Youth Soccer Concussions: Removal From Play

| By Dr. Jennifer Hunnicutt

Study shows 40% of youth soccer players continued to play on the same day of their concussion

Concussion laws across the U.S. and Canada require athletes to be removed from play right away when a concussion is suspected. (1,2)

But how do we know if these laws are being adhered to?

A team of researchers at the University of Texas Southwestern Medical Center sought to answer this question. (3)

They reviewed medical charts of youth soccer players (≤18 years) who were diagnosed with a concussion by a single sports medicine physician in Texas. The soccer players were categorized into one of two groups: those who returned to play on the same day of a suspected concussion and those who did not.

Concussion Checklist For Parents and Athletes

Research Questions

  1. What percentage of youth soccer players were not removed from play after sustaining a concussion?
  2. What factors are associated with removal from play after sustaining a concussion?


40% continued to play after concussion. 

Of the 87 youth soccer players that were included in this study, 40% continued to play on the same day of their concussion.

Loss of consciousness and Hispanic ethnicity were associated with removal from play. 

Players who experienced loss of consciousness were more likely to sit out. Hispanic players were also more likely to sit out, but this could be due to the small sample size of Hispanics in this study. Future research should further investigate these trends in different ethnic groups to ensure equal access to care across groups.

Girls were 5 times more likely to continue to play.

An interesting and surprising finding was that girls were 5 times more likely to continue to play after a concussion compared to boys. Authors attributed this to: 1) potential decreased access to medical care for girls youth soccer, and 2) the competitive nature of girls soccer that stresses mental and physical toughness.  

Soccer players evaluated for concussion were more likely to be removed. 

Soccer players who were evaluated by a coach or medical professional immediately following injury were more likely to be removed from play. Unfortunately, the researchers don’t have more specific information about who (coach vs. athletic trainer vs. physician) made the decision to have athletes removed from play. 

Alarmingly, 20% of youth soccer players returned to play on the day of their concussion, even after concussion evaluation! Athletes who return to play after concussion are at heightened risk of prolonged recovery or more severe brain damage.


Significant progress has been made in terms of legislation to remove athletes from play post-concussion. But this study showed some concerning results regarding the 40% of youth soccer players, mostly girls, who did not adhere to concussion regulations. Even upon evaluation for concussion, 20% of youth soccer players were allowed to return to play on the day of their concussion. 

There are a few limitations of this study that should be addressed. First, it was a relatively small sample size consisting of only soccer players in a single location. Second, the soccer players were asked to recall their experiences, which can introduce error in the form of recall bias. And lastly, as previously mentioned, researchers did not have information regarding access to a medical professional and who evaluated/removed the soccer players.


  1. McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport-the 5(th) International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med 51(11): 838-847, 2017.
  2. Concussion.
  3. Zynda AJ, Sabatino MJ, Ellis HB, Miller SM. Continued Play Following Sport-Related Concussion in United States Youth Soccer. Int J Exerc Sci. 2020;13(6):87-100. Published 2020 Feb 1.
Dr. Jennifer Hunnicutt

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