Why Concussions Are Harder on Women

Women get the short end of the stick, it seems

illustration by darren gygi

The last thing Briana Scurry remembers about her soccer career is crouching to pick up a ball rolling toward the goal. Although she can’t remember what happened next, the former U.S. National Team and Anoka High School goalkeeper—winner of the 1999 World Cup and two Olympic gold medals—has seen the replays. An opposing forward’s knee crashed into the side of her head and the two of them tumbled to the ground with no foul called. At that point, Scurry realized where she was only because she looked down and saw that she was wearing her uniform. 

“You’re not OK, are you?” the trainer asked as Scurry left the field at halftime.

That was in 2010. It’s taken several years, surgery, and months of physical therapy, but Scurry can finally say that she is OK. Though she can’t play soccer anymore, her new career is fitting: advocate for concussion awareness in a sport where half of female players will experience a head injury at some point in their career. 

But while concussion awareness is at an all-time high, Scurry says understanding of these injuries, and their real-life consequences, is still lagging. Take this summer’s celebrated World Cup: In a semi-final game, a U.S. midfielder collided with a German forward. After a brief on-the-field examination by team doctors, both players returned to the field.

“C’mon,” Scurry says. “For crying out loud. People were bleeding.”

Scurry is advocating for new rules that would allow players to be evaluated by a neutral doctor while a sub, used only to replace head-injured players, takes her place on the field. She calls it unfair to expect an athlete to make a decision in the heat of a game that could impact the rest of her life.

Scurry’s doctor, Kevin Crutchfield, director of the Comprehensive Sports Concussion Program at Sinai Hospital of Baltimore, agrees—with a caveat. Crutchfield thinks that doctors are so focused on concussions that they sometimes fail to diagnose other head and neck injuries. Scurry, for example, was plagued for three years by intense headaches. After several attempts at finding treatment to relieve her pain, Crutchfield determined that she had occipital nerve damage causing intense pain behind her ear, vestibular issues, and depression and anxiety—a suite of conditions beyond the scope of the CAT scans she had received showing images of her brain.

Nine months later, Scurry was on the operating table, undergoing surgery that removes tissue in the neck to release pressure from the occipital nerve. It’s not a new procedure, but it hadn’t been used to treat many concussion patients. (About 8 percent of the patients in his clinic present chronic, persistent symptoms that may not actually be from concussions and are thus good candidates, Crutchfield says.)

When she woke up, Scurry realized she was pain free. Eight months of physical therapy helped her resolve other symptoms; she slowly learned to tolerate visual motion to reduce dizziness, and to strengthen and flex her neck. 

“It’s a challenge because there’s still a lot we don’t know,” says Scurry’s physical therapist, Laura Morris, who also works at Sinai Hospital of Baltimore, where she specializes in concussion patients. “The science is still very limited; it’s hard to say if what we’re doing is the right thing all the time.”

Scientists are just beginning to realize concussions affect males and females differently. Now there’s also recognition that women with concussions report more migraines and take longer to heal than men.

Despite the now-known risks, Scurry says she doesn’t have any regrets about playing soccer. “I want every person in this world to experience the beautiful game at some point in time, but I also don’t want us to be so Neanderthal that we’re behind the NHL and NFL,” she says. “We have a lot of concussions partly because we have a lot of kids playing. Can we protect them? With great growth comes responsibility.”