A Systematic Review of Female Athletes in Concussion Research: Gaps, Findings, and Future Directions

Despite the growing participation of female athletes in contact and high-impact sports, their representation in concussion research remains disproportionately low. This imbalance limits the generalizability of clinical guidelines and return-to-play (RTP) protocols, potentially compromising athlete safety and recovery outcomes.

Methods

A systematic literature review was conducted on concussion studies published between 2021 and 2024 to assess changes in female representation. The analysis focused on three key objectives: (i) identifying primary research areas in concussion studies, (ii) evaluating the prevalence of female participants, and (iii) determining whether sample sizes were sufficient for statistically meaningful, sex-specific conclusions.

Results

A regression analysis revealed a statistically significant decline in female representation over time ( B =-0.2478, p <.001), and female participant numbers decreasing 25% yearly and by 31% between 2021 and 2024. The female-to-male ratio analysis confirmed that male sample sizes continue to dominate, reinforcing the reliance on male-centric data in concussion assessment and RTP decision-making. Additionally, while generalized linear models remain widely used for broad comparisons, traditional statistical methods often fail to capture nuanced sex-based differences, particularly given the persistent sample size disparities.

Conclusion

This review underscores the continued underrepresentation of female athletes in concussion research and the reliance on male-driven data for clinical decision-making. Although efforts to include female participants have increased, sample sizes remain insufficient for robust, sex-specific analyses. Addressing these gaps is critical for developing evidence-based, individualized concussion recovery models that account for the unique neurobiological and biomechanical profiles of female athletes.