Biomechanics of Traumatic Head and Neck Injuries on Women: A State-of-the-Art Review and Future Directions

Abstract

The biomechanics of traumatic injuries of the human body as a consequence of road crashes, falling, contact sports, and military environments have been studied for decades. In particular, traumatic brain injury (TBI), the so-called “silent epidemic”, is the traumatic insult responsible for the greatest percentage of death and disability, justifying the relevance of this research topic. Despite its great importance, only recently have research groups started to seriously consider the sex differences regarding the morphology and physiology of women, which differs from men and may result in a specific outcome for a given traumatic event. This work aims to provide a summary of the contributions given in this field so far, from clinical reports to numerical models, covering not only the direct injuries from inertial loading scenarios but also the role sex plays in the conditions that precede an accident, and post-traumatic events, with an emphasis on neuroendocrine dysfunctions and chronic traumatic encephalopathy. A review on finite element head models and finite element neck models for the study of specific traumatic events is also performed, discussing whether sex was a factor in validating them. Based on the information collected, improvement perspectives and future directions are discussed.

Risk Reduction of Concussion in Athletes: Do Neck Size or Neck Strength Make a Difference?

“…Ligamentous laxity predisposes a joint to injury as it is inherently more unstable, and relies more on dynamic stabilizers (i.e., muscles) to prevent injury. A study performed by Carmo et al examining whiplash injury in motor vehicle collision showed that females had higher risk of concussion 22 . Although not sports related, this study suggests that the external forces combined with the female anatomy could lead to differing exposure to head injury than males.…”

“…Female vertebrae from C3–7 are significantly smaller than male vertebrae in the anterior-posterior dimension. Males also have more linear and areal dimensions of the cervical spine compared to females 22 . This could indicate males have a more stable spinal column that could resist inertial loads.…”

“…There is markedly more evidence showing that isometric neck strength is a protective factor from SRC. Cervical musculature is primarily responsible for maintaining posture and stabilizing the head at rest 22 . Cervical muscle contraction is theorized to more rigidly couple the head to the torso and therefore decrease the acceleration experienced by the brain 14 .…”

“…Cervical musculature is primarily responsible for maintaining posture and stabilizing the head at rest. 22 Cervical muscle contraction is theorized to more rigidly couple the head to the torso and therefore decrease the acceleration experienced by the brain. 14 Neck stiffness, via the cervical musculature, is the dynamic ability of the neck to reduce translational head displacement, velocity, and acceleration.…”

Quantitative assessment of traumatic brain injury risk in diverse age groups of females: Insights from computational biomechanics

“…TBI affects individuals across a wide spectrum of demographics, but the specific risk factors, outcomes, and mechanisms of injury can vary significantly among different groups [ 3 , 4 ]. While TBI research has traditionally centered on general populations, there's a growing recognition of the necessity for tailored investigations, particularly in the context of unique subpopulations such as females [ [5] , [6] , [7] ]. It is now clear that TBI doesn't uniformly impact all individuals.…”