Concussion is an issue for athletes in many sports. In a recent blog, we highlighted the higher relative risk of concussion amongst female athletes compared to their male counterparts. In this follow-up blog, we will take a deeper look at some of the proposed reasons women are at a higher risk and what the stakeholders in women's sport can do to help as part of their sponsorship or partnership mix.
Lucy Bronze will represent England at the 2022 UEFA Women’s Eoropean Championships
Women’s sport is on the up. According to the Women’s Sport Trust, women’s sport viewership in the UK increased by 140 per cent year-on-year in the first part of 2022. FIFA has described the women’s game as the ‘single biggest growth opportunity in football’. This week the UEFA Women’s European Championships begins in England. The tournament has already achieved record ticket sales with over 500,000 sold before a ball has been kicked.
Some of the worlds best players will showcase their skills to a global audience which will, include young girls, who now see female role models within elite sport as the norm. However, the increase in female sporting participation over the last decade has uncovered findings of a greater risk of concussion in female sports. This is particularly the case within sports such as football where rules are the same for both sexes.
Why the difference?
The big question that researchers are grappling with is:-
Why are female athletes at greater risk of concussion?
A number of reasons have been offered but due to the lack of research examining sport related concussion the available evidence upon which to base any definitive answers is limited. Despite this paucity of research, what research that does exist points to four main areas; neck strength, head accceleration, hormones and brain structure.
Neck strength
Soccer is one of the few, if not the only sport where the head is commonly used to control, pass and strike a ball. Research examining links to heading and concussion as well as heading and other neurodegenerative conditions has gained significant media attention.
A reason often cited for the increased risk of heading related concussion in female football is reduced neck strength amongst players. Studies looking at soccer players have found female players have significantly less neck strength than their male counterparts. A much referenced study from 2008, actually showed that female players had 50% less isometric neck strength compared to male players with similar heading experience. Reduced neck strength presents a problem as it may render players unable to absorb or stabilise their heads effectively whilst heading the ball. This leads to increased head acceleration with the potential for increased brain movement inside the skull. It is this mechanism that may be one factor that underpins the heightened concussion risk factor amongst female players.
To combat a lack of neck strength, additional training has been proposed. Whilst research has been able to show that increasing neck strength does lead to reduced head acceleration, only one paper has been able to then link this to a reduced risk of concussion. Collins et al (2014) described a 5% decrease in concussion risk per pound of increased neck strength. This dosn’t sound like a lot, but any reduction in risk is going to be very beenfitial.
Head acceleration
Head acceleration as an issue in female concussion is linked to neck strength. If female athletes don't have the neck strength to limit head acceleration then they are more likely to suffer concussion caused by lower level impacts. This would mean that if the exact same impact force was applied, male head acceleration would be significantly less than female head acceleration therefore the risk of female concussion is higher.
However, some evidence exists that highlights the issue being more complicated than just neck strength differences. A case study in 2019 by Sayre et al, showed that two college level female athletes had suffered concussion at significantly lower head acceleration levels than that observed in male athletes. While no definitive threshold has been established for head acceleration forces that will result in concussion, the potential for a lower threshold amongst women is an area that will need further evaluation.
Hormonal
One of the most intriguing areas of investigation when looking at female concussion is the potential role of sex hormones and the menstrual cycle. A report in 2019 highlighted a possible window in the menstrual cycle within which the risk of concussion may be increased. The study showed that 66.7% of concussion occurred within nine days coinciding with the late luteal phase and first two days of menstruation. Zooming in a little more, just the late luteal phase accounted for 50% of concussions (La Fountaine et al 2019).
This is an area that needs major focus and significantly more study in order to draw any solid concussions. However, the rise in concussion incidence would fit with a drop in both progesterone and oestrogen. These hormones have a neuroprotective effect which includes the promotion of myelin formation, protection of neurons and the optimisation of cell survival.
Brain structure
Hormone levels and brain structure and function have received much less attention than the external factors of neck strength and head acceleration. Nonetheless, the limited research that has taken place does show the need for further investigation. Currently, brain structure and function analysis point more toward longer term neurodegenerative issues rather than instant concussive incidence (Rubin et al 2018).
In research examining the impact of heading on brain microstructures, results showed that when exposed to similar head impacts women exhibited greater changes in white matter compared to men. White matter plays a major role in communication within and between the brain and spinal cord. Often changes are associated with reductions in sensory, motor and cognitive function. The authors highlight that sex based differences in susceptibility to brain injury need further investigation to understand why it is happening and the best course of action in terms of interventions (Rubin et al 2018).
The research gap
Rule changes and adapted protocols will only be introduced following quality evidence based assessments. Unfortunately, a gap between male and female research exists across much of science and medicine. It is probably fair to say that across sport science and sports medicine, that gap is further exacerbated for a host of reasons.
Closing this gap relies on highlighting the issues and encouraging researchers to take on female focused projects. To achieve this, funding needs to be available as well as access to female subjects as volunteers. Hopefully, the expansion of female sport will lead to a greater pool of subjects willing to volunteer to take part in studies helping to address some of this imbalance.
Funding has historically proven to be the biggest hurdle. However, multiple national and international goverinign bodies are now making increased efforts to support female focused research. But it remains behind male sport. Male research’s head start is further exacerbated by the financial power of many professional clubs who can pioneer their own areas of study as they search for performance advantages. For women’s sport to catch up, it will need additional support from outside the traditional funding channels.
The role of sports marketing
As has been mentioned in previous SSA articles, research can form a cornerstone of a sponsor's relationship with a rights holder and sport more generally. In fact, partnering with one team or NGB, but then spearheading research, gives that brand a credible and easy platform to address fans across the entirety of the sport. Nike in particular has capitalised on the research element of sports marketing. Through its work on the ZoomX Vaporfly 4% and then the ZoomX Vaporfly Next% it managed to captivate the sporting world. Yes, much of their research is direct in terms of brand led product development, but it still managed to gain significant global traction across the sporting and news pages, not just in running publications, which would have been it’s natural landing space.
For those within the marketing industry that have made long term commitments to women’s sport, their brand proposition can be significantly enhanced by helping to close the research gap. While many areas of research within women’s sport need to be addressed, the issues of concussion and head injury offer multiple avenues to create meaningful insight.
Funding is the obvious area where partners can support research. Many governing bodies do have funds ringfenced for performance and player welfare research. By topping this up, and offering other forms of value in kind, such as staff expertise, partners can help to accelerate and broaden programmes of study that are very much needed across female sport.
Marketing support is also of huge value. This can come in the form of campaigning to ensure that the issues of concussion and head injury are understood. Campaigning can be invaluable in terms of unlocking pre-existing funding channels. Promotion in the early stages can also attract and retain volunteers. If rights such as player appearances can be donated so that stars continue to take part in research studies, this can be used to attract other volunteers. Good quality research is dependent on a strong subject sample, so, links with role models can create significant kudos, encouraging others to take part in the same studies.
The promotion of results and showcasing the consequences of research then offers a credible platform upon which to build a comprehensive comms and PR campaign. The benefits of being involved in quality and relevant research can last for decades. This is because the brand has a legitimate and credible platform upon which to position itself in front of key audiences whenever a topic such as concussion is discussed.
Quality research investigating meaningful topics never goes away, it is only built on. This means for partners of womens sport, if they invest today, they will have built an association that can be amplified by others on their behalf, long after their contractual terms have ended. The increasing success of women’s sport is to be celebrtated, however, it faces challenges to ensure performance and player welfare continues to improve. In concussion, there is a very real issue to be tackled. Getting it right will take time, effort and financial support. If a partner is willing to invest in any or all of these aspects, the payback will last for years…
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