Sports Medicine Research: In the Lab & In the Field: Should the Focus Be on Limiting Player Contact Instead of Soccer Heading? (Sports Med Res)
Wednesday, August 19, 2015

Should the Focus Be on Limiting Player Contact Instead of Soccer Heading?

An evidence-based discussion of heading the ball and concussions in high school soccer

Comstock RD, Currie DW, Pierpoint L, Grubenhoff JA, Fields SK. JAMA Pediatric 2015; ahead of print.

Take Home Message: Banning heading from youth soccer would likely prevent some concussions; however, reducing player-to-player contact may play a more effective role in preventing concussions as well as other injuries.

Soccer was introduced as a safer alternative to youth sports, but soccer-related concussion rates are high among United States high schools. To reduce the risk of concussions in soccer some are calling for a ban on soccer heading; however, there is little research to support such a ban. Therefore, the authors analyzed data from 2005 to 2014 from the National High School Sports-Related Injury Surveillance Study’s High School Reporting Information Online to evaluate trends among girls’ and boys’ soccer concussions, to 1) identify injury mechanisms commonly leading to concussions, 2) delineate soccer-specific activities during which most concussions occur, 3) detail heading-related soccer concussion mechanisms, and 4) compare concussion symptom patterns by injury mechanism. As part of the injury surveillance system, certified athletic trainers from high schools around the country reported injuries and exposures (playing/practice time per athlete) for soccer concussions. In girls’ soccer, 627 concussions were sustained during 1,393,753 athletic exposures (4.5 concussions per 10,000 athletic exposures). In boys’ soccer, 442 concussions were sustained during 1,592,238 athletic exposures (2.8 concussions per 10,000 athletic exposures). In both girls and boys soccer, competition and practice concussion rates increased over the 9-year period. For girls (51%) and boys (66%) player-to-player contact was the most common concussion mechanism. Heading was the most common soccer-specific activity, responsible for 25% of the girls’ concussions and 31% of the boys’ concussions. Rate of concussions resulting from heading increased over time among girls, but not for boys. Contact with another player was the most common mechanism of injury in heading-related concussion among girls (62%) and boys (78%). Symptom resolution time was shorter when the athlete sustained a concussion during player-to-player contact compared to contact with a playing apparatus. There were no differences in return-to-play time.

This study is important because it answered the question “During what soccer-related activity do concussions most commonly occur?”, and concluded that consistent with previous reports heading is the activity with the highest proportion of concussion in boys and girls soccer. However, the most frequent concussion mechanism is with player-to-player contact. This suggests that it may be the player-to-player contact, and not the ball striking the head that increases concussion opportunities. Limiting player-to-player contact instead of eliminating heading may be more beneficial in preventing concussions. Medical personnel, coaches, and referees should be aware that most concussions are resulting from player-to-player contact, and not just from the ball striking the head. Therefore, rules may need to be augmented or enforced to limit player-to-player contact.

Questions for Discussion: Is player-to-player contact necessary in youth soccer? Do you see fouls called for player-to-player contact. Should there be a rule change to eliminate or decrease soccer headings?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

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Comstock RD, Currie DW, Pierpoint LA, Grubenhoff JA, & Fields SK (2015). An Evidence-Based Discussion of Heading the Ball and Concussions in High School Soccer. JAMA Pediatrics PMID: 26168306

3 comments:

Dennis Coonan, MSE, LAT, ATC said...

Certainly a great topic. While the study does show that player to player contact is the most common way concussions occur on a soccer field, what about the cumulative effect of the repeated impacts to the head game after game (practice after practice) via heading the ball? And this cumulative effect could occur over weeks, months, and especially years. I would be interested to see a long range study conducted to evaluate this effect. Also, do the repeated impacts of head balls over time make someone more susceptible to a more severe concussion when player to player contact does occur?

Paul R. Geisler, EdD, ATC said...

There are a few glaring "ommissions" from this review and perhaps even, the article. First, it doesn't seem to be mentioned that a lot of the "player-to-player" contact that generates concussions is actually DURING the act, or attempt to "head the ball"--thus the 2 issues are fundamentally interrelated as part of the game--when 2 players are both challenging to win a header, the shoulders and heads come together at the same point, often with high speed, and often in the air (jumping), thus with no base support, and then, "boom" the heads collide, or a head collides with a shoulder, or an elbow, causing a concussion, regardless of whether or not the ball was actually headed. Second, soccer is a contact game...if "player contact" is legislated out of the game, controlled, curbed, etc., then players will never learn how to defend, shield, or fight for 50-50 balls, and thus attacking players will never learn how to fight off contact to win or maintain possession of the ball--both of which would seriously impede technical and physical development in the game of soccer. I'm all for safer sport--as an AT and as a parent--but soccer is a contact sport, and thus their is risk of injury inherent in the game, and more so once a soccer player passes 12-13 yrs. old or so for boys, perhaps a yr or 2 later for girls. If an athlete wants to be an outstanding or elite soccer player, he/she HAS to learn to deal with they physicality of the game, and changing the rules to decrease physicality of the game fundamentally changes the game and thwarts the development of the player in said game. New rules a few years ago stated that any contact to the head, intentional or not, is a yellow card...but it is rarely called as such. Refs need to enforce current rules about swinging elbows, and other aggressive mechanisms that can be avoided when trying to win headers, and their certainly needs to be more consistency in what "is a foul" and what is "not a foul" across the board, and proper technique, avoiding headers for younger players in pxtce (it rarely happens in games anyways), and shoulder/neck strengthening are sound interventions to reduce concussion rates/severity

Jeffrey Driban said...

Paul, you raise some great points. The article notes that "Contact with another player was the most common mechanism of injury in heading-related concussions among boys (78.1%) and girls (61.9%)". It fails to note how many contact-related concussions were during heading but Table 1 indicates that boys experienced 296 concussions after contact with another player and 107 heading-related concussions occurred after contact with another player. So a large portion of contact-related concussions occur during heading but there's still a large portion that needs to be accounted for. I agree with you that removing contact or heading from soccer could hinder player development and I think increase the risk of injury later in the career when players start doing those activities. We've previously discussed your other point that we need to enforce the rules already in place. http://www.sportsmedres.org/2013/05/rule-changes-NHL-concussions.html We've seen in ice hockey and lacrosse that concussions often occur after hits that violate the rules of the game and yet no penalty is called.

Dennis, you are correct that we also need to get a better understanding of the cumulative implications of head impacts during a person's career. As Paul noted, it may be helpful to reduce the number of headers during practice. We probably don't want a situation where younger players never do headers until they reach a certain age b/c we probably want them to learn the technique over time so they have time to optimize their neuromuscular control during headers before they start heading soccer balls that are traveling at significantly higher velocities.

Thanks for the comments!

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