Female soccer players are at a higher risk of concussion than their male counterparts.Photo credit: Derek Davis / Portland Press Herald / Getty

According to a study of more than 80,000 teenage players in US high schools, female soccer players are twice as likely to get a concussion as males.

The researchers analyzed survey data from approximately 43,000 male and 39,000 female players from schools in Michigan over 3 school years. According to results published on April 27 on JAMA Network Open1, there was a remarkable difference between the sexes in the likelihood of sports-related head injury, with girls 1.88 times more likely than boys to get a concussion.

Scientists already suspected that head injuries occurred more frequently in female athletes and required longer recovery times. However, there was a lack of concrete data, says Willie Stewart, a neuropathologist from the University of Glasgow, UK, who led the study. “We do so little research on female athletes,” he says. Such a large volume of data on sports injuries, collected by the Michigan High School Athletic Association, provided an opportunity to investigate whether female athletes are actually at higher risk for concussions (see “Concussion Risk”).

Source: ref. 1

“There were actually differences between male and female athletes,” says Stewart. The way high school players suffered their injuries also differed significantly between teenagers and women: the most common way to complain was to hit another player, with nearly half of all reported Concussions occurred this way. Girls were most likely to be affected after colliding with another object such as the ball or one of the goal posts. Boys were also more likely to be removed from play immediately after a suspected head injury than girls.

The different mechanism for head injuries in girls is an important finding, says Stewart. “It could be a reason why girls with concussions weren’t picked up in the field as regularly,” he added. Concussion management systems currently in use – from detecting potential head injuries during a game to treating athletes to returning to the game – are determined almost entirely by testing male athletes, Stewart says. “Instead of the current, male-informed, unified approach to concussion management, gender-based approaches may need to be considered,” he says. This could include restrictions on the heading of soccer balls or the presence of more medically trained staff during women’s games.

Liz Williams, who studies biomechanics and head injuries at Swansea University in the UK, conducted a large international study of women rugby players and their injury experiences in 2020. Stewart’s results come as no surprise. “We all find the same thing, women are more prone to brain injury than men,” she says, “and the incidence, in my opinion, is probably higher than what has been reported.”