For years, clinicians, researchers and others have been operating under the assumption that women take longer to recover from a sport-related concussion than their male counterparts.
This belief most likely stems from the fact that the majority of concussion research has focused on football, which is a predominately male sport with no female equivalent—thereby, no suitable female sample. In fact, a 2022 literature review showed that 40% of 171 published athlete concussion recovery studies had no female participants, and relied on samples that were overall 80% male.
In a new study—that boasts a 61% female sample and no football players—researchers at Ohio State University have now shown that women and men recover along the same trajectory within the same time frame.
“We’ve been making clinical decisions based on studies that included only a very small percentage of females,” said senior study author Jaclyn Caccese, assistant professor in the Ohio State University. “For many years we’ve thought women took longer to recover, but this evidence suggests that if women get the same access to care, they do recover similarly.”
The study findings are based on an analysis of medical data from 906 student-athletes competing in sports at National Collegiate Athletic Association (NCAA) institutions. The sample was 61% female and included student-athletes in 15 sex-comparable sports ranging from basketball and diving to ice hockey, soccer and volleyball. Members of all-male football and wrestling teams and all-female field hockey squads were excluded.
Before their respective seasons began, all of the athletes completed baseline assessments, which would be used later for comparison to health status after a sport-related concussion. Post-concussion evaluations were taken within six hours of the injury, 24 to 48 hours later, the day the athlete entered return-to-play protocol, the day they were cleared for unrestricted play and six months post-injury.
The post-concussion tests included assessments of cognition and memory, balance, reaction time, overall symptoms and how distressing they were, as well as evaluations on health, anxiety, depression, and satisfaction with life.
According to the study results, statistical analysis showed that recovery trajectories did not differ by sex, with the exception of women reporting more problems with eye and inner ear function than men within the first 48 hours of injury. As a group, women waited a day longer than men to start return-to-play workouts, but there was no statistical difference in student-athletes’ return to unrestricted competition—on average, about two weeks post-concussion.
Caccese said the findings suggest that individual baseline data or established data on sex-specific norms is needed to properly evaluate athletes’ overall condition after a sport-related head injury.
“Otherwise, clinical providers might think women are not recovered who actually are,” she said. “Historically, some women’s sports haven’t had the same on-site access to health care [as men’s sports], and what that does is result in delayed evaluation, delayed initiation of treatment and prolonged recovery. I think having someone on the field watching and taking care of athletes and knowing them and knowing how to provide concussion management is key.”