Women playing basketball
The symposium brings together concussion experts to discuss how women experience and recover from concussions – for example the noted observation of a greater incidence of concussions among female basketball players per player as compared to men. (Photo: Flickr, US Coast Guard Academy)

Women are tired of hearing that they're "different."

Media trends of the last few years have been about the journey of women for equality and recognition between the sexes in everything from wages, to leadership positions, to the ability to play sports.

So when former Olympian and women's ice hockey champion Cassie Campbell-Pascall heard that the Canadian Concussion Centre (CCC) was organizing Canada's first symposium on concussions in women and girls, she had some misgivings.

"My first reaction was 'here we go again,'" she says. "Girls are once again being singled out and being perceived as 'weaker' or 'inferior' in some way and I admit that I was reluctant to acknowledge this differentiation."

However, having worked many times over the years with Dr. Charles Tator to promote injury prevention in sports, she reached out to him to better understand what this symposium was meant to address and came away from the discussion as the invited emcee for the event.

"Parents are always approaching me for advice on how to keep their kids safe while playing sports," she says. "I feel that I'm pretty familiar with the athlete side of the concussion dialogue, so I'm looking forward to hearing more about this topic from medical experts and scientists.

"The more information I have, the better I'll be able to help in the future." 

There are differences in susceptibility

On Saturday, Cassie will both host and attend Canada's first symposium on Concussions in Women and Girls, an all-day event focused on the emerging evidence that women experience concussions differently.

"Through research, we are learning that there are differences between men and women in their susceptibility to, as well as symptoms and recovery from concussions," says Dr. Tator, Research Director of the CCC and one of three co-chairs of the symposium.

"This isn't a question of whether women are weaker, it's strictly scientific – as we see these differences arise, what can we do as experts to better treat and prevent concussions in women," Dr. Tator says.

"Even outside of concussion, we can't lump everyone together," adds Dr. Carmela Tartaglia, neurologist and researcher with the CCC who is also acting as co-chair of the symposium along with MD/PhD candidate Swapna Mylabathula.

"Gender and sex specific differences arise in all diseases and in the case of concussions, it's becoming obvious that women are more at risk of persistent symptoms but we're not yet sure why," Dr. Tartaglia says.

In recent years, both studies and clinical evidence have identified particular factors that indicate women are not only more susceptible to concussions but are also more likely to suffer from persistent symptoms.

For example, neck muscles in women are usually less developed making them less able to resist the whiplash effect from a direct blow and their head prone to snap back as a result of impact, causing more jiggling in the brain. Could neck strengthening exercises as part of sports training help mitigate this risk?

Cassie herself has some familiarity with this issue when she sustained a major concussion in the last year of her hockey career that bruised her spinal cord. She was kept off Canada's national hockey team for seven months to recover.

A variety of topics up for discussion

"I almost missed my last Olympics because of that injury," she recalls. "I spent months building my shoulder and neck strength so that I would be able to play."

Other topics include research on whether there are hormonal factors, such as the phases of a woman's menstrual cycle that might make her more susceptible to concussions. There is also the noted observation of a greater incidence of concussions per player in women in hockey and basketball as compared to men; as well as the reality that women are more likely to sustain a concussion as a result of domestic partner abuse.

"It's imperative that we increase awareness and prevention of concussions in organized sport, in our schools and in everyday community life, and the CCC's symposium is an opportune time to look at why concussions affect women and girls differently," adds Eleanor McMahon, Minister of Tourism, Culture and Sport who is also presenting at the symposium.

The research to date in these areas and more will be presented and discussed by experts from both Canada and the United to States to share information and identify common strategies to better help women living with the effects of concussions.

"We hope that by coming together to share this information, we will increase awareness of the physical and societal factors that contribute to concussions in women as well as the importance of considering these gender-related differences when analyzing research on this brain injury," says Dr. Tartaglia.

"It's through a scientific approach of following the evidence that will help us understand how these different variables affect an outcome."​

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