Concussions in Soccer
Rate of concussions
Research has shown that concussion rates in soccer are comparable to those of other contact sports such as American Football and Ice Hockey, which are typically considered more dangerous and high-risk sports. As high as 22% of all soccer injuries are concussions.
Guidelines on headers
United States Soccer Federation
Since 2016, the United States Soccer Federation is recommending, and US Club Soccer is requiring immediately, new rules relating to heading, which include, but are not limited to:
Players in under-11 programs and younger shall not engage in heading, either in practices or in games.
Limited heading in practice for players in under-12 and under-13 programs. More specifically, these players shall be limited to a maximum of 30 minutes of heading training per week, with no more than 15-20 headers per player, per week. There are no heading restrictions in games.
Scottish Football Association
Since 2020, the Scottish Football Association has limited heading in youth soccer.
The Scottish Football Association recommends no heading practice in children’s football (primary school age children).
The Scottish Football Association recommends a gradual approach to heading in the youth ages (secondary school age children).
The Scottish Football Association recommends using the lowest ball pressure permitted by FIFA rules so as to not over inflate the balls.
According to a 2012 literature review, the size and inflation pressures of soccer balls used in youth soccer should be age-appropriate.
"The size of the soccer ball used must be age-appropriate. This is particularly important for children who, because of their inexperience at heading and immature skull and neck anatomy, have been suggested to be more at risk of concussion. In addition, appropriate inflation pressures of soccer balls need to be ensured as it has been suggested that hyperinflation may be responsible for headache and concussion."
Female Soccer Players
A research study of more than 80,000 high school soccer athletes in the U.S. found that the risk of documented concussion was 1.88 times higher among female soccer athletes than males. These female soccer players were nearly twice as likely to suffer concussion compared to the male soccer players.
Heading in Soccer
Approximately 30% of concussions in high school and middle school soccer occur during a heading movement, when players attempt to head the ball. Concussions are more likely to occur during this heading movement than during any other movement in soccer.
The majority of these heading-related concussions occur when players make contact with another player or with the ground. This is because when soccer players jump up in an attempt to head the ball, they can collide with an opponent’s head, elbow, or another body part. Or, they may fall and make contact with the ground.
Still, research shows that approximately 15 to 30% of heading-related concussions occur when a player makes direct contact solely with the soccer ball.
Causes of concussion
Research has shown that player-to-player contact (collison) is the principal cause of concussions. Player-to-player contact includes head/head, head/elbow, and head/knee contact.
In addition to player-to-player contact, head/ground & head/ball contact also lead to concussions.
Effects of heading
Intentional heading is defined as when a player ‘intentionally’ or purposely makes contact with the soccer ball using their head. Intentional heading is in contrast to unintentional heading when players are unknowingly hit in the head with the ball (e.g. kicked ball hitting a player in the back of their head).
One study suggests that “intentional heading in soccer represents a form of repetitive subthreshold mild brain injury over time and could be a cause of chronic traumatic encephalopathy (CTE).” However, this possible cause-and-effect relationship between heading and CTE remains hypothetical until further research is conducted.
Another study states that “to date, it remains unknown whether intentional heading in football represents a form of repetitive minor injury and as such a cause-and-effect relationship between headers and possible late brain damage remains hypothetical.”
Neverthless, younger soccer players may be more vulnerable to heading and its potential effects. Youngers players have brains that are still maturing and possess necks that are typically weaker. Additionally, they have not yet mastered the heading technique.