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How Concussions Affect a Female Athlete’s Brain

There has been a lot of research performed over the last few years analyzing the effects concussions and repeated head injuries have on athletes, however, most of this research has been done on men’s brains. Chris Nowinski, Ph.D., co-founder and CEO of the Concussion Legacy Foundation, talks about the shift toward increasing gender equity in these studies, and what we’ve learned about female athletes and concussions.

Chris Nowinski, Ph.D.

Co-Founder and CEO, Concussion Legacy Foundation

What are the differences between men and women when it comes to concussions?

Scientists have uncovered differences between how male and female athletes respond to concussions. In sports like basketball and soccer, females are more likely to suffer concussions. Some studies show females report a higher number of symptoms and are more likely to have a longer recovery. 

Biomechanical differences appear to be one cause of the increased concussion risk. Women tend to have smaller and less muscular necks than men, which in a collision results in their head moving farther and faster, increasing their risk of concussion. 

Other research has shown that gender norms, rather than sex, affect concussion reporting, with women more likely to continue playing while symptomatic with a concussion.

What do we know about the long-term effects of concussions or repeated head impacts in women?

Unfortunately, most of what we know about the long-term effects of concussion and repeated head impacts is from studying men. At the VA-Boston University-Concussion Legacy Foundation Brain Bank, the world’s largest brain bank studying the long-term effects of head impacts, only 2 percent of more than 800 brains donated post-mortem are from females. 

One reason for the gap points to history. Before Title IX, few women played contact sports, so there are fewer older female athletes who have sustained thousands of head impacts. Another reason is that most of the research on both living and deceased athletes is on football players, and few women play football. 

The Concussion Legacy Foundation is supporting research on female athletes by funding the new S.H.I.N.E. study at Boston University. 

What is the S.H.I.N.E. Study?

S.H.I.N.E. stands for Soccer Head Impacts and Neurological Effects, and is the first study to look at the long-term effects of playing soccer on the brain in female athletes. Launched in 2019 at Boston University and funded in part by the Concussion Legacy Foundation, scientists will examine 20 former elite women’s soccer players over age 40 using MRI scans, blood tests, and tests of brain function. 

U.S. Women’s National Team legends Brandi Chastain and Michelle Akers are participating and leading the recruiting effort. Chronic traumatic encephalopathy, or CTE, has been diagnosed in nearly 500 male athletes, but it has yet to be diagnosed in a female athlete. Many of the study’s participants, including Akers and Chastain, have also pledged to donate their brains to our research. 

What can the sports industry do to reduce concussions and CTE risk?

While a lot of attention is paid to concussion testing and returning to play, we believe athletes and coaches should invest more time in preventing concussions and CTE. Once a concussion has occurred, it is difficult to influence recovery, and some athletes never return to normal. 

Both outcomes are prevented with the same strategy – reducing the number and severity of head impacts. In soccer, that means limiting repetition of headers. In all sports, that means reducing the use of dangerous drills in practice and enforcing safe play in games. Sports are wonderful but there is no benefit to getting hit in the head.

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