concussions

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Uneven Playing Field: Female Athletes Are More Likely to Get Concussions Than Males
Sep 26, 2024
When you think of an athlete who has suffered a concussion or other traumatic brain injury (TBI), you might conjure up images of boys on the football team ramming into each other at full speed. In every high school sport played by both girls and boys, concussion rates are higher among the girls. While football is the number one sport that sees the most concussions, girls’ soccer comes in second, with 8.4 concussions per 10,000 games and practices.

Research suggests that female athletes have a longer recovery time than their male counterparts and may experience worse symptoms. Women and girls are participating in sports at increasing rates, and it’s important to recognize the difference in concussion symptoms and recovery so athletes get diagnosed and treated promptly and appropriately.

Reasons Behind the Frequency
While there are physiological reasons why women are more susceptible to concussions, men are less likely to report symptoms of a concussion. Women, on the other hand, are more likely to seek out medical care, resulting in more documented cases of concussions in females.

“Women tend to have thinner skulls than men, along with smaller neck muscles, which can predispose female athletes to getting a concussion,” says Sarah Menacho, MD, a neurosurgeon and neurocritical care specialist at University of Utah Health. “Data shows that women are also more likely than men to report concussion-related symptoms, and these symptoms can persist for a longer time period prior to recovery than in male athletes.”

Understanding the Difference in Symptoms
Concussions occur after a blow to the head. In sports, this can happen after colliding with another athlete, such as during a header in soccer, or after being hit with a ball or other equipment, like a field hockey or lacrosse stick. This impact causes the brain to jostle around inside the skull, which can cause bleeding and other injuries to the brain.

After suffering a concussion, women and men both may experience telltale signs, including:

Headache
Nausea and vomiting
Amnesia
Confusion
Ringing in the ears
Fatigue
Blurred vision
However, women often present their symptoms differently than men.

“Women will often note more difficulty with vision and memory following a concussion but are less likely to experience a loss of consciousness than male athletes,” Menacho says. “Female athletes may also experience more trouble with mood-related symptoms like anxiety, depression, and difficulty sleeping but are less likely to report feeling more irritable after a concussion than male athletes.”

Female athletes also tend to have longer recovery times than males, though this isn’t always the case. Recent studies have shown that men typically recover from their concussions significantly faster than women. This is thought to be because women may experience more severe symptoms, which require more time to resolve before returning to sports.

Preventing Concussions to Stay in the Game
Sports can be unpredictable, and injuries are sometimes inevitable. However, schools and sports programs can take some measures to reduce the number of concussions, especially among female athletes. These measures include:

Implementing the use of protective head gear. Few women’s sports require the use of helmets by all their players, even if the male version of the game does, like lacrosse for example.
Rule changes. In 2015, the United States Soccer Federation banned heading of the ball for all athletes under the age of 10.
Staying informed. Knowing that female athletes are more susceptible to concussions during sports can help coaches, parents, and the athletes themselves know when to seek medical attention.
“Any athlete, male or female, with concern for a sports-related concussion should be immediately removed from play and assessed by a trained medical professional,” Menacho says. “The effects of multiple head injuries can lead to permanent cognitive damage and a predisposition to diseases such as Alzheimer’s and Parkinson’s, so it’s crucial that head injuries are treated immediately to prevent long-term issues.”

Learn About Brain Injury Symptoms >
Learn More About Our Concussion Program >

https://healthcare.utah.edu/healthfeed/ ... h%20Health.

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Post-concussion brain changes to white matter and cerebral blood flow

In a study of 187 college athletes, researchers found that those who got a concussion while playing (25 of them) still showed signs of brain injury on MRI scans when they were cleared to play their sport again, a couple of months later, and even a year after being cleared.

Persistent changes from pre-concussion scans were seen in the athletes’ cerebral blood flow and in white matter microstructure. But these effects were only in the brain — the athletes did not see clinical symptoms persist that long, the authors noted. More long-term research is needed to understand if and how the brain re-normalizes. The study also reinforces existing concerns about the damage that repeated concussions could cause, the authors add.

This study provides direct evidence of persistent postconcussion changes in CBF and white matter at RTP and up to 1 year later. These results support incomplete recovery of brain physiology at medical clearance, with secondary analyses emphasizing the sensitivity of CBF to clinical recovery.

Post-Concussion Brain Changes Relative to Pre-Injury White Matter and Cerebral Blood Flow
Read the study at: https://www.neurology.org/doi/10.1212/W ... 0000213374

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Why Do Female Athletes Get More Concussions in Contact Sports?
Feb 25, 2025 | By Dr. Jennifer Hunnicutt


Did you know that female athletes in contact sports experience more concussions and worse outcomes compared to male athletes?

Unfortunately, concussion research on female athletes is far less than concussion research on male athletes.

In today’s blog, we are highlighting findings from a recent literature review conducted by researchers in Germany. They investigated sex-specific differences in concussion rates, biomechanics, biomarkers, imaging, and outcomes in contact sports.

First, let’s define contact sports…

What are Contact Sports?
Contact sports are competitive physical activities that involve direct physical contact as an integral part of the activity. This contact can be intentional, such as tackling in football, or incidental, like collisions in soccer.

Examples of contact sports include:

● American Football
● Soccer
● Rugby
● Ice Hockey
● Boxing

Female participation in these sports is growing, making it essential to understand the unique risks they face.

The Literature Review on Concussions in Female Athletes in Contact Sports
Twenty-two research studies met criteria for inclusion in this literature review. Of the topics covered, there was a lack of research in biomarkers and imaging, while the topics of concussion incidence, biomechanics, and outcomes were more represented.

Why Do Females Get More Concussions in Contact Sports?
The review identified several factors that contribute to the higher concussion rates in female athletes:
Biomechanical Differences: Female athletes generally have less neck strength, smaller neck circumferences, and lower head-neck segment mass compared to males. These differences mean that female athletes experience greater head acceleration during impacts, making them more susceptible to concussions.

Hormonal and Biological Factors: Female brains differ in metabolism, cerebral blood flow, and inflammatory responses compared to male brains. These variations may play a role in their heightened vulnerability to concussions and the severity of symptoms experienced.
Increased Symptom Reporting: Studies suggest that female athletes are more likely to report concussion symptoms than males. This may stem from societal norms, with male athletes often facing pressure to “tough it out.”

What Happens After a Concussion?
The review also revealed key differences in how concussions affect female athletes:
More Severe Symptoms: Female athletes report more frequent and severe symptoms,
such as headaches, nausea, fatigue, and cognitive difficulties.
Longer Recovery Times: Women often take longer to recover and return to full-contact
play.
Greater Neurocognitive Deficits: Female athletes experience more significant declines in
memory, reaction time, and processing speed following a concussion.

How Can We Better Support Female Athletes?
These findings highlight the urgent need for tailored approaches to concussion prevention, treatment, and recovery in female athletes.

Here are some steps that can help:
Enhanced Training Programs: Strengthening neck muscles and teaching head
stabilization techniques may reduce the risk of concussion in female athletes.
Rule Changes: Modifications should be evaluated through research. For example,
research is showing that the rule to forbid body checking in women’s hockey is not
working – it is not reducing head impacts.
Increased Research: More studies are needed to understand the long-term effects of
concussions on female athletes and develop effective treatments.

Looking Ahead
While this review sheds light on the unique challenges female athletes face in contact sports, it also highlights the need for more inclusive and comprehensive research. By understanding the distinct risks and outcomes for female athletes, we can develop better strategies to protect their health and ensure their safety in doing the sports they love.

References
Fahr J, Kraff O, Deuschl C, Dodel R. Concussion in Female Athletes of Contact Sports: A
Scoping Review. Orthop J Sports Med. 2024 Oct 16;12(10):23259671241276447. doi:
10.1177/23259671241276447. PMID: 39421039; PMCID: PMC11483826

Author Recent Posts
Dr. Jennifer Hunnicutt is a licensed athletic trainer with a PhD in Health and Rehabilitation Science, who has worked with all types of athletes, including professionals and Olympians. She has held prominent research positions at Emory Sports Medicine and the NBA Hawks Center in Atlanta, GA, as well as serving on the national network of healthcare providers for U.S. Figure Skating. Now the owner of Hunnicutt Writing and Consulting, LLC, Dr. Hunnicutt collaborates with global institutions, spearheading innovation and research among professionals and businesses in Sports Medicine and Orthopedics. Learn more at https://drhunnicutt.com.

https://www.headcheckhealth.com/female- ... oncussions.

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Jason Jensen was accidentally hit by one of the players during a Holy Family girls hockey practice on January 31, causing him to fall and hit his head on the ice.

On Sunday, Jason Jensen returned to the ice rink at the Victoria Recreation Center for the first time in two months.
As a goalie coach for the Holy Family Catholic High School boys and girls hockey programs, the arena is a place he'd spent much of his time. "It's kind of like a home away from home," he said.

Jensen has coached and youth and high school hockey for approximately 15 years.

He is grateful to be back, Jensen said, after spending two months in the hospital as he recovered from a traumatic brain injury. During a Holy Family girls hockey practice on January 31, Jensen was accidentally hit by one of the players, causing him to fall and hit his head on the ice. He wasn't wearing a helmet, which made his injuries more severe.

A prominent scar on his head shows the area of his skull that was temporarily removed in order to allow his brain to heal, before it was all sewn back together.

Jensen and his wife Kelly spent one month at the Hennepin County Medical Center before transferring to Shirley Ryan Ability Lab, a rehabilitation center in Chicago. After undergoing three operations, Jensen returned to Minnesota on Friday.

As he sat in the stands of the Victoria Recreation Center for the first time in two months, he said he's grateful for his recovery. "Grateful for, I guess, what you'd kind of say is a second chance at life.”

Jensen said he hopes his story will inspire state-wide changes requiring high school hockey coaches to wear helmets on the ice. "If it can prevent some of the heartache that my family felt from my decision not to wear a helmet, I'd be all for it," he said. Kelly is pushing for the same thing, adding that her husband's accident could happen to anyone. "It could happen to you, and we don't want it to happen to you," she said.

Following the incident, the Holy Family Catholic High School boys and girls hockey programs immediately implemented a policy requiring coaches to wear helmets on the ice. Jensen said the Chanhassen High School boys hockey program, which he also coaches, also implemented the change.

The Minnesota State High School League "highly recommends" that coaches wear helmets on the ice, but it's not currently a requirement.

Jensen said he looks forward to getting back one the ice once the new Holy Family season starts in October. "I'll definitely be back with a helmet the next time I'm on the ice," he said.

Jensen is undergoing occupational, physical and speech therapies as he looks forward to returning to work as a Lakeville Police Department lieutenant.

'A second chance at life' | High school hockey coach shares story of recovery, advocates for coaches to wear helmets on the ice
Watch the video at: https://www.kare11.com/article/news/loc ... fa451241d2

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Jensen has spent the past nine months recovering, including seven surgeries and special therapy to regulate his emotions

Jason Jensen didn’t think he needed a helmet.

The goalie coach for Holy Family Catholic High School in Victoria had played Division I hockey and spent much of his life on skates.

When the girls team began practice Jan. 31, Jensen anticipated a short but fun session, followed by a dinner date with his wife, Kelly.

“The great thing about life is you always get humbled pretty quick when you start to think you’re a big deal,” Jensen said.

Less than two minutes into practice, Jensen was in the goal crease, talking, when a player slipped and fell into him. He lost balance and slammed his head to the ice.

“He had blood bubbling out of his ear,” Holy Family head coach Randy Koeppl said. “There are certain images that will never leave my mind.”

The near-tragedy rekindled a debate over whether helmets should be mandatory at practice for high school hockey coaches. For now, they are not.

Lakeville girls hockey coach Buck Kochevar and former Gophers star Mike Crowley are among those who have had “wake-up calls” without helmets while coaching.

“I wish the [state] high school league would just say, ‘You gotta do it,’ ” Koeppl said. “I mean, this is gonna happen again this year, I guarantee it. Maybe not to this extent, but somebody’s gonna fall, get tripped and drill their head.”

Jensen, 44, has spent the past nine months recovering, including seven surgeries and special therapy to regulate his emotions. He said he feels about 95% to 96% recovered and has been coaching since girls hockey practice started Oct. 27.

His primary job is with the Lakeville Police Department, where he’s a lieutenant overseeing investigations. He’s a former Minnesota State Mankato goalie who also serves as goalie coach for the Holy Family and Chanhassen boys teams.

Since that fateful practice at Victoria Recreation Center, Holy Family, Chanhassen, Edina, Minnetonka and East Ridge are among the schools with new mandates that high school coaches wear helmets for practice.

“While wearing a helmet probably wouldn’t have prevented an injury,” Jensen said, “it definitely would have minimized the extent of my injuries.”

No consensus

Minnesota Hockey, which oversees the state’s robust youth program — but not high schools — began requiring helmets for its 8,000 coaches in 2006.

When that rule took effect, coaches were motivated, in part, by tragedy. Wes Barrette, a popular St. Paul youth hockey coach, died in 1998 at age 70 after hitting his head on the ice when he wasn’t wearing a helmet.

Back then, former Gophers and North Stars player Tom Younghans said: “It’s not that I’m against a helmet. But we are adults and we should take personal responsibility. … I want to have the right to make that decision.”’

In 2018, USA Hockey went a step further, imposing a 30-day suspension for a coach at practice with no helmet.

“I should eat a little crow,” Jensen said. “When it was first mandated by USA Hockey, I didn’t feel the need for it. I’d skated for years, and it wasn’t a big deal.”

The Minnesota State High School League (MSHSL) and the National Federation of High School Associations (NFHS) recommend but don’t require high school coaches to wear helmets.

That’s partly because of jurisdiction. The NFHS writes rules for varsity competition — not rules for practice or coaches equipment. The same goes for the MSHSL. Last year, hockey organizations quickly began requiring players to wear neck protection after the 2023 death of former Minnesota Duluth player Adam Johnson, who took a skate blade to the neck. The NFHS adopted that rule for games, but neck guards still aren’t mandatory for high school practice.

Another example: Major League Baseball and the NCAA require first base and third base coaches to wear protective helmets, but there is no such rule for Minnesota high school coaches. Again, it’s up to the schools.

Bob Madison, senior associate director for the MSHSL, said the league works closely with the coaches associations. If strong support emerged from coaches to make helmets mandatory, the MSHSL would look at that.

After Jensen’s injury, “there was obviously momentum around helmets for coaches at the time,” Madison said. “But there’s a real mixed opinion, I would say, from the coaches association.”

Dustin Vogelgesang, executive director of the state’s coaches association, said the helmet issue was discussed last spring, but there was no vote.

“We are highly recommending all of our coaches wear helmets for practice,” he said. Vogelgesang took it further at East Ridge, where he coaches boys hockey, mandating that his coaches wear helmets.

After her husband’s fall, Kelly Jensen sent a letter to the MSHSL, making her case.

“My hope is that I could find somebody to tell my story,” she said. “I’m not trying to be difficult, and I don’t want to preach, but if we can get five months back from [Jensen’s] life, we would do it in a heartbeat.”

‘A freak accident’

Jason and Kelly Jensen were high school sweethearts in Rosemount and have two kids — Noah (ninth grade) and Olivia (fourth).

“The best thing I ever did was I tricked a beautiful, intelligent, smart woman to marry me,” Jason said.

Kelly arrived to find Jason in critical condition Jan. 31 at Hennepin County Medical Center. There, he had emergency surgery to remove part of his skull to relieve swelling and bleeding in the brain. Within 48 hours, Kelly was on FaceTime assuring players and families.

“I just let them know there’s nobody at fault,” she said. “This was a freak accident, and that if I can support them in any way, I will.”

The GoFundMe started to raise money for the Jensen family gathered $122,882. Eventually, Jason would spend six weeks at Shirley Ryan AbilityLab, a rehab hospital in Chicago, and about 10 weeks at QLI Omaha, a rehab center in Nebraska.

“In the hospital at HCMC, I was told, basically, he’ll never be the same again,” Kelly said. “That’s obviously something that you don’t ever want to hear. And so I prepared myself for the worst, and I’m so thankful for the doctors working to get him back.”

In Kelly’s view, Jason is closer to 98% recovered, higher than his own assessment.

“He still has his humor,” she said. “He still has his ability to be compassionate, and conversation is very easy for him. "But there were moments in the process when Jason would get agitated, too.

“At first it was a little alarming,” Kelly said, “just because his moods, his attitude — he was not the Jason that we’re used to.”

That led to the decision to send him to QLI Omaha.

“There was such extensive damage to my frontal lobe that I struggled with emotional regulation,” he said. “I owed it to the kids to have positive, fun interactions with them and didn’t want them worried if Dad was going to be crabby.”

Jason returned from Omaha in July and was back to work at the police department full-time by August.

Helmet believers

Crowley, a two-time Hobey Baker Award finalist for the Gophers, turned 50 this summer. "He's one of the best skaters ever to play in Minnesota,” Koeppl said. “This guy is still in great shape, and he wears a helmet any time he goes on the ice.”

Two years ago, Crowley wasn’t wearing a helmet when he was helping coach Holy Family’s boys team. At one point, he joined the players in a high-speed skating drill around the faceoff dots.

“I lost an edge and went into the boards pretty hard,” said Crowley, who suffered broken ribs and a heavily bruised shoulder. “If I hit my head, there would have been a problem. I started wearing a helmet after that, just because it was a wake-up call for me.”

Kochevar, 59, suffered his accident on Valentine’s Day 2011.

An Eveleth, Minn., native, he remembers having two drills he wanted to show his players that day. He demonstrated for the team and was going full speed, “when I turned from forward to backwards and hit a rut in the ice. I flew I’d say 8 to 10 feet and then hit my head.

“I was out instantly, but I was lucky. Basically, I still can’t smell or taste, but I’m standing vertical.”

You won’t find him without a helmet at practice now. The same goes for Gophers coach Bob Motzko, 64, who has been wearing a helmet at practices the past three seasons.

“I don’t move like I used to,” Motzko quipped last winter. “I know it looks like it, but I don’t.”

For ‘your loved ones’

Soon after Jason Jensen’s accident, Edina High activities director Troy Stein went to his head hockey coaches — Curt Giles and Sami Cowger — seeking their opinion about a helmet mandate.

Turned out, in that short span of time, Giles, 66, had already started wearing a helmet. So, it was just a matter of convincing the rest of the coaching staff.

“Hockey is a unique culture, right?” said Stein, whose four kids all play youth hockey. “I’ve talked to coaches that have said, ‘There’s no way I’m going to wear one.’”

Without a statewide or national mandate, this will remain up to individual schools. "I would just encourage all schools to look at this,” Stein said, “just like Minnesota Hockey has looked at this [for youth hockey] and said, ‘This is the right thing to do.’”

If any of Edina’s coaches were reluctant, Stein had one more message.

“I told them, ‘I want to make sure that you’re going home to your families and your loved ones,’ ” he said. “And they agreed. I mean, everybody was like, ‘Yeah, makes sense.’ ”

Helmet debate continues following coach’s fall that led to brain injury
Without a statewide or national mandate, the decision to require coaches to wear helmets during practice is up to individual schools.

Read more: https://varsity.startribune.com/high-sc ... /601497557