Beyond Football Players: The NCAA¹s Concussion Gender Gap
The NCAA knows even less about concussions among women than it does about those among men; will that change?
“With 22 seconds left in a December 2012 game against South Carolina, Toni Kokenis stepped up to the free-throw line to try to protect Stanford’s two-point lead. She knew where she was, but had no idea what would happen next.
“I remember going to the line and being like, ‘Oh my gosh. I hope this goes well,’” she says.
An hour earlier, she was splashing water on her face during halftime, trying to shake concussion symptoms that had been lingering for the entire season. She hadn’t hinted to her coaches or teammates just how bad they had gotten.
Throughout the second half of the game, Kokenis, then the starting point guard for the No. 1 team in the nation, struggled to run back and forth between the two 3-point lines at opposite ends of the court. During timeouts, she’d fight overheating with cold towels and ice packs for her head. Now, Kokenis could no longer go through the motions — not when the game was on the line.
“So much of that time was a blur,” she says, looking at highlights from the game.
But to the rest of the arena, Kokenis seemed at the top of her game.
Kokenis, a 77 percent free-throw shooter the previous season, hit both of her shots, putting the Cardinal up three. Then, South Carolina fouled Kokenis again, sending her to the line for a second time in 12 seconds. Again, she’d hit both shots. With three seconds to go, South Carolina hit a 3-pointer, forcing the Gamecocks to foul Kokenis for a third time with 1 second on the clock. With a chance to ice the game, she did just that, sinking her two remaining free throws to seal a 53-49 win.
That sixth and final free throw concluded a 22-second stretch that felt endless for the hazy Kokenis.
“I remember talking to my mom after the game and saying, ‘I don’t know how that happened because I could not focus,’” she tells me.
It wasn’t the first time Kokenis would fight the haziness and headaches from her concussion symptoms. But it would be one of the last.
After at least five or six concussions — four that were diagnosed during high school and college and another one or two she believes she suffered during high school — Kokenis, a key part of the Cardinal’s Final Four runs in 2011 and 2012, was forced to retire from college basketball in the summer of 2013.
Three years after her retirement, however, the conversation around concussions among female athletes and what it means for life after sports has not advanced in the same way as it has for football-related concussions among male athletes. This is particularly evident in the college ranks, where concussion-related retirements of women in college athletics — particularly in sports that don’t generate the same level of revenue or attention as football programs — go virtually unnoticed.
Even in a groundbreaking decade in research on concussions, one with more increased awareness on head trauma in sports than any time in U.S. history, there’s still a noticeable knowledge gap between what we know about the effects of concussions on men and women. What we do know, however, only leaves us wanting more, especially when it comes to women who play college sports.
“There’s enough information out there about CTE [chronic traumatic encephalopathy], and I think female athletes are struggling to figure out, ‘Does the media coverage of football players – and their ultimate demise – apply to me?’” says Katherine Snedaker, executive director of the nonprofitPINKconcussions, who helped lead a very comprehensive study on the experience of sport-related concussion on women athletes.
...“The gender gap is as wide as it can be,” says Chris Nowinski, founder of the Concussion Legacy Foundation, a nonprofit focusing on research and education of sports-related head injuries. “There hasn’t been a lot of intensive research on difference in gender, outside of speculating on why the numbers are so different.”
Critics such as Nowinski wonder whether the knowledge gap in concussion research between the genders can be bridged, especially in a field so heavily focused on men’s sports — namely, football.
In December, Nowinski told America Tonight that the NCAA has “no motivation in changing” current policies to help better protect past and present student-athletes, adding that the governing body has done “the worst job of any level of sports in terms of the protections they offer their players.” The most jarring example of safety concerns regarding concussions in women college athletes is the ongoing lawsuit from Casey Conine, a former University of Illinois women’s soccer player who has accused the university of ignoring concussion protocol, forcing her to end her soccer career.
Now, in the run up to an expected settlement in a concussion lawsuit involving the NCAA and thousands of former college athletes affected by head trauma, Nowinski’s skepticism of the NCAA has been echoed by former female athletes — from Division I college programs in basketball, soccer and volleyball — interviewed for this story.
Kokenis and other women who have had to retire from their sport because of at least one concussion are part of a growing group of women who are finding their voice, and gaining their footing, on a topic of research that has been mostly dominated by one gender and one sport.
“If I knew everything I know now, I would have not let myself play in certain games with those concussion symptoms,” says Kokenis, now a first-year law student at Northeastern University in Boston. “That’s a lot of responsibility to put on a player who’s expected to perform and contribute for her team. And it’s just way too much to expect one player to do herself.”
Inside her Boston apartment, blocks away from Northeastern’s law school, she turns to me with a look of helplessness for what’s still happening for women college athletes: “No one knows what to do when a woman athlete has a concussion.”
...Stories like Kokenis’ are beginning to gain traction throughout college athletic departments.
In basketball, players like Texas’ Chelsea Bass , UCLA’s Lauren Holiday all ended their careers in the last three years. Each suffered anywhere from two to five instances of head trauma during high school and college. This month, Toledo’s Nancy Kessler announced her decision to step away after at least four concussions.
But perhaps no sport in women’s athletics has been under more scrutiny for concussions than soccer, with recent, notable retirements from Stanford’s Emily Oliver, Northwestern’s Anna Cassell and Utah’s Molly Poletto, who each suffered at least two reported concussions during the course of their high school and college playing careers.
In Chapel Hill, North Carolina, Caitlin Ball, a member of the University of North Carolina’s women’s soccer team, suffered five concussions within a 15-month period — four in soccer and another one while hiking. Ball, who retired in 2014, is thankful for the program for honoring the rest of her scholarship, but is still surprised by people’s reactions when they learn about her history with concussions.
“If you ask the normal fan, they would be somewhat surprised that any women’s soccer player has had to retire due to head trauma,” Ball says. “There’s quite a few cases every day, week, month and year, but it’s not terribly talked about at all.”
It was something of a different situation for Emily Peters in 2009. Before Peters ever played a game for the women’s soccer team at the University of Pittsburgh, she was forced to retire, suffering an estimated eight concussions — only three of which were ever diagnosed. After she retired, she slipped into depression and suicidal ideation, relying on marijuana to help her eat and sleep. The experience, which has taken up a quarter of her life, has left a sour taste for Peters.
“It got to a point where I was feeling s***ty or s****ier,” says Peters, who continues to fight symptoms, such as vertigo, six years after stepping away from soccer. “I know universities have put out certain rules, kind of like, ‘wash your hands’ signs. The NCAA has a lot of room to grow, and the teams and universities aren’t doing their part, either.”
The transition into retirement wasn’t easy for Kokenis, whose lingering symptoms forced her to take three incompletes during the semester she retired. Refocusing her attention back toward her academics proved to be difficult, especially given that she was still trying to disconnect herself from the team, and sport, for which she’d sacrificed so much for so many years.
...“Once college athletes medically retire, you’re kind of forgotten. It’s like, ‘You did your time, you helped us do this and that, but what are you doing for us now?’” she says. “And it wasn’t my choice. I didn’t choose to leave. I got injured representing my school and giving all of myself to my school and community.”
Finding a strong voice
...“When a football player retires, they’re given a stage in which to note their history,” says Snedaker, a mother of two sons who suffered multiple concussions of their own. “I’m not sure a female athlete in equestrian or polo or field hockey who is retiring from concussion is going to make any sort of influence. I don’t think women have a strong enough voice in the first place.”
To help find that stage, Snedaker actually had to help create one. Through PINKconcussions, her nationwide initiative on female concussions, Snedaker teamed up with researchers from Clemson University for the first-ever study on the effect of concussions on women, titled, “No Guts, No Glory: What price does she pay to play the game?” The study, which polled 520 former female athletes with varying sports backgrounds, crystallizes the bigger issues in play for women at the collegiate level:
Nearly 58 percent of the women polled who have suffered at least one concussion — and continue to play organized sports today.
More than 69 percent of the women polled continue to play through a head injury, and never report it, while experiencing symptoms such as headaches, blurred or double vision, dizziness, slowed thinking and nausea.
More than half of the women polled are still suffering from symptoms they believe could only be caused from their head injuries.
“Our research showed women do not always report concussions as commonly thought in the past; and they hide concussions for different reasons than the male athletes — due to their lack of awareness of concussions and lack of resources like an athlete trainer,” Snedaker says of the results of the study. “Women’s sports need more concussion education for their athletes, education targeted specifically for women and athletes trainers present at their practices and games."
If the NCAA hopes to change those perceptions surrounding its concussion research of women athletes, it starts with research and legislation. In May 2014, the NCAA announced a partnership with the Department of Defense (DoD) on a $30 million study on concussions among student-athletes and military members. As of Dec. 15, 2015, 21 schools and 17,500 student-athletes had enrolled in the study, according to the Concussion Assessment, Research and Education (CARE) Consortium.
Drs. Thomas McAllister and Steve Broglio are two of the medical professionals leading the CARE Consortium, overseeing two of the three major branches of the research effort.
McAllister, chair of Indiana University’s School of Medicine Department of Psychiatry, oversees the fiduciary oversight of the effort. He acknowledges that there’s “a big gap” in what we know between men and women who suffer concussions.
“There are indications that given equivalent biomechanical force exposure or hits that females may be more likely to get a concussion. And there is some emerging evidence suggesting that the resolution of symptoms after a concussion takes a little bit longer in females,” McAllister says. “But other than that, we don’t know enough really about why, or if, either of those are true.”
Broglio, director of the NeuroSport Research Laboratory at the University of Michigan, is coordinating the research on the concussion history among college student-athletes. Broglio is confident the findings in the ongoing study will help bridge the gender gap “sooner rather than later.”
“The data will allow us to address the things we know about men and things we don’t know about both genders,” Broglio says.
While the NCAA-DoD study is a step in the right direction for women’s athletics, Snedaker is pushing for even more female-specific concussion research in college athletics.
“They’re starting from behind and are trying to make up for lost time,” says Snedaker, referring to the NCAA’s efforts on concussion research. “They have the money and the expertise to do this. I’m always optimistic they’ll do the right thing.”
To learn more about concussions in women athletes, check out the International Summit on Female Concussion and TBI in Washington, D.C., later this month. To hear more from Emily Peters and Dr. Steve Broglio, check out Timothy Bella’s “Life After Concussions in College Sports panel at South by Southwest in March.
Beyond Football Players: The NCAA’s Concussion Gender Gap
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