Slow recovery from sports-related brain concussion in women compared to men

The authors from the United States investigated the outcomes after sports-related brain concussion in 1,751 college athletes of both sexes. Results showed slow recovery from sports-related brain concussion in women, in participants who sustained injuries in sports with no or limited contact during training sessions, in those who had a greater number of symptoms immediately after injury, and those who had completed fewer post-injury assessment time points.

The most recognized example of a sport-related neurological injury is a brain concussion. Athletes can also experience other traumatic injuries, such as the severe brain or spinal cord injuries. A lack of consensus exists in the use of the term, with an overlap in the use of concussion and mild traumatic brain injury. The American Academy of Neurology guidelines for sports-related brain injuries do not separate concussion from mild traumatic brain injury. Nonetheless, the Zurich Consensus Statement on Concussion in Sport from 2012 proposed that concussion and mild traumatic brain injury should be viewed as separate entities.

A sport-related concussion is a biomechanical injury that results in altered brain function. Sport-related concussion can lead to somatic, cognitive and, emotional disorders. Recent developments in modern neuroimaging techniques, such as diffusion tensor imaging (DTI) and, functional magnetic resonance imaging (fMRI), have provided some new insights into the pathophysiology of concussions. According to DTI data, acute injuries are associated with an alteration in brain microstructure and a higher mean diffusivity of white matter. fMRI data suggest that the most significant change in brain function in concussed athletes is an increase in global functional connectivity. These brain changes were found in the bilateral inferior parietal lobes, bilateral middle temporal gyri, right angular gyrus, and left inferior frontal lobe. These findings were considered to be a protective mechanism in response to injury.

A sport-related concussion typically presents with a short period of signs and symptoms, lasting 7–10 days, with a highly favorable prognosis for complete recovery. A small percentage of individuals experience a longer recovery time, whereas some cases remain symptomatic for months or even years after an injury. The fMRI data demonstrated an increase in global functional connectivity (integration) in dorsal brain regions of athletes who took longer to reach a safe return-to-play. A minority of athletes with concussions may develop more chronic symptoms and more severe conditions, such as chronic traumatic encephalopathy.

The clinical determination of safe return-to-play in injured athletes is based on self-reported symptoms. The factors like female sex, more severe initial injury, pre-existing psychological issues, older age, and previous head injuries, increase the likelihood of persistent symptoms. Previous studies have shown a greater number of post-concussive neurological and behavioral symptoms in women compared to men, such as an increased reaction time, more difficulties with visual memory tasks, and delayed resolution of symptoms. According to clinical data, women experience less favorable outcomes and have higher mortality rates than men following moderate to severe traumatic brain injury. The underlying mechanisms that could explain sex-related differences in outcomes after a sport-related brain injury remain unclear and under-researched. These data are consistent with studies showing that women who survive a stroke experience less favorable outcomes than men.

About the study


This prospective study encompassed 1,751 college athletes who got a sport-related brain concussion. The slow recovery was defined as exceeding the time points by days 14 and 24. This group of college athletes who had a slow recovery included 399 college athletes.

The findings revealed that 80% of the participants reached the return-to-play time point by days 14 and 24, respectively. Participants who experienced slow recovery were more likely to be women, sustained injuries in sports with no or limited contact during training sessions, had a greater number of symptoms immediately after injury, and had completed fewer post-injury assessment time points.

The slow recovery group, which included 399 college athletes, took more than 24 days to return to play. Of the 399 athletes with delayed recovery, only 11% did not return to play by the end of the 6-month follow-up. However, the results that more than three-quarters (78%) of participants were able to return to play within 60 days of injury, and that four-fifths (84%) were able to return to play within 88 days of injury, are encouraging. The authors stated that these findings are an important message for athletes with a slow recovery from sports-related brain concussion.

This study was published in the scientific journal Neurology.

Journal Reference

Walker McAllister T. Characteristics and Outcomes of Athletes With Slow Recovery From Sport-Related Concussion: A CARE Consortium Study. January 18, 2023. (Open Access)