Mind the gap; issues surrounding female concussion

Stories like AFLW's Kirsten McLeod’s are becoming increasingly common across women’s sport. While much of the focus on concussion in sport has been about trying to prevent issues for players in later life, for many female players, the risks seem to be not only in retirement but also in the here and now.

McLeod has been part of the AFLW since its inception in 2017. Her career with Western Bulldogs has seen her win team and individual titles, including the AFLW grand final in 2018. But during pre-season training ahead of the 2022 season, she suffered a number of blows to the head. She wasn’t to know it at the time but these injuries would change the trajectory of her season and impact both careers on and off the pitch.

Research suggests there are differences in how men and women experience both the type and severity of concussion symptoms. According to Shreya McLeod, lecturer at Australian Catholic University researching sport-related concussion, women report more symptoms, for longer periods of time, with increased severity. All athletes report symptoms such as headaches, mental fatigue, concentration difficulties and mood swings. Men, however, report amnesia and disorientation more frequently, whereas women report symptoms such as migraine-like headaches and photosensitivity.  

The literature describes a range of possible physiological contributors, such as women's shorter and narrower necks, smaller head mass and differences in the corpus callosum (the large bundle of nerve fibres that separate the two hemispheres of the brain).

A level of caution does need to be expressed when discussing reasons for the differences seen in concussion between men and women. As has been mentioned in other HITIQ blog posts, the research specifically examining sport-related concussion in women is limited. Additionally, the provision in medical treatment within women's sport is often less comprehensive than that in mens. Therefore the ability to record and report incidents to identify how and why a concussion has occurred may be different. 

Another major hurdle that sports medics have to overcome is the reliance on players to be open about symptoms (the search for biomarkers to help identify concussion is progressing. But this research is still in its trial stages). The desire to play, and not let teammates and fans down can often override the sensible decision to seek help. In the case of Kirsten McLeod, the drive to maintain her career via a new contract clouded her judgement as to the best course of action for her health long term. 

While McLeod suffered from migraine-like headaches prior to her injuries, the intensity and frequency increased following them. initially, though, this wasn’t linked to the impacts she had sustained. Women are five are times more likely to have migraine-type headaches than men. Therefore ongoing post-concussion symptoms such as migraines can be overlooked or misinterpreted. Persistent migraines and feelings of sickness during training were eventually the cue for Kirsten to seek further support. After various visits to medical experts, the recommendation to take 12 months out of the sport to recover came. 

For most adults, recovery from a concussoin takes between 7 and 10 days. Gender differences can mean that women may take on average 6 to 20 days longer than men to recover. Guidelines differ from sport to sport, but generally suggest players be sidelined for a minimum of 10 - 14 days if they suffer a concussion. The argument is, knowing that concussion can effect men and women differently, should guidelines be developed specifically for women’s sports? Addressing the issue Shreya McLeod said  "Until recently, most of the research has been focused on the male domain. Guidelines that have been drawn up specifically for men have then been applied to women's programs. We can no longer rely on male data that's generalised to the female population”.

Another area of consideration, as highlighted by the example of Kirsten McLeod, is that for many female athletes, full professional status is still to be achieved. Being fully professional would allow for monitoring and recovery by the medical team to take place with limited distraction. However, few female sports such as AFLW are fully professional. This means players often have outside factors to be considered. This, as is the case for McLeod, included her job. Others may have studies or family responsibilities to contend with. This once again drives at the issue of specific guidelines across women’s sport that can be supportive of players and offer care that is realistic to the situations that are presented with. 

Concussion can change the course of a sporting career. For McLeod incentives to try and cope with a condition that can have both short and long term consequences are easy to understand. The overreliance on athlete feedback in order to diagnose concussion and manage recovery plans will remain an issue until better diagnostic tools are developed. HITIQ’s is working to support this development. Its enhanced technology is available to medical teams throughout the AFLW providing them with greater access to objective data and therefore a clearer picture of impact and injury to support diagnosis and treatment.   

As women’s sport continues to grow, the need to protect players is ever increasing. HITIQ is working with the AFLW to provide players and teams with the latest concussion technology. The aim is to help protect players in the short term and also gather data to support research that will underpin the future understanding of female-specific needs. By doing this, the gap between male and female concussion knowledge can begin to close, specific guidelines, treatments and recommendations may be developed and female players can be protected from the consequences of concussion.