Concussion: the data gap costing women their careers and their lives
The ramifications of concussion – including repeated concussions over an athlete's career – was a dominant headline in sports' news prior to the pandemic. The consequences of repeated blows to the head were severe: the RFU, World Rugby and Welsh Rugby Union were facing lawsuits from retired players suffering early onset dementia, while multiple lawsuits from former American football players alleged neurological conditions as a direct result of injuries sustained from playing sports. The cost to athletes, to their families, to the teams and the organisation boards were increasing and there was a desperate scramble for explanations for how to better protect athletes.
Recently, a new test has been developed for diagnosing concussion hopefully pitch side to indicate whether a concussion has been sustained and whether a player can continue playing. Where other tests use biomarkers in the blood to check for concussion, this one uses saliva. The product of a three year effort that studied 1,028 professional men's rugby players, the tool has promise outside the field of sports. Now that there has been a tool developed for men, the company are looking to expand their research to incorporate women and young adults into their study.
Historically, women have been excluded from rugby-based concussion analysis. Of the 17 articles used for World Rugby’s consensus statement — which was published in February 2020 and develops a framework for video analysis research in rugby union — not a single one was based on elite women’s rugby, despite the fact that women account for 28 per cent of players globally.
Caroline Cicado Perez, author of Invisible Women, found that there are data gaps when it comes to women throughout sports and medicine; here, where the fields intersect, the potential for those data gaps has a real impact on the lives of athletes and their ability to continue with their sport. Data from the Department of Prevention and Sports Medicine at the medical school of Hamburg found that when measured comparatively, women were more at risk for concussion in both football and ice hockey. Dr Willie Stewart, a neurobiologist, recently gave parliamentary evidence that women were twice as likely to experience concussion in sport.
Research has shown that there are gaps in understanding the mechanism of injury and the differences in how men and women sustain concussion, in the symptoms they experience afterwards and in the recovery times. Women appear to experience prolonged headaches, mental fatigue, mood changes and concentration difficulties, where men are more likely to experience amnesia.
The data gap could be explained by the lack of attention given to women's sports previously if one feels generous – research is often funded by those with money, for example – or, if one is feeling less generous, reflects a bias in the sports and medicine industry that undervalues female athletes and underestimates their pain. Research into pain prescribing found that women's physical pain is more likely dismissed as 'emotional' or 'psychosomatic'. Women are less likely to receive painkillers than men on presentation with the same symptoms and despite burgeoning research into the sex differences in pain experience, if women are treated for their pain, they routinely must wait longer to receive that treatment.
This data gap is most obvious in sports with male- female comparisons. In traditionally female sports such as roller derby, cheerleading and dance, there is even less information available to us. We don't have comparative data with which to make reasonable hypotheses about the risk to athletes. Certain healthcare policies for athletes who experience concussion deliberately excludes cheerleading and dance, despite the American Academy of Paediatrics identifying cheerleading as having one of the highest rates of concussions during practices, second only to boys' football.
It is necessary that we understand why these data gaps exist, but it is more important that we fill them. The health and the lives of millions of athletes depend on it.
 Overman, D., How a spit test could diagnose concussion, Physical Therapy Products, 30 Mar 2021, https://ptproductsonline.com/sports-medicine/how-a-spit-test-could-diagnose-concussion/  Tomas F., Special report: The hidden concussion crisis in women's rugby, The Telegraph, 19 Dec 2020, https://www.telegraph.co.uk/rugby-union/2020/12/19/special-report-hidden-concussion-crisis-womens-rugby/  Perez C., Invisible Women, Penguin RandomHouse UK, 2019  Prien A., Grafe A., Rossler R., et al., Epidemiology of head injuries focusing on concussions in team contact sports: a systematic review, Journal of Sports Medicine, April 2018, DOI: 10.1007/s40279-017-0854-4  Kostyun R., Hafeez I., Protracted recovery from concussion: a focus on gender and treatment interventions in an adolescent population, https://pubmed.ncbi.nlm.nih.gov/25553213/  Robson D., Why women are more at risk from concussion, BBC, 31 Jan 2020, https://www.bbc.com/future/article/20200131-why-women-are-more-at-risk-from-concussion  Perez c., Invisible Women, pp. 227- 228  Ibid.