Sports-related head injuries in female athletes have significantly risen in the past decade. In high school, girls’ concussions have increased 3 to 4 times more. Head injuries during sports have increased more than 200% among female athletes between the ages of 14 and 18, according to a new study released this year from the American Academy of Orthopedics. Strangely, it is not only happening to girls in sport. It is affecting girls in recreation activities as well. These statistics are just from girls who reported their injury and symptoms at the hospital. However, there are a few different reasons why this is happening. Here are some explanations why females are more prone to concussions.

The National High School Sports Injury Surveillance (NFHS) study looked at 9,542 concussions that occurred in high school sports. Out of every 10,000 practices and games:

• Boys playing football suffered 10.2 concussions.
• Girls playing soccer, which was second, suffered 8.4 concussions.
• Comparing boys to girls soccer, the boys had 3.5 concussions.

To add more fuel to the fire, a study in the journal, Pediatrics confirms that high school girls soccer athletes had the same risk for concussions as boys high school football. This is an interesting and alarming statistic considering boys where helmets and the force and impact football produces on the body.

In 2017 the American Academy of Neurology found that females are 50% more likely than male athletes to have a concussion caused by sports.

1. Girls are more likely to report injury more than boys.

In a study, the report said that girls are more likely to say they have a head injury and report symptoms more than boys. The report also showed that boys tend to hide an injury or not speak the truth about their symptoms related to injury.

2. Females and males are biologically different.

Girls start menstruation at 10-14 years old. They begin to have changes in estrogen and progesterone levels. Surprisingly, female menstruation leads to poorer outcomes for females and concussions. A published study done in 2014 in the Journal of Head Trauma Rehabilitation found that the menstrual cycle has a detrimental impact pertaining to a females’ concussion.

They found that women who experienced a concussion during the last two weeks of their menstrual cycle had worse post-concussion symptoms when compared to the first two weeks. When a girl suffers a concussion or head injury during the last two weeks progesterone is high. And during the first two weeks, progesterone is low.

Furthermore, oral contraception helps to balance these two hormone levels in the body. And those who take oral contraception did not have worse symptoms of concussion.

What’s more is, female high school athletes who have experienced concussions have reported that their periods stopped entirely or became more irregular over months.

3. Females have cerebral nerve differences.

When someone suffers a concussion, the nerve fibers are stretched rapidly. However, the nerve fibers stay intact and it is the microtubules that rupture and break from the force. Researchers found that with a concussion, female nerve fibers dramatically swell more than male nerve fibers. This was noticed within a 24-hour period. This information was confirmed in a study done by Penn Medicine published in the journal, Experimental Neurology.

Robert A. Groff a professor of neurosurgery at the University of Pennsylvania found that female nerve fibers were smaller, more fragile, and had fewer microtubules than men that were easier to break from the application of force to the head. What’s most important is that the size of the nerve determines its strength and the number of microtubules. Microtubules transport molecules and electric currents and provide protection and regeneration of the nerve. And, since females have smaller nerves, which leads to fewer microtubules, it makes the female brain more susceptible to concussion and a severe concussion. The larger the nerve fiber, the more microtubules you have, the less prone to concussion you will be.

What’s more, in another study, they found that females have concussion symptoms for about three weeks longer than males. A typical concussion for a male last about ten days on average.

4. Weaker neck muscles in females increase trauma to the head.

Hunt Batjer, MD, is a professor at the department of neurosurgery at the University of Texas Southwestern Medical Center in Dallas. He says most females don’t have the same musculature as men in the neck and shoulder regions. When a female hits their head, their neck and shoulders do not support the impact of the force in the same way as a male. The application of force to a female’s head is worse. He says that weak neck muscles increase the risk of concussion.

High school female athletes seem to have less developed neck muscles than boys. With strong neck muscles, the head stabilizes and prevents excessive movement of the head during impact. A strong neck means force is absorbed over a greater surface area and not only isolated to the head affecting the brain.

Researchers have known about these differences for years that female athletes have greater risk to head trauma and concussions. So, why is it still going unnoticed and unresolved? Ignorance is not bliss. It leads to tragedy and detrimental life-altering situations.

Research is not done to show superiority or inferiority. It is done to provide the greatest amount of safety for athletes to show their superior talents and performance skills on the field. Burying this research and looking the other way will only produce more victims to injury because of ignorance, not pride. There is nothing proud about seeing an athlete end their career early suffering from an injury that could have been prevented. You need to look at the playing field pertaining to skills and performance equally while acknowledging differences physiologically and listening without prejudice.

It is a terrible inequality and slap in the face to allow females to be exposed to life-threatening situations. High school sport organizations and professional ones need a call of duty to respect sport and protect those who play within its realm. There needs to be specific guidelines that protect females and high school girls.

Until today, no sport has produced female-specific protocols for concussions.