Blowing the Whistle on Sex-Based Disparities in Sport-Related Concussion Research

Terminology Note: In this article, sex refers to biological attributes such as chromosomes, hormones, and reproductive anatomy that may influence physiology, biomechanics, and injury risk. Gender refers to socially constructed roles and lived experiences that shape participation in sport, access to resources, and health reporting. Altho

ugh many studies categorise athletes as male or female, both sex and gender exist along continua rather than strict binaries, and biological and social factors interact to influence concussion risk, symptom reporting, and recovery.

The impact of sport-related concussion can be felt on the pitch and beyond, and it is more important than ever to close the gap between male and female athletes in sports medicine research. Female athletes are already making an impact by contributing to novel technological advances, making it clear that leveling the playing field is the next step forward for the future of concussion research.

Women in High-Contact Sports: Progress and Challenges

The historic boom of women’s involvement in high-contact sports, a traditionally male-dominated domain, brings with it empowerment, visibility, and community for female athletes. But alongside this progress lies a troubling reality: the disparity in how sport-related concussions (SRCs) are managed in women. In recent years, research raising the alarm on SRCs has flooded the media, bringing the brain to the forefront of the conversation on sport-related injuries. In particular, chronic traumatic encephalopathy (CTE), a brain disease linked to repeated head trauma, has become a hot topic as scientists identify troubling trends for athletes who have experienced multiple concussions. 

Despite growing interest in concussion research, a significant  group of individuals has been left behind in this discussion: female athletes. Although evidence suggests that women experience concussions at higher rates and at lower impact thresholds than men, contributing to a “concussion crisis” in women’s sports, few studies emphasise the inclusion of women in concussion research, and little is known about the specific mechanisms driving this disparity. 

What we do know is that female athletes are severely underrepresented in sports medicine research at large, and when it comes to brain health, this inequality has serious implications for the wellness and safety of female athletes. 

Impacts Beyond the Collision

A concussion is more than just a bump on the head; it is a brain injury with the potential for lifelong impacts. Cognitive impairment and other physical deficits can arise from a single collision, ranging from mild dizziness, nausea, and confusion to more serious symptoms, such as severe behavioural changes, loss of consciousness, or seizure.

Repeated head trauma can exacerbate these risks. Cases of CTE arising in athletes, particularly those who play high-contact sports, have brought sport-related head injury to the public’s attention in recent decades. 

CTE is a progressive degenerative brain disease that manifests from repeated head trauma, and researchers are just beginning to scratch the surface of its long-term impact. The disease is linked to increased risk of dementia and Alzheimer’s Disease, leading to permanent changes in personality, memory, impulse control, and movement, among other possible physical and cognitive deficits. 

A common misconception is that CTE happens only to older adults. But athletes of any age and across all levels of competition can experience negative effects of repeated head injury. Understanding these risks is essential to allow players to participate in sports safely and confidently. That confidence is built on clinically-assessed knowledge which provides the basis for safety guidelines. But what happens when a significant proportion of the sport population is missing from the data?

Butting heads: Where Female and Male Athletes Diverge

Prevention begins with understanding the events that lead to a concussion, and what science-backed steps can be taken to reduce the chance of injury. But when it comes to discussions on sports injury research, women don’t just struggle to find a prominent seat at the table; they are often left out entirely. 

The vast majority of studies on SRCs focus exclusively on men, or include only a small sample of women that fails to represent the broad spectrum of female athletes. The few studies that do focus on female athletes have identified a disturbing development in the past decade: concussion rates for female athletes have tripled, while the same trend has not been observed in males. Even when accounting for differences in rules and equipment, female athletes continue to experience higher concussion rates - and researchers are still understanding why.

Biomechanics and Biology

Biomechanical factors likely play a role. On average, female athletes have smaller neck circumferences, weaker neck strength, and lower head-neck segment mass compared to their male counterparts, which contributes to greater head acceleration during impacts. These biological and anatomical differences may help explain why female athletes report more severe symptoms and experience longer recovery periods. 

Beyond the Brain: Resources Matter

Biology alone does not tell the whole story. External, modifiable factors - particularly access to medical resources - could contribute more than previously thought. A study of 1071 SRCs experienced by collegiate athletes occurring over a 3-year period has revealed that concussion recovery across women’s and men’s sports was similar at Division I levels, but female athletes experienced longer recovery at Division II/III levels than their male counterparts. The key difference? Resource allocation.

The presence of on-field athletic trainers and medical professionals, which is impacted by sports program funding, reveals a disparity in how male and female athletes are treated on the field, as well as their recovery beyond. Research shows that female athletes are evaluated less frequently by athletic trainers directly after SRC, and this immediate health care matters - receiving on-field care by an athletic trainer is significantly associated with shorter time to symptom resolution, and athletes who continue to play or delay reporting SRCs display notably longer recovery times. 

For women’s sports programs, who may receive less than half of the funding available for comparable men’s sports teams, this disparity is part of a concerning trend of insufficient support that has massively contributed to the concussion crisis in women’s sports. Differences between the concussion injury profile of men and women, potential contributors to the crisis, are still under great debate.

Results may be impacted by social or environmental factors, such as the fact that men tend to both underreport and downplay post-injury symptoms.  Women generally start contact sports later than men due to a lack of opportunity to play at early levels, leading  to a shorter window of possible concussion, which could mean fewer overall SRCs. For girls who do participate in early sports, the risks are particularly concerning: young female athletes have more than a 1.5x higher concussion risk than their male peers.  

The Research Gap

Addressing  these discrepancies is possible only if an adequate, representative sample of women is included in experimental research. Men have historically dominated clinical research due to claims that pregnancy, fluctuating hormones, and menstruation create too much “noise” in the data, yet modern evidence consistently demonstrates that data based solely on men cannot be relied upon to make safe and effective guidelines for female athletes. The natural solution is to include more female athletes in concussion research, and recent advances in technological solutions demonstrate exactly how to make this possible. 

The Future of Concussion Research is Female

The 2025 Women’s Rugby World Cup was a historic event for a multitude of reasons; it saw record-breaking attendance levels, contributed to massive growth and engagement in women’s sports, and introduced innovative concussion technology implemented on the pitch for the first time ever. 

While mouthguards have been a staple in contact sports for decades, the flashing LED mouthguards worn by players at the Women’s Rugby World Cup have the unique ability to detect heavy impacts using smart technology. If an impact is severe enough to potentially cause a concussion, match officials and athletic trainers are then notified by the red flashing LED in the mouthguard, stopping play and allowing the participant to receive a head injury assessment off the pitch.  

This advancement in sports medicine creates an opportunity not just to protect individual athletes, but also to implement equitable solutions that assess differences in how female and male athletes sustain concussions. The smart mouthguards work by measuring the change in a player’s velocity and the rotational force they are subject to during a collision. While the rotational force required to trigger an alert is the same for men and women (4,500 rad/s²), acceleration alerts trigger at 75Gs for men and 65Gs for women. The difference takes into account that women are more susceptible to concussions at lower impacts, allowing female athletes to receive the same level of care as male athletes without requiring a rule change or modifying behavior on the pitch.

The subtle integration of the smart mouthguard in women’s sports is a promising step forward in evening the playing field for female and male athletes. Testing this new technology on the pitch also demonstrates the valuable role women can play in experimental research, as demonstrated at the 2025 Women’s Rugby World Cup, which enjoyed full “opt-in” with the smart mouthguard technology. Female athletes are ready to embrace opportunities, and it’s time that sports medicine research catches up with the global influence of women’s sports. 

Towards the Future of Women’s Sports 

Recognising the dangers of concussion does not mean individuals should be discouraged from participating in sports. Rather, deepening our understanding of brain health allows us to create better recommendations and improve injury prevention guidelines, giving all athletes the confidence to safely engage in sport.

Research is beginning to uncover a number of modifiable factors that may help to moderate the concussion crisis in women’s sports, such as increasing neck strength, focusing on good tackle form in high-contact sports, and most importantly, providing adequate funding for on-field athletic trainers and proper healthcare. Including data driven by research specifically conducted on female athletes allows women to participate with the same level of confidence as their male peers, with the knowledge that sport guidelines take into account the unique facets of being a female athlete.

With opportunities to participate in women’s sports growing every day, now is the time to focus on equality for basic health and safety, and see how much of an impact female athletes can make.

Thank you to Dr. Anthony Steven Dick, Dr. Rebecca Curtis, and Deirdre Murphy, M.S. for comments and editorial support. Photo credits in this article go to Manish Gosalia (@manishsportsphoto) and Morgan Walker.

References

• Barnhart, M., Bay, R. C., & Valovich McLeod, T. C. (2021). The influence of timing of reporting and clinic presentation on concussion recovery outcomes: a systematic review and meta-analysis. Sports medicine, 51(7), 1491-1508.

• Bunt, S. C., Didehbani, N., LoBue, C., Stokes, M., Heinzelmann, M., Rossetti, H., ... & Cullum, C. M. (2022). Sex differences in reporting of concussion symptoms in adults. The Clinical Neuropsychologist, 36(6), 1290-1303.

• Bussey, M. D., Salmon, D., Nanai, B., Romanchuk, J., Gomez, R. M., Tong, D., ... & Falvey, É. (2025). Assessing head acceleration events in female community rugby union players: A cohort study using instrumented mouthguards. Sports Medicine, 55(2), 499-512.

• Covassin, T., Elbin, R. J., Harris, W., Parker, T., & Kontos, A. (2012). The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. The American journal of sports medicine, 40(6), 1303-1312.

• D'Lauro, C., Jones, E. R., Swope, L. M., Anderson, M. N., Broglio, S., & Schmidt, J. D. (2022). Under-representation of female athletes in research informing influential concussion consensus and position statements: an evidence review and synthesis. British Journal of Sports Medicine, 56(17), 981-987.

• Fahr, J., Kraff, O., Deuschl, C., & Dodel, R. (2024). Concussion in female athletes of contact sports: a scoping review. Orthopaedic Journal of Sports Medicine, 12(10), 23259671241276447.

• Henson, M. (2025, August 12). Flashing mouthguards to indicate HIA at World Cup. BBC Sport. https://www.bbc.com/sport/rugby-union/articles/ce3jy4v28w2o

• Ingle, S. (2025, August 11). Flashing mouthguards for concussion to be introduced at Women’s Rugby World Cup. The Guardian. https://www.theguardian.com/sport/2025/aug/11/rugby-union-womens-world-cup-flashing-mouthgards-concussion

• Hannah, T. C., Li, A. Y., Spiera, Z., Kuohn, L., Dai, J., McAuley, F., ... & Choudhri, T. (2021). Sex-related differences in the incidence, severity, and recovery of concussion in adolescent student-athletes between 2009 and 2019. The American Journal of Sports Medicine, 49(7), 1929-1937.

• Matthews, C., Watson, P., Dening, T., Varley, I., Hunter, A., Malcolm, D., ... & AlHashmi, R. (2023). Concussion in sport–What do we know, and what’s next?: Proceedings from a symposium at Nottingham Trent University, UK. Communications in Kinesiology, 1(5).

• Master, C. L., Katz, B. P., Arbogast, K. B., McCrea, M. A., McAllister, T. W., Pasquina, P. F., ... & Broglio, S. P. (2021). Differences in sport-related concussion for female and male athletes in comparable collegiate sports: a study from the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium. British journal of sports medicine, 55(24), 1387-1394.

• Prosak, O. L., Hajdu, K. S., Amedy, A., Anesi, T. J., Williams, K., Jo, J., ... & Zuckerman, S. L. (2024). Sex differences in resource allocation and access to care after sport-related concussion. Journal of Athletic Training, 59(8), 785-792.

• Stern, R. A., Riley, D. O., Daneshvar, D. H., Nowinski, C. J., Cantu, R. C., & McKee, A. C. (2011). Long-term consequences of repetitive brain trauma: chronic traumatic encephalopathy. Pm&r, 3(10), S460-S467.

• Tsushima, W. T., Siu, A. M., Ahn, H. J., Chang, B. L., & Murata, N. M. (2019). Incidence and risk of concussions in youth athletes: comparisons of age, sex, concussion history, sport, and football position. Archives of Clinical Neuropsychology, 34(1), 60-69.

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This article was written by Marilyn Curtis and edited by Neave Smith, with graphics produced by Saba Keshan. If you enjoyed this article, be the first to be notified about new posts by signing up to become a WiNUK member (top right of this page)! Interested in writing for WiNUK yourself? Contact us through the blog page and the editors will be in touch.