Physical examination of the cervical spine should be conducted in female athletes with a history of concussion.

Background: Female athletes may be at increased risk of injury following sports-related concussion (SRC), even after symptom resolution. Residual cervical spine impairments have been proposed as a potential contributor; however, these have not been well characterised in female athletes. This study aimed to examine whether a history of SRC was associated with clinical assessments of the cervical spine in female athletes. Methods: In this cross-sectional observational study, 156 elite and pre-elite female athletes from water polo, soccer, diving, rugby-7s and cycling/BMX were recruited. History of SRC within the previous 12 months was self-reported. Assessments included questionnaires and physical examination of the cervical spine, comprising range of motion, manual examination, joint position error (JPE) and maximal isometric neck strength. Between-group differences were examined using univariable statistical analyses. Results: Athletes with a history of SRC demonstrated a higher prevalence of reduced cervical range of motion, positive findings on manual examination, increased JPE and a history of headaches or migraines compared with athletes without concussion history. No deficits in maximal isometric neck strength were observed in athletes with a history of SRC. Conclusion: Cervical spine impairments were more commonly observed in female athletes with a history of SRC within the previous 12 months, including in athletes who did not report current neck pain. These findings suggest consideration of targeted cervical spine assessment beyond symptom-based screening in athletes with a concussion history. Whether identification and management of cervical spine impairments influence subsequent injury risk requires investigation in prospective and interventional studies.