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

BackgroundDespite 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. MethodsA 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. ResultsA 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. ConclusionThis 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.