fall to the ground compared to men. This is reinforced by data from the mouthguards that have been developed to measure forces applied to the head.

The implication of this is that training around how to fall more safely can be developed so that players can learn ways to fall that limit potential damage to the brain.

There are also differences in the structure of nerves within male and female brains. When force is applied to the head forces are transmitted deep inside the brain to the neurons and axons (nerves), which can become damaged, causing inflammation and irreparable damage. Females have smaller axons than males (Dollé et al., 2018). This makes the axons more prone to damage and affects the outcome of a head trauma.

Coaches of female athletes need to be more vigilant than those of male athletes because concussion resulting from contact between the head and the ground are much harder to see happening than those that occur during head-to-head contact. There is evidence that boys are 1.5 times more likely to be immediately removed from the field of play and return to play 2 days sooner than girls with sport-related concussions (Bretzin et al., 2021).

We are continuing to learn more about sport-related concussion in females. It has taken a long time for the consequences of sport related concussion to be taken seriously in men’s sports, such as rugby and football. But we can’t stop here. Best practise for identifying and treating concussion by sex is the really important next step.