Concussion-Prevention Strategies Used in National Collegiate Athletic Association Divisions I and II Women’s Soccer

Jeffries KK, Girouard TJ, Tandy RD, & Radzak KN.  J Athl Train. 2020 55(5) Online ahead of print. doi: 10.4085/1062-6050-142-19.

Full Text Freely Available

Take-Home Message

Among women’s soccer programs, there is a discordance between what athletic trainers think will prevent concussions and what the teams are implementing.


Over the past 20 years, we’ve seen more research trying to identify concussion-prevention strategies. However, it is unclear what prevention strategies are being adopted in high-risk sports, such as women’s soccer.  Hence, these authors studied whether NCAA I & II women’s soccer programs used concussion-prevention strategies and if athletic trainers thought these programs were effective. The study team sent surveys to 587 athletic trainers that provided the primary medical services to a women’s soccer program, and 222 responded.  The survey included structured and open-ended questions to identify the use of cervical-strengthening programs, headgear, and other prevention strategies. Less than 20% of the athletic trainers indicated that the women’s soccer team implemented any stability or cervical strengthening training to prevent concussions. However, 70% of athletic trainers believed that cervical strength training could prevent concussions within women’s soccer.  Interestingly, about one-third of the athletic trainers reported that players on the team wore headgear; however,  < 10% of athletic trainers believed headgear could prevent concussions.  The majority of athletic trainers (70%) reported that education on proper techniques was part of their concussion prevention strategy.


This study is interesting because it shows that women’s soccer programs seem to be relying on education as the primary means for concussion prevention, despite believing that stability or strengthening programming would be beneficial.  Many of the posts on Sports Med Res have focused on lower extremity injury prevention programming with much less high-quality evidence assessing concussion prevention in isolation.  Programs such as the FIFA 11+ effectively reduce concussions. It would have been interesting to see if these women’s soccer programs were also using any type of general injury prevention programming that may have some carryover to concussion prevention.  Most injury prevention warm-up programs do not incorporate neck strengthening into their programs, and this is a known risk factor for female soccer players’ risk of concussion. However, there is a need for more evidence to decide if cervical strengthening programs can reduce the risk of concussion. Despite the lack of evidence, 70% of athletic trainers think cervical strengthening may protect against concussion. The authors observed considerable discordance between implemented prevention strategies and athletic trainers’ belief in these programs. It would have been interesting to know who is making the final decision about which programs to implement and what role the athletic trainer had in these decisions. This may clarify why teams with athletic trainers that believe in cervical strengthening fail to implement the program. Alternatively, it may clarify why headgear is used when an athletic trainer thinks they won’t help.  Overall, this research highlights a significant gap in clinical practice, and the need to understand better how teams decide to implement concussion-prevention strategies. It may be beneficial for clinicians to review who is making key decisions about prevention programs and to educate those stakeholders.   

Questions for Discussion

Why do you think concussion prevention has taken so long to gain traction?  What do you think we can do to improve awareness and implementation?

Written by: Nicole M. Cattano
Reviewed by: Jeffrey Driban

Related Posts

High Adherence to the FIFA11+ Decreases Injury Risk Among Youth Female Soccer Players
Youth Soccer Girls Heading Up in the Concussion Rates
Give a Heads Up to Your Club Sports on Concussions

Evidence-based Assessment of Concussion (5 EBP CEUs)