Current Topics in Women's Sports Medicine

Evaluation and Treatment of the Female Athlete

Miho J. Tanaka, MD


Curr Orthop Pract. 2019;30(1):11-15. 

In This Article


Even though the rate of overall sports-related concussion is lower in women, female athletes have increasing rates of concussion and have been reported to be at a 1.9 times greater risk for concussions in sex-comparable sports including baseball or softball, basketball, and soccer.[30] A recent study in Canada showed a 5.5-fold increase in concussion rates from 2003 to 2013, with a rate of increase in female athletes almost double that in males during this time period.[31] In collegiate sports, women's sports have been found to have higher rates of concussion than men's sports in soccer (2.09 vs. 1.36/1000AE), basketball (0.74 vs. 0.48) and hockey (0.91 vs. 0.41).[32,33] At the high school level, girls are noted to have higher rates of game-related concussions in soccer (0.97/1000AE vs. 0.59) and basketball (0.60 vs. 0.11).[34]

Several explanations have been proposed that may account for some of the gender differences in concussion prevalence within these sports. Female athletes have a smaller head to ball size ratio and relatively less neck strength and stabilization compared to male athletes, which could increase the relative impact sustained at the time of injury.[35] There is some evidence suggesting that female athletes are more likely to report concussion symptoms than male athletes.[36] Overall, studies are limited in this area, and the differences in protective equipment and contact rules between men's and women's sports may affect these findings.

In addition to the increased risk of concussions among female athletes within these sports, evidence suggests that female athletes are more likely to have greater severity and increased duration of symptoms after a concussion than male athletes.[30,33,37–42] Kostyun and Hafeez[43] reported in a retrospective study of adolescent athletes at a concussion clinic that the average time to resolution of symptoms in females was 75 days versus 49 days in males. Furthermore, female athletes have been found to have more concussion-related symptoms when compared to male athletes 8 days after a concussion, with significant differences in verbal and visual memory scores.[38] Physicians treating female athletes with concussions should be cognizant of these differences and understand the evolving role of gender in the diagnosis and management of concussions.

Recent data also have shown a relationship between concussions and increased incidence of musculoskeletal injuries. Herman et al.[44] reported that the risk of musculoskeletal injury was 3.39 times higher in the first 90 days after returning to play for athletes who had sustained concussions. Houston et al.,[45] in a recent study of 468 collegiate athletes, found that athletes reporting multiple concussions were more likely to report an ankle sprain or knee injury (OR 2.43–2.46, P>0.004). Furthermore, they reported that female athletes with a concussion history also were more likely to report an ankle sprain or knee injury compared to those without (OR 1.88–2.54, P>0.020), while this relationship did not exist in male athletes. As postconcussive athletes have been shown to demonstrate a difference in neuromuscular kinematics,[35] future directions in injury prevention may address the interplay between gender, concussions, and neuromuscular control.