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