Why are girls more prone to concussions than boys?

With attention on concussions largely focused on professional football and men's sports, these brain injuries may get overlooked in women's sports.

Concussion experts agree that while football still sees the most concussions, every sport involving contact needs be aware of the issue.

"There really isn't a sport that is concussion-proof," said Dr. Stacy Suskauer of the Kennedy Krieger Institute in Baltimore.

If anything, girls seem to be more prone to concussions than boys. Research of high school athletes suggests that in sports both genders play in a similar way, girls are twice as likely to sustain a concussion, according to a report published in the American Journal of Sports Medicine in 2011.

Said Dr. Gerard Gioia of the Children's National Medical Center in Washington, D.C.: "If you look at sports that are similar in terms of how girls play it — soccer, basketball and baseball/softball — in those three sports, girls do have a higher incidence of concussions."

What Gioia doesn't know is why this is the case.

"Is it because their necks are not as strong? Is there something about the hormonal differences that affect how we respond to the blow? Is it because girls are more willing to report the problem? I think it's important to widen the scope and realize that we need more information about that," said Gioia, the director of the Safe Concussion Outcome Recovery & Education (SCORE) Program, which evaluates and monitors the care of youths with concussions.

"Honestly, I would say athletes are athletes," Fried said. "I think there's people of both genders who try to stay on the field — I don't think women are more likely to report their injury than a male."

Lauren Burkhead, the director of Clinical Services at Righttime Medical Care in Annapolis, Md., agreed, saying: "I think when you really get into the serious athlete — the girls want to ignore their symptoms just as much as the boys do."

In Fried's sport in particular there has been a lot of controversy surrounding concussions and whether women's lacrosse players should be required to wear helmets. Fried is one of many coaches who maintain that helmets are not necessary in the women's game, which has different rules than the men's game, where helmets are worn.

"I think it really depends on, I guess, where the sport is," Fried said. "There's not a necessity [for helmets in women's lacrosse] with the way the rules are currently, if it's being played, coached and officiated the way it's supposed to. The helmet isn't necessarily going to take care of hitting the ground, because it's not necessarily the impact, it's the brain being moved around in the helmet."

However, Fried did not downplay the importance of the concussion issue in women's sports.

But while the awareness has increased on the girls' side of sports, so much is still left unknown.

Suskauer, who directs the Brain Injury Rehabilitation Programs at Kennedy Krieger, doesn't dispute the data that girls report more concussions but did point out that at her clinic alone they see more boys than girls in the younger group of children, and even among teenagers they see "slightly more boys."

The reality is that doctors aren't even sure whether children are more susceptible than adults, let alone being sure about the role gender plays.

Both Kennedy Krieger and the SCORE Program at the Children's National Medical Center focus on youth concussion patients, but neither Suskauer nor Gioia are certain that kids are more vulnerable. They both believe more data is needed.

However, Gioia did say: "There's one study that compares high school kids to the pros and suggests that the high school kids take longer to recover [from concussions]."