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

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.

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.

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?

by: Jane McDevitt, PhD
by: Jeff Driban


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