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Enforcing rules, not banning headers, would better reduce soccer concussions, study suggests

Eric Bolte-USA TODAY Sports
United States midfielder Morgan Brian and Germany forward Alexandra Popp collide attempting a header during the first half of the semifinals of the FIFA 2015 Women's World Cup at Olympic Stadium.

The number of young people playing soccer in the United States has risen dramatically over the past three decades — and the exciting win by the U.S. team in the Women’s World Cup earlier this month will only boost the sport’s popularity.

Soccer is a great game for young people, offering many health benefits, both physical and mental. But along with the growing number of children and teens taking up soccer have come increasing safety concerns, especially around the issue of head concussions.

Some parents and others have called for a ban on soccer ball heading (keeping the ball in play by hitting it off the head) until players reach high school. Studies have suggested that up to 37 percent of soccer-related concussions among young players are caused by heading the ball.

But the findings of a new study, published online this week in the journal JAMA Pediatrics, indicate that soccer’s concussion problem is much more nuanced. For although the study did find that heading the ball was responsible for most concussions in youth soccer, those heading-related concussions tended to occur during rough contact between players.

“When you look more deeply in the data, it’s not the act of athletes hitting the balls with their heads at all,” said Dawn Comstock, the study’s lead author and a sports injury epidemiologist at the University of Colorado, to Reuters reporter Andrew Seaman. “Rather, it’s athlete-to-athlete contact that occurs during heading.”

Comstock and her study co-authors conclude that although banning headings from youth soccer would prevent some concussions, efforts would be better spent on enforcing the existing rules to eliminate unnecessary — and often illegal — player contact.

Study details

For the study, the researchers looked at the frequency and causes of concussions that occurred among soccer players at 100 private and public high schools between the years 2005 and 2014. They identified 627 concussions among girls and 442 among boys during that nine-year period.

That meant that for every 10,000 “athlete exposures” (times a student played in a game or in practice) 4.5 girls and 2.8 boys sustained a concussion.

Heading the ball was involved in almost one-third of the boy’s concussions (30.6 percent) and slightly more than one-quarter of the girls’ concussions (25.3 percent).

Yet, it wasn’t the soccer ball impacting the player’s head that caused most of those concussions. Instead, the injuries occurred as a result of player-to-player contact. That was true for 68.8 percent of the boys’ concussions and 51.3 percent of the girls’ concussions.

Limitation and implication

The concussions identified in the study were player-reported ones, which is a major limitation of the study.

Still, Comstock and her colleagues believe their findings suggest that soccer can be made safer for young people without an all-out ban on heading — if coaches would emphasize fair play and officials would enforce existing rules. 

“Nobody is willing to address the elephant in the room, which is rough play,” Comstock told NPR reporter Jesse Rack

“If we’re not going to control the aggressive play, if we keep letting soccer evolve into a game that’s starting to look like football, by all means ban heading,” she added. “We will keep some kids safe.” 

The study was funded by a grant from the Centers for Disease Control and Prevention and with other funding from the National Federation of State High School Associations, the National Operating Committee on Standards for Athletic Equipment, DonJoy Orthotics and EyeBlack. You can read an abstract of the study on the JAMA Pediatrics website, but the full study is behind a paywall.

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