Why women’s ice hockey has a higher concussion rate than football

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When college athletes play the same sport, women report concussions more often than men.

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In college, women’s hockey players are reporting concussions at a higher rate than male hockey players. In fact, female hockey players are reporting a higher concussion rate than nearly all sports sanctioned by the National Collegiate Athletic Association (NCAA). In several studies, female hockey players have reported concussions more often than men’s college football, and at a rate that is comparable to men’s college wrestling and men’s college ice hockey.

Compared to sports like women’s tennis or women’s basketball, hockey is faster, played on harder surfaces, and involves more collisions, which partly explains the high rate of concussions but doesn’t account for the fact that female athletes are reporting more concussions than male athletes who also play hockey. In fact, several surveys have demonstrated that, besides hockey, female athletes consistently report a higher concussion rate than male athletes playing the same gender comparable sport (e.g basketball, soccer, softball/baseball).

The reasons why are unclear, but this video highlights some of the plausible factors, including: gender bias, reporting bias, differences in style of play (for example, body checking is allowed in men’s hockey and is illegal in women’s hockey), hormonal differences (progesterone is of particular interest to researchers), neck strength, and differences in the structure of nerve fibers called axons.

To help understand how these factors might influence the concussion rates, this video features interviews with University of North Carolina researcher Zachary Kerr and retired US Women’s Hockey player Josephine Pucci, who ended her career following several concussions. To hear her story of how she came back to win a 2014 Olympic Silver Medal while playing on the Harvard Women’s team, make sure to watch the video above.

Resources:

Headway Foundation: http://headwayfoundation.com/

PINK Concussions: http://www.pinkconcussions.com/

CDC Heads Up Initiative: https://www.cdc.gov/headsup/basics/concussion_prevention.html

Sources:

Concussion Surveys:

2007 epidemiology (Journal of Athletic Training):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941297/

2010 7-year review of women's ice hockey injuries (Canadian Journal of Surgery)

https://www.ncbi.nlm.nih.gov/pubmed/20858376

2012 study (Journal of Neurosurgery):

https://www.ncbi.nlm.nih.gov/pubmed/23199425

2014 survey (NCAA):

https://www.ncaa.org/sites/default/files/Concussion%20%20GOALS%20Exec%20Summary_Feb_12_2014_FINALpost_0.pdf

2014 research paper on injuries in women's ice hockey (Current Sports Medicine Reports):

http://bit.ly/2EHXLOk

2015 epidemiology (The American Journal of Sports Medicine):

http://journals.sagepub.com/doi/abs/10.1177/0363546515599634?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

Further Research:

2014 research on neck strength (The Journal of Primary Prevention):

https://www.ncbi.nlm.nih.gov/pubmed/24930131

2014 research on hormonal influence (Journal of Head Trauma):

https://www.ncbi.nlm.nih.gov/pubmed/24220566

2017 research on nerve fiber structure (University of Pennsylvania/Experimental Neurology):

https://www.pennmedicine.org/news/news-releases/2017/november/women-may-be-more-vulnerable-to-concussions-because-of-leaner-nerve-fibers-penn-study-suggests

https://www.ncbi.nlm.nih.gov/pubmed/29104114

Hockey Manuals:

USA Hockey Checking Manual:

http://assets.ngin.com/attachments/document/0042/6379/Checking_Manual_FINAL.pdf

USA Hockey Introduction to Body Contact:

http://assets.ngin.com/attachments/document/0020/3311/IntroductiontoBodyContact.pdf

Additional Sources:

2007 women’s Hockey epidemiology (Journal of Athletic Training):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941287/

“Concussion” Chapter 15, “Sex Differences in Sports Medicine” by Dunbar and Putukian, 2016.

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