Concussions in soccer comprise 8%-13% of all sport injuries in high school
This prominence as well as the long and short-term side-effects of concussion highlight the importance of trying to reduce the incidence of concussive injuries in high school soccer. The question then arises as to whether wearing headgear while playing soccer can reduce the incidence or severity of concussion in these student-athletes (4-5).
A paper published in April 2019 outlines the results of a study that examined this question.
Despite postulating that using protective headgear would reduce the incidence of concussion, the study found that wearing headgear in high school soccer does not influence concussion incidence or severity. This result is consistent with many other studies looking at the effectiveness of headgear in preventing concussion other sports and finding minimal benefit. This study also supports the 2017 Berlin Concussion Consensus Statement that states that there is minimal evidence supporting the use of headgear in reducing the incidence or severity of concussion.
The Methodology and the Objectives
Generally speaking, protective headgear has not been appropriately tested to conclude whether it reduces the risk of sustaining a concussion in soccer (6-8). Studies like this one however, are important in contributing to the body of evidence. In fact, this study is the first large scale trial of its kind, looking at 2766 participants – 66% of which were female – ages 14-18 and analysing a total of 151,157 soccer exposures to determine whether wearing protective headgear in soccer is beneficial.
The study randomly assigned high school soccer teams to one of two groups: the headgear group or the no headgear group. Again, the objective was to see if the number of concussions were higher in the latter group by using athletic trainers who recorded in-season data including: concussive and non-concussive injuries, athletic exposures, and compliance with wearing or not wearing headgear (out of the 151,157 soccer exposures, only 0.47% non-compliant exposures occurred). A secondary goal was to see if the severity of the concussive injuries varied between groups, as determined by number of days of soccer participation missed.
The Results: Unsurprising
130 concussions were sustained during the study period. There was no-to-minimal difference between groups in the number of days: a) participants reported concussion symptoms; b) spent in RTP protocol; or c) missed from participating soccer. There was also no difference in the risk of obtaining a non-concussive injury between the headgear and no headgear groups. In fact, these results rebuff the idea of “risk compensation” which suggests that players wearing headgear may play more aggressively due to the feeling of protection.
Differences between Certified Protective Headgear?
Those that wore headgear were able to choose which model they wanted to wear for the season as long as it met ASTM testing standards and were approved for use by the National Federation of State High School Associations. Interestingly, this study found differences in incidence of concussion between certified protective headgear – despite not specifically researching that question. For instance, the Storelli Exoshield had a 2.5% incidence of concussion rate whereas the concussion incidence rate for players wearing the Ultra Forcefield Sweatband was just over twice that at a rate of 5.4%.
The Gender Equation
It should be noted that, similar to other studies, concussion occurred at an increased rate amongst females than males. In fact, females suffered from concussion at twice the rate in comparison to males. The study’s authors suggest that these results should be interpreted with caution and should be further examined in future studies. In saying that, out of the 130 studies, 12 participants – 11 of which were female – were told by a medical professional that they could not return to soccer for the rest of the season. Not only is this a matter of increased incidence of concussion in females, but also increased severity of concussion in females in comparison to males.
It is important to examine female concussions specifically as well as include accelerometers and video footage in order to see whether headgear reduces impact forces. Furthermore, it may be important to ensure that only a single headgear model is used to determine its efficacy.
About The Author
Rebecca Babcock is a recent graduate of the University of Otago in New Zealand, completing a Master’s in Bioethics and Health Law. Her thesis examined the ethical and legal issues surrounding concussion management. She currently spends her time working for the Concussion Legacy Foundation – Canada as a programming coordinator and at Sunnybrook Hospital investigating concussion prevention, management, and education services. Her dream is to be a clinical ethicist at a hospital which she is starting to fulfill by volunteering as a bioethics assistant at Humber River Hospital in Toronto.
- Marar M, McIlvain NM, Fields SK, et al. Epidemiology of concussions among United States high school athletes in 20 sports. Am J Sports Med 2012;40:747–55.
- O’Connor KL, Baker MM, Dalton SL, et al. Epidemiology of sport-related concussions in high school athletes: national athletic treatment, injury and outcomes network (nation), 2011–2012 through 2013–2014. J Athl Train 2017;52:175–85.
- Khodaee M, Currie DW, Asif IM, et al. Nine-year study of US high school soccer injuries: data from a national sports injury surveillance programme. Br J Sports Med 2017;51:185–93.
- Comstock RD, Currie DW, Pierpoint LA, et al. An evidence-based discussion of heading the ball and concussions in high school soccer. JAMA Pediatr 2015;169:830–7.
- Schneider DK, Grandhi RK, Bansal P, et al. Current state of concussion prevention strategies: a systematic review and meta-analysis of prospective, controlled studies. Br J Sports Med 2017;51:1473–82.
- Benson BW, Hamilton GM, Meeuwisse WH, et al. Is protective equipment useful in preventing concussion? A systematic review of the literature. Br J Sports Med 2009;43(Suppl 1):i56–67.
- Daneshvar DH, Baugh CM, Nowinski CJ, et al. Helmets and mouth guards: the role of personal equipment in preventing sport-related concussions. Clin Sports Med 2011;30:145–63.
- Navarro RR. Protective equipment and the prevention of concussion – what is the evidence? Curr Sports Med Rep 2011;10:27–31