Does women's hockey produce more concussions than football?

Much of the recent media attention around concussions has centred on football, with the NFL and NCAA attempting to settle concussion lawsuits and the CFL currently facing litigation of its own. However, football's far from the only sport dealing with concussion issues, and it may not even be the one with the most prevalent brain injuries. Roy MacGregor explored concussions in women's (ice, although field hockey has its own concussion issues) hockey this week in The Globe and Mail, starting his piece by stating data suggests they may be even a bigger problem than football concussions:

That claim deserves a little more context. That specific language MacGregor quotes doesn't appear to come from the Women's Sports Foundation (an education-based non-profit Billie Jean King founded in 1974)'s own website, but rather from a Feb. 10 Washington Post op-ed from WSF senior director of research Marjorie Snyder. Snyder's piece cites the specific survey referenced, which was published in the Journal of Athletic Training in 2007 and analyzed NCAA injury records from 1988 to 2004. Hence that particular survey isn't exactly current. It's difficult to imagine that concussions in women's hockey have declined dramatically since then, but perhaps the numbers of reported concussions in football have risen given the increased focus on that sport.

That's a key point here; the survey also only considers reported concussions (the lawsuit against the NCAA alleges that the organization "failed to establish comprehensive policies for the diagnosis and treatment of head injuries," and there have been plenty of accusations of underreporting in football in particular). This is also on a per-practice and per-game basis. It would be interesting to see what the NCAA injury records for the past decade say, as concussions in football now are getting so much attention that it's much more difficult not to report them.

Moreover, testimony from medical experts in the NCAA settlement asserts that NCAA football players are three times more likely than the general public to develop chronic traumatic encelopathy (CTE), while NCAA athletes in all other sports (including hockey) are only one-and-a-half times as likely to develop CTE. Those figures aren't broken down by gender, though, and it wouldn't be surprising to see concussions in women's hockey occur more frequently than in men's hockey (despite rules against bodychecking), as that's been the case in more recent studies about soccer and other sports. It's just not  conclusively proven that women's hockey continues to create more concussions than football, especially in Canada.

That's an interesting point to explore, too. The data MacGregor cites is not just from a different country (the U.S.), but from a specific level of competition (the NCAA). There's no comparable data from Canada, and that's an excellent point MacGregor goes on to make in his piece. So far, Hockey Canada hasn't been supportive of the idea of creating its own national concussion database, and there certainly would be challenges with it. But if U.S. high schools can come up with a reporting system that works, the idea of implementing one in Canada has plenty of merit.

The key takeaway here isn't that women's hockey is safe. While that NCAA study only covered 1988-2004, its results are still amazing, and they illustrate just how many concussions even a sport that doesn't include legal bodychecking (watch high-level women's hockey, though, and you'll see there's still plenty of contact) can produce. Moreover, there's lots of evidence to suggest that women's sports in general can create more head injuries than men's. Exactly why that is up for debate, with theories ranging from varying neck strengths to hormonal differences to even a greater willingness to report head injuries, but it's reasonably well-established that in the same sport at a similar level, there will be more concussions reported by female athletes than male ones. Thus, MacGregor's basic thesis on the dangers of women's hockey isn't wrong.

Hockey Canada also appears cognizant of the issue. As MacGregor writes, they've taken plenty of steps to try and reduce and properly address concussions, including mandatory education for coaches and even a concussion awareness app. Those are good steps.

However, hockey in general, and women's hockey in particular, still doesn't seem to receive the same amount of concussion attention that football does. That's true regardless of how many concussions happen in the sport, and it speaks to a need for more research on just how many concussions do happen in women's hockey, especially here at home. The takeaway here isn't that women's hockey is safe; it's that we don't really know just how dangerous it is.

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