What is the risk of concussions in soccer?
Soccer is a popular sport in the US and around the world. Like any activity, there are risks in participating in soccer, including the risk of concussion. The concussion risk in soccer is less than the concussion risk in American football. That’s probably not a big surprise to anyone. However, I’d like to quantify the difference in concussion risk between the two sports and provide better context to that risk in soccer. The risk of concussion in American football is 2.3x the risk of concussion in soccer (1). That might provide some comfort, but that doesn’t really tell you how often concussions occur in soccer. The concussion rate in high school soccer is 3.58 concussions for every 10,000 athlete events, where an athlete event is one athlete participating in one game or practice (2). If you’re a parent, you’re probably trying to add-up all the practices and games you’ve taken your child to, and had to stop somewhere in the thousands. The good news is the risk of concussion and injury in general is lower at lower levels of competition. In reality 5% of high school soccer players will sustain a concussion each year (3). I’m guessing this is higher than most people expect. It’s a low level risk of sustaining an injury, but it warrants a better understanding of concussion in soccer, what causes it, and how we can reduce the risk.
Now that we understand the concussion risk for high school youth, let’s explore some of the variables that can increase the risk: gender, previous concussion, player position. The injury rate for males and females is different, even when they are playing the same sport like soccer. The concussion rate for females in high school soccer is 4.5/10,000 AE compared to 2.8/10,000 AE for males in high school soccer. It is unclear yet what causes this increased risk for females (2). Research has shown that females experience less head impacts than males, but still have a higher concussion risk (4). This would suggest that females are more susceptible to concussions, or that they are more likely to report symptoms than their male counterparts. Whatever the reason, this disparity in concussion by gender needs more research and should be something coaches, trainers, and parents consider. Another important variable in concussion risk is having a concussion. Once a player has had a concussion in soccer, they are 3x more likely to have another concussion (5). This is another variable that coaches, trainers, and parents should consider. Once a player has sustained a concussion, they should be removed from participation immediately. The player should seek medical attention, and their return to play should be directed by a trained professional. The return to practice, full practice, and competition should be conducted based on symptomatic milestones not arbitrary timelines. Everyone is different and every concussion is different. It is critical to ensure players are fully recovered before full participation to minimize the risks of another concussion. Even after following these precautions for return to play, there is still an elevated risk of concussion. The last variable that influences concussion risk in soccer is the position played. Goalies and defenders are at a higher risk of concussion than other positions on the field (5). In order to understand why these positions are at a higher risk, we must evaluate how players are concussed.
What causes a concussion is called the injury mechanism. As you’d expect concussions are typically caused by blunt impacts to the head. Soccer is unique in that players intentionally use their head to redirect the ball. This has been an area of concern for some time, and organizations in the US are trying to restrict heading the ball to older participants and limit heading when introduced into the game (6). Research in this area shows that the injury mechanism for concussions is very rarely a ball impacting the head. Concussions are most commonly caused in soccer by head-to-head impacts and head-to-ground impacts (2). Players often experience the concussive head-to-head impacts while competing to head a ball. So heading the ball can be dangerous, but typically the other players are the impact source that causes the injury rather than the ball. Even when a player is concussed by the ball, it is typically not an intentional header, it is a hard shot at close range (2). This explains why goalies and defenders have a higher incidence of concussion. They are getting shot at and jumping for headers and generally getting in the way of the ball and offensive players in their efforts to defend their goal.
There are products designed to reduce the risk of concussions in soccer. Consumers call these products all sorts of things: soccer concussion headband, concussion band, soccer protective headbands, soccer protection, soccer header headband, anti concussion headband, and anti concussion soccer headband. Players will often wear these protective headbands after they’ve had a concussion to provide additional protection. This is an effective strategy, but I’d rather players wear protection before they are injured. Also of note, wearing a protective headband should not alter the symptoms based return to play strategy prescribed by a trained professional. Regardless of what they’re called, there is a bit of controversy about how well these headbands work. Some researchers have shown that soccer headbands do not reduce head kinematics when players head the ball at certain ball speeds (7). The problem with that evaluation of soccer headbands is that they are intended to protect you from head-to-head contact, head-to-ground, and other incidental impacts. As described earlier, the injury mechanism in soccer is not typically heading the ball, so the best evaluation of a soccer headband is how it protects in head-to-head impacts. One study demonstrated that protective headbands can reduce the head motion in simulated head-to-head impacts by an average of 33% (7). Despite these promising results in the laboratory, there hasn’t been a study to prove that wearing protective headbands on the field reduces the risk of concussion for soccer players. One reason for this is studies tend to allow users to select their headband, and there are some ineffective products on the market. Researchers at Virginia Tech have created a Star rating test methodology for soccer headgear (8). It includes head-to-head impacts at multiple speeds to the sides and back of the head. The headgear are rated 0-5 Stars based on how well they protect the wearer in these test conditions, which are the most common injury mechanisms for soccer players. We believe that an on-field study could be conducted that would prove that headgear does reduce the risk of concussion if only 4 and 5 star rated products were available to participants.
At Syzmik, we created the X11 headband with a low profile that makes it feel like a typical sweatband. The X11 also has a front touch pad that is textured to provide grip when heading the ball. The goal was to provide a high level of protection and maintain your ability to head the ball. We know that many players don’t want to wear any protection, and that some people think it is unnecessary. So we created the X11 as a great entry into soccer head protection while looking and feeling like a traditional sweatband. The X11 is rate 4-Star by Virginia Tech. We also created the X7c specifically for goalies. This headband is a little thicker for players who want something more substantial. It also doesn’t have the touch pad on the front, because goalies don’t have to head the ball. This product was designed for the player position with the highest risk of concussion. The X7c is rated 5-Star by Virginia Tech.
- Pfister T, et al. Br J Sports Med 2016;50:292–297. doi:10.1136/bjsports-2015-094978
- Comstock RD, et al. JAMA Pediatr 2015 ;169(9) :830-837. Doi :10.1001/jamapediatrics.2015.1062
- https://headcasecompany.com/concussion_info/stats_on_concussions_sports
- Huber CM. Et al. Med Sci Sports Exerc. 2021; 53(6):1245-1251. Doi:10.1249/MSS. 0000000000002567.
- Delaney, JS et al. Clin J Sport Med 2002 ; 12 :331-338.
- http://www.usyouthsoccer.org/assets/56/6/us_youth_soccer_policy_on_players_and_playing_rules.pdf
- Withnall, C. et al. Br J Sports Med 2005;39:i40-i48.
- http://hdl.handle.net/10919/82952
