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The Concussion Conversation: addressing medical inequality

Mary Konstantopoulos talks to physiotherapist Shreya Mcleod about the importance of addressing the medical knowledge gap when it comes to women’s injuries and concussion inequality.

Shreya Mcleod is focused on concussion in the NRLW. Sourced: NRLW
Shreya Mcleod is focused on concussion in the NRLW. Sourced: NRLW

When it comes to conversations about fairness and equality for women in sport there are many battlegrounds; access to facilities, the importance of media coverage and of course, pay. 

But there are so many other factors to consider.

Shreya Mcleod is a Sports and Musculoskeletal Physiotherapist with over 20 years experience treating elite athletes. She is currently completing her PhD at the University of Newcastle and has a particular interest in injury risk prevention—particularly in female contact and collision sport.

The focus of McLeod’s PhD is an evaluation of the identification of concussion in the NRLW Telstra Women’s Premiership. 

For Mcleod, an area that needs additional consideration, as well as distinction from the men’s game, is the identification of concussion and the way data is managed and collected, specifically in women’s sport. Whilst concussion management has been a key priority in men’s sport for the last two years, Mcleod is yet to see that same rigour applied to women’s sport, and in a manner which recognises the physical differences between men and women and the difference in opportunity that girls and boys have had growing up. 

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“I think a lot of women who have started playing contact sports do not necessarily have a background in collision sports,” said Mcleod.”

“The boys grow up learning certain skills and it’s only now that we are seeing pathways develop for girls that we will see a similar opportunity for girls.”

“I have worked with cricket in the past, and a lot of the girls didn’t know how to fall at the boundary correctly, how to dive or how to roll properly.”

“There are girls playing collision sports who will have had a similar experience in that they did not grow up learning how to tackle.”

Mcleod has seen some sports place greater emphasis on teaching women these skills. For example, Cricket NSW and Cricket Australia have worked hard to address this recently.

But for Mcleod, there also needs to be a better understanding of the physical differences between men and women and this is an area where further research is being undertaken.

“Longer term, there may be considerations about whether women need to change their tackle technique because of their breasts; an issue that the male players don’t have to contend with and something that hasn’t really been considered to date,” said Mcleod. 

It’s only recently that the impact of the menstrual cycle has been considered for elite athletes.

“In the second half of the cycle, women tear their ACL ligaments in their knees a lot more,” said Mcleod.

“We know this is something we need to look at.”

There is also additional work to be done on the impact the menstrual cycle can have on concussions.

“The components of osteopenia and anorexia, periods/lack of periods—that all has to do with bone density and nutritional value,” said Mcleod.

“If you are someone who menstruated late and then has irregular periods, there is a likelihood you may have osteopenia, and for collision sports, there is a huge component where you need the ability to get your nutrients quickly and effectively.

“There is more research coming out in this space too.”  

Whilst there is additional work to be done in the research space, there is also an important role for education.

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The NRLW is a short season; this year it will last just six weeks. 

There is a risk that women may underreport or not report concussion symptoms. 

“It’s hard, who wants to miss a six week season,” said Mcleod.

“That could be part of any potential underreporting.

“There needs to be an education piece around an awareness that it is a short season, but there are these measures in place because we need to make sure that safety is the priority for you as an athlete.

“If we can detect it, remove you from the field of play, do further testing and if you have a concussion there is a period before you can return to play.”

What is clear for Mcleod is that there is plenty of work to be done in this space, with a need for sports to begin developing a gender-specific strategy when it comes to the management of concussions.

For Mcleod, there is an opportunity for collaboration between the sports to achieve this.

“There is a difference in the way the games are played, a difference in tackle technique and a difference in the inherent requirements of the game,” said Mcleod.

“But groupings of sport could work together – for example, rugby union and rugby league could collaborate, cricket is different, but potentially gymnastics and cheerleading could work together.”

“You need to group the sports based on their requirements, but a blanket female strategy is not specific enough either.”

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