Our member Concussion Toolkit was sparked by personal experience. Co-founder Pippi Heath sustained a concussion while at university, and after struggling through a confusing and isolating recovery, she began looking more closely at the research underpinning mainstream concussion guidelines. What she found was deeply concerning. This International Women’s Day, we chatted to Millie Puddephatt about what Concussion Toolkit is doing to make care and research around these injuries more inclusive and gender-responsive.

Tell us about Concussion Toolkit and why it was established…

A meta-analysis of 171 sports concussion studies revealed that 80.1% of participants were male, and 40.4% of studies excluded women entirely. Yet this research underpins concussion guidelines that are distributed across all levels of sport and are often treated as universal.

Despite being underrepresented in research, there is growing evidence that women:

• Report higher rates of sport-related concussion
• Experience more severe symptoms
• Have longer recovery periods

At the same time, mainstream concussion guidance rarely acknowledges gender differences in symptomology, recovery timelines, or mechanisms of injury.

What barriers do women commonly face in receiving diagnoses or support?

The consequences of this gap can be devastating. If women are more likely to experience prolonged or more severe symptoms, but are managed according to protocols developed predominantly on male samples, they may be at greater risk of premature return-to-play, second-impact syndrome and longer-term neurological harm.

There is also limited understanding of how concussion interacts with the menstrual cycle. Emerging research suggests that hormonal fluctuations may influence both susceptibility and recovery. Overlap between menstrual symptoms (such as fatigue, headaches, mood changes) and concussion symptoms can lead to delayed or missed diagnoses.

How are you solving this issue?

Concussion Toolkit takes a gender-informed approach. This means:

• Integrating current evidence on sex and gender differences into mainstream concussion education
• Highlighting potential differences in recovery timelines and symptom presentation
• Providing women-specific guides that validate lived experiences often dismissed
• Offering baseline testing and symptom-tracking tools that allow athletes to log menstrual cycle stage and hormonal contraception use, helping build a clearer picture of individual brain health across the month

More research is needed. But the team’s mindset has always been ‘what can we do to help now?’

How does Concussion Toolkit collaborate with women with lived experience?

Lived experience sits at the centre of our design process. We are not from traditional medical backgrounds. Our expertise lies in interdisciplinary research, user-centred design and implementation. That allows us to:

• Conduct in-depth user research with athletes
• Co-design resources alongside women who have experienced concussion
• Test materials in real-life environments and iterate based on feedback
• Ensure guidance is practical, culturally relevant and emotionally validating

We also embed and amplify other existing women’s health resources. This is not about competing, it is about building a stronger ecosystem.

How is Concussion Toolkit raising awareness?

We work primarily within universities and grassroots sport, where medical support can be inconsistent and guidance is often relied upon most heavily.

Our Concussion Toolkit itself is a gender-informed, holistic, co-designed digital tool. It was developed through interdisciplinary research and in collaboration with student-athletes, clinicians and lived-experience contributors. Rather than focusing solely on return-to-play, the Toolkit supports return-to-learn, wellbeing, and longer-term brain health. We work with organisations on a one-to-one basis to build their bespoke tool to work with and strengthen their existing symptoms and human resource.

Alongside the Toolkit, we deliver interactive workshops for athletes, coaches and sports departments. These sessions:

• Upskill individuals to recognise and recover from a concussion
• Highlight emerging research on sex and gender differences in concussion
• Emphasise individual variability and the importance of personalised recovery
• Emphasise creating cultures of support and tackling stigma

What changes are needed in women’s health policy and research?

Greater transparency: Medical guidance should clearly state the research base it is built upon, including sample composition. Without this, people may unknowingly follow guidance that is not fully applicable to them.

Increased funding for women-specific injury research: Decades of androcentric research cannot be corrected without intentional investment.

Interdisciplinary collaboration: Sport-related concussion is often treated as a narrow clinical issue. In reality, it sits at the intersection of multiple systems. We need intentional collaboration between clinicians, sports scientists, endocrinologists, psychologists, implementation researchers, sociologists, and athletes themselves.

A whole systems approach: Concussion management often fails because systems are fragmented (their coach may not understand it; their academic department or employer might not accommodate it etc). A whole-system approach means designing concussion support across the entire environment in which an athlete operates in.

How can others get involved?

There are several ways individuals and organisations can support this work:

Audit your current protocols:  Who was the research behind your guidance based on? Does our protocol acknowledge potential sex and gender differences? Do we have clear academic or workplace adjustment pathways?

Embed concussion education and guidance into existing roles: Rather than adding entirely new systems, consider how concussion awareness can be integrated into your existing infrastructure, e.g. safeguarding training, coach development programs, athlete induction sessions, wellbeing check-ins etc.

Support women-led research and initiatives: This may mean collaborating, amplifying, mentoring, or redirecting funding toward work that centres underrepresented populations. Structural imbalance in research will not correct itself without deliberate support.

Share lived experience (if safe to do so): personal stories shift culture in ways statistics cannot.

Be intentional in procurement and partnerships: When selecting consultants, providers or collaborators, ask: Whose experiences informed this work? Does this organisation demonstrate inclusive methodology? Who might be unintentionally excluded?

We often say that concussion is an invisible injury. But for many women, the systems surrounding concussion make it even more invisible.

This is not about replacing existing medical guidance. It is about strengthening it, making it more transparent, more inclusive, and more reflective of real people.

Women-led sport is growing rapidly. Our research, policy and implementation strategies must grow with it.