Teenage girls who play football are at almost double the risk of concussion compared to boys, a Scots study has shown.
New research published today found girls were also less likely to be removed from play and take longer to recover from the injury than their male counterparts.
The study was led by Professor Willie Stewart, who led ground-breaking research that suggests footballers are up to five times more likely to die from Alzheimer's disease than the general public.
The findings led to the SFA introducing a ban on children under 12 under heading footballs.
Working in collaboration with researchers at the University of Pennsylvania and Michigan State University, Prof Stewart, reviewed three years of injury data for a population of around 40,000 female high school footballers in the Michigan High School Athletic Association and compared these to data for a similar number of male footballers.
The study confirmed findings from previous research that, overall, risk of sports related concussion among female footballers was almost double – 1.88 times higher – that of males.
Importantly, the researchers also identified several sex-associated differences in sports concussion mechanism and management providing new insights into the injury in this age group.
Male footballers were most often injured colliding with another player and were 1.5 times more likely to be removed from play on the day of injury, compared with females, who were most often injured from contact with equipment, such as the ball or a goalpost.
READ MORE: Call for football-linked dementia to be classed as an industrial injury
Adolescent female footballers also took on average two days longer to recover from injury and return to play.
The study authors said the findings raised the question of whether sports should consider sex specific approaches to both participation and concussion management.
Prof Stewart, senior author of the study, said: “Given we know the importance of immediate removal from play for any athlete with suspected concussion, it is notable that “if in doubt, sit them out” appears more likely to happen for boys than girls.
"This, together with the finding that mechanism of injury appears different between boys and girls, suggests that there might be value in sex-specific approaches to concussion education and management in this age group.”
Dr Abigail Bretzin, lead author of the study and postdoctoral fellow and certified athletic trainer at the University of Pennsylvania, said: “This is the first study to look in this detail at sex-associated differences in concussion management and outcomes in teenage footballers.
READ MORE: Scholarship tribute to Scots doctor after her death from disease that claimed lives of both parents
"Our findings add to research showing that female athletes are at increased concussion risk compared to male athletes, and highlight the importance of sex-specific research in this field.”
Fifty former elite rugby players are being recruited to a study into whether they are more likely to show early warning signs of dementia.
Those involved include England's Ben Kay and Wales' Shane Williams.
The Alzheimer's Society work comes amid growing concern over long-term head-injury risks in rugby and football.
Governing body World Rugby said safety was taken very seriously and injury-prevention strategies implemented based on the latest research.
There are now strict protocols to deal with head injuries and concussion - but in previous decades, there was less awareness of the risks.
The paper ‘Sex-associated differences in adolescent soccer concussion incidence and characteristics’ is published in JAMA Network Open.
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