Women Are at Higher Risk for Concussions Due to Ball or Equipment Contact in Soccer and Lacrosse

Abstract

Background There is ample evidence to suggest sex- and gender-based differences in the incidence of sports-related concussions. The mechanisms of concussion may vary between male and female athletes and contribute to this observed difference. Understanding the underlying etiology by pooling data from primary studies across different settings and sport types will inform interventions that can reduce concussion rates. Questions/purposes Specifically, we asked: (1) In which sports are female athletes less likely to experience concussions from player contact? (2) In which sports are female athletes more likely to experience concussions because of ball or equipment contact? Methods PubMed, EMBASE, and Cochrane Library databases were searched to identify articles published from January 2000 to December 2018. Ten studies met the inclusion criteria, which were studies that reported concussion incidence by mechanism for both male and female athletes. Exclusion criteria included non-English studies, conference abstracts, and studies on non-sports related concussions. The sports represented by the 10 studies included ice hockey (n = 4), soccer (n = 5), basketball (n = 4), baseball/softball (n = 4), and lacrosse (n = 5). The rate ratio was calculated as the incidence rate in female athletes/male athletes for each concussion mechanism or activity. Data were pooled using the DerSimonian-Laird random-effects model. Study quality was assessed with the Newcastle-Ottawa Scale. Results Female athletes were at lower risk of player-contact-induced concussions in lacrosse (pooled rate ratio 0.33 [95% CI 0.25 to 0.43]; p < 0.001), basketball (pooled rate ratio 0.86 [95% CI 0.76 to 0.97]; p = 0.01), ice hockey (pooled rate ratio 0.64 [95% CI 0.56 to 0.73]; p < 0.001), soccer (pooled rate ratio 0.70 [95% CI 0.66 to 0.75]; p < 0.001), and soccer heading (pooled rate ratio 0.80 [95% CI 0.72 to 0.90]; p < 0.001); in these sports, men were at higher risk of concussions from player contact. Female athletes were more likely to experience concussions because of ball or equipment contact in lacrosse (pooled rate ratio 3.24 [95% CI 2.10 to 4.99]; p < 0.001), soccer (pooled rate ratio 2.04 [95% CI 1.67 to 2.49]; p < 0.001), and soccer heading (pooled rate ratio 2.63 [95% CI 1.84 to 3.77]; p < 0.001). Conclusions The mechanism or activity underlying concussions differs between male and female athletes across different sports. This finding remains the same regardless of whether there are rule differences between the men’s and women’s games. The implementation of other interventions are required to further ensure player safety, including protective head equipment, concussion prevention training, or rules limiting player contact in the men’s game. Level of Evidence Level III, retrospective study.

Association of Sex With Adolescent Soccer Concussion Incidence and Characteristics

“…Specifically, although the most common reported cause of SRC in male athletes was contact with another player, accounting for almost half of SRCs recorded in males, in female athletes the most common mechanism was contact with an object (41.9%). These findings echo those reported in a meta-analysis 27 of high school and college sports that revealed female soccer athletes were more likely to sustain an SRC from contact with a ball, including during heading, or equipment and less likely to sustain a concussion from player contact than male athletes. In general, soccer ball heading has been considered an infrequent direct cause of SRC, 28 although it is widely recognized that collision with opponents during heading can result in concussion.…”

Epidemiology of Concussions in National Collegiate Athletic Association (NCAA) Sports: 2014/15-2018/19

“…Moreover, for sex-comparable high school and collegiate sports, studies have suggested SRC incidence to be higher among girls’ and women’s sports compared with boys’ and men’s sports. 19,26,29 Previous studies also have illustrated player and apparatus contact to be the primary mechanisms attributed to SRCs in this population among men’s and women’s sports, respectively. 9,37…”

Systematic Review and Meta-Analysis of Sex-Based Differences in Recurrent Concussion Incidence Across Sports

“…Previous studies have shown that women experience more concussions in sexcomparable sports 17 and that in ball-based sports like lacrosse and soccer, women are at higher risk for concussions due to contact with the ball or equipment. 19 Furthermore, in soccer, women are more likely to sustain concussions when heading the ball or while goalkeeping. 18 This study builds on these findings by demonstrating that this sex-based discrepancy in primary sports concussion incidence is observed with concussion recurrence as well.…”

“…18 In particular, the mechanism of injury (MOI) differs between male and female athletes, with player contact being the predominant MOI in men and equipment contact being the predominant MOI in women. 19 A study by van Ierssel et al found that children and adolescents who have sustained previous concussions have nearly four times greater risk of a recurrent concussion compared to those with no previous concussion incidence. 20 Our metaanalysis aimed to compare recurrent concussion incidence between male and female athletes across various sports.…”