One Concussion is Not Like the Other

“One Hit Does NOT Fit All”

Your world goes blank. “What happened?” the crowd gasps in unison, “Are you alright?” A sharp and nauseating pain surges through your head. “Do you remember your name?” This is what happens in the minutes after a concussion takes place, and this is the reality for 1.8 million athletes a year in the United States alone. Every person that has ever experience a traumatic brain injury gets asked the same three questions. What occurs in the next days, weeks, months, or even years is rarely the same. Everything about the concussion differs from women to men.

The medical studies surrounding sports-induced concussions is at the base of what divides female and male concussion sufferers. To start, Broshek, neurologist and one of the authors of “Sex Differences in Outcome Following Sports-Related Concussion”, says, “Return-to-play decisions and concussion management must be objective and made on an individual basis, including consideration of factors such as patient sex rather than relying on a one-size-fits-all guideline”. Since the diagnosis of concussions began, there has been a single return-to-play protocol for both females and males. Doctors and neurologists are starting to realize that individualizing the treatment of concussions can help to shorten recovery time and decrease the severity of the patient’s symptoms. The deficit of having only one guideline to base every recovery off of is that the medical field can not move forward in their concussion research. This single treatment approach should be more of a band-aid approach than a permanent solution to the problem. Moreover, Broshek also stated that “As females increasingly participate in sports, a greater understanding of the role of patient sex is needed”. This comment stems from his work with high school and collegiate level athletes and has allowed scientists to pinpoint what is causing so many concussed sportswomen. One of the main topics within Broshek’s work is Title IX. While Title IX was a monumental step forward in gender equality, it had its drawbacks, especially when talking about concussions. More women were playing sports, but the equipment was not designed for their body types. The female athletes used the same helmets and shoes the men used, or worse yet, played in skirts and dresses. When women used the same athletic attire as men, they were more likely to get hurt and have long-term pain. Not having the right equipment caused many injuries in women’s sports, the most concerning being concussions. Even today, “[the] medical community does not yet have any female-specific guidelines, protocols, care plans or education resources for women with brain injury including concussions” (Snedaker). This piece came from the website, Pink Concussions, which focuses solely on concussions in females. This non-profit organization holds events and medical summits to raise awareness on concussions in women, as well as improve pre-injury education and post-injury care of concussion individuals. Not having the right guidelines to assess gender-specific concussions is one of the main reasons athletic trainers and doctors can not separate concussed women from concussed men. This individualized approach has the potential to cut down on wrong diagnoses.

The symptoms that come after a concussion show a great difference in concussed women versus concussed men. For example, an extensive study conducted by six doctors from University of California, Ohio State, and the University of Virginia explained that “Males reported more cognitive symptoms, whereas females reported more neurobehavioral and somatic symptoms”. Another study on the influence of sex on concussion symptoms, recovery time, and time to return to play between female and male high school athletes showed that men were more likely to have amnesia, disorientation, confusion as symptoms, while women had higher rates of drowsiness and sensitivity to noise. Another factor to take into consideration when diagnosing a concussion for a female athlete is her menstrual cycle. If the concussion happens within the two weeks before the athlete starts her period, her symptoms can drastically change, and her recovery can last definitively longer. The idea that menstrual cycles play into a concussion would not be available if the medical field did not start to individualize the study of concussions based on gender. In the same way, “Addressing Gender Differences” noted “female athletes were more likely to require academic accommodations, vestibular therapy, and medication during recovery”. The article talks about not only the sociocultural influences of reporting concussions but also the differences in male and female anatomy. The increase of progesterone in a female athlete’s body when the concussion happens can worsen the post-concussion pain, as well as how long her symptoms last. Males, on the other hand, are less likely to seek concussion treatment and medication. This lack of treatment increases depression in male patients. Many people say that the reason research in female concussion is insufficient is because they don’t know where to start, or are dumbfounded by the idea that women can have a higher number of anything compared to men. One study concluded that “There are all these different theories out there about why concussions are higher in women than in men, but we really don’t know why”. There are many blurred lines when it comes to studying concussions. This confusion is understandable because concussions do not show up on any brain scan. For this reason, they are the “invisible injury”. Every concussion is different, so firm conclusions are hard to make. Doctors make diagnostic decisions based off of what the patient tells them. Women and men report symptoms differently. This difference makes studying female versus male concussions side-by-side unrealistic. While there are thousands of inconclusive studies, scientists and doctors alike have already found the biological reason why women get more concussions than men. On an anatomical level, females and males differ in multiple ways. One way that goes mostly unthought of are the neck muscles. In men, the trapezius muscles, located at the very top of the back, are larger than women’s. Men’s shoulders are broader than women’s, so their upper backs are better at absorbing the impact felt when a concussion happens. Since women have smaller backs, absorption of impact is more difficult, which results in an increased number of concussions.

The stigmas and stereotypes that surround concussions are the last way women’s traumatic brain injuries differ from men’s. First and foremost, Rodriguez, author of “Addressing Gender Differences”, writes “They [women] are generally more expressive…there are fewer cultural prohibitions against ‘complaining’ or being unable to ‘tough it out’ as compared to males”. Neurology Advisor is a website run by neurology professionals. Stigmas surrounding injuries vary from gender to gender. Since women tend to speak up, they get diagnosed sooner than men. Men stereotypically want to ‘play through it’ because ‘if there is no pain, there is no gain’. Pulling a player out may be detrimental to the outcome of the game, but not doing so could lead to lifelong consequences. Incidentally, a large study conducted at Duke University explained, “Even though women get concussions at higher rates than men in many sports and may suffer more severe and persistent symptoms, there is less research about the female concussion”. This article is providing awareness to concussions in women and talks about the lack of studies and test done on female concussion sufferers. Evidence also suggests that doctors should start treating concussions with gender-specific treatments, similar to cardiac diseases. Until the past couple years, concussions in women’s sports went unnoticed for decades. Their symptoms were disregarded and called “hormonal” or “period pains”. Furthermore, “Females self-reported significantly more symptoms following concussion compared with males”. One reason why women report their symptoms more than men is that they experience pain differently than men. They pay more attention to their bodies than men do, too. What also makes studying symptom reports between the sexes is the misunderstanding of the terms “gender” and “sex”. Most studies use the terms interchangeably, which causes mix up as to which factor the doctors are referring to, social differences or biological differences. When women talk about their feelings, whether physical or emotional, society deems it as acceptable. This confirmation makes them more likely to talk to someone about their potential symptoms. This verification is not as readily available for men; they are supposed to be tough and emotionless. Even though women are usually more open about the way they feel and are more apt to step up and talk about their symptoms, concussion treatment still lacks in women.

In conclusion, the biomechanical, social, and structural differences in women and men alter the way neurologists deal with their patients’ concussions. Knowing that concussions differ between sexes is a breakthrough that sets medical professionals on the right track to further investigating concussions. Although much about concussions is still unknown, defining this line and moving forward with separated research betters the prevention and treatment of brain injuries.

Women Show Persistent Memory Impairment After Concussion
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