Concussions are a growing concern in soccer, particularly those that occur from headers.

Why now? What does this mean for the future of soccer?

More Studies Means More Data, Not More Injury

Over the past 10 years, concussion diagnosis and treatment has evolved significantly.

Because there’s more research, there’s more data available to see more accurate rates of concussion and the after-effects. It’s still growing, so we still don’t know everything.

Keep in mind that more data does not mean higher incidence in recent years. It just means that we now know more than we used to.

Concussion in Soccer

Soccer is not a sport known for its concussions, particularly in youth sport. Incidence rates are low in young players, occurring only 0.19-0.27 times out of every 1000 per athletic exposure. (6)

However, it does make up for 22% of all injuries in the entire sport. (4)

That’s a big difference. There’s no research (to my knowledge) that explains this gap. But, it’s logical to think that older, experienced players are more aggressive and place their body on the ball more often.

That’s not inherently bad. In fact, that’s what older, experienced players SHOULD do.

However, like with any sport, more involvement and competition does increase injury risk. That’s where headers start to enter the chat.

More research means more data. So, we see more data on the causation of concussion.

Two studies, one observing middle-school girls and another observing high-school players, found that up to 30.6% of concussions are caused by headers. Girls tend to be more vulnerable to this injury. (3, 5)

Most heading-related concussions tend to occur when players are fighting for the ball in the air against an opponent, like during corners. Other types of concussions are traumatic injuries against another player, like an elbow to the head. (3)

Now that we know how heading-related concussions account for nearly one third of all concussions, research is trying to see how that statistic can change.

Will Soccer Change Because of Concussion Statistics?

Ah, a controversial question indeed.

We all know how annoying it is when FIFA tries to change rules every year. It’s hard to follow and it’s hard to understand why.

“Imperfection is part of the game! Stop trying to perfect the sport!”

It’s true – soccer is a simple game, and by trying to change too much, it becomes complicated. More rules take away freedom and creativity. Keep soccer how it is.

With that being said, should we change rules on headers to preserve players’ health? Do these statistics justify change?

To be honest, probably not (yet). At least, not in the elite levels. Injury is a risk in any sport and you can’t eliminate all risk.

Also, could you imagine how boring corner kicks would be?

Soccer isn’t known for concussion the way football or hockey is known for it. Instead, soccer is known for leg injuries like ACL tears and ankle sprains. Financially and statistically, it makes sense for teams to invest in prevention efforts of leg injuries over the rest.

This doesn’t mean that concussions don’t deserve attention. This is especially true as the topic of chronic traumatic encephalopathy (CTE) continues rear its ugly head in professional sport.

I suspect that prevention efforts against concussion will improve as more evidence regarding CTE is unveiled, but it will take years.

Chronic Traumatic Encephalopathy (CTE) and Heading

CTE is a neurodegenerative condition that arises after repetitive brain injuries and can cause neurodegenerative disease later in life.

The scary part of CTE is that it cannot be diagnosed in the living. It’s only diagnosed after death with an autopsy. This means that it’s hard, nearly impossible, to detect it before it’s too late. (1)

The massive movement in research between athletics and head trauma correlates with a similar movement between head trauma and neurodegenerative diseases (Alzheimer’s and Parkinson’s). This is not a coincidence.

Even though 30% of concussions in the studies above are related to headers, it’s impossible to understand how many of these header-related concussions can lead to CTE.

Even more concerning, there is emerging evidence which suggests that sub-concussive impacts, or head blows that do not cause concussion, can cause a cumulative injury. This means headers over a period of time can eventually cause brain injury and lead to CTE if not detected. (2)

This is all very new. For reference, the first confirmed case of CTE in a soccer athlete was Scott Vermillion who passed away in 2020. You can read more here.

Right now, the only way to combat CTE is through prevention.

CTE is the reason why studies are trying to push for safer heading practices, among other proactive changes toward prevention of brain trauma.

The concern is less about the immediate head trauma… it’s more about the future consequences of head trauma.

What Science Suggests

Science is our friend! It understands our love for soccer. That’s why researchers are trying to figure out how to mitigate risk but preserve the game.

Purdue University did a study investigating how to reduce the forces of a soccer ball’s impact with the head during headers.

“You can easily decrease the forces, and then the accelerations, just by changing the ball pressure and ball mass a little bit and make it essentially a much safer game,” stated Eric Nauman, professor of mechanical engineering at Purdue, “it’s actually not very hard.”

Here’s how.

PS: Send this to your coach!

Less Pressure

Did you know that soccer’s regulating bodies have guidelines regarding the air pressure in a soccer ball?

Ideal pressure for game play, according to FIFA, is between 8.5 psi and 15.6 psi.

Purdue University compared the impact of a ball at various pressures in FIFA’s psi spectrum. They found that, by inflating the ball only to the lower part of the psi spectrum (closer to 8.5 psi), forces are reduced by 20%.

That’s significant and can save a lot of brains.

Does your club or high school regulate the pressure of their soccer balls? If you’re not sure, ask. This is one way you can advocate for safer heading.

No Waterlogging

If it’s going to be a rainy game, Purdue says that it’s smart to keep some dry soccer balls nearby.

Waterlogged soccer balls can increase in weight, which can create more forceful impacts during heading.

In rainy weather, a new soccer ball should be subbed into the game periodically to keep the waterlogged ones off the field.

If you foresee a wet forecast, then request that coaches and refs have extra balls available during the game.

Respect the Sport

Fear of injury, including concussion, is real and valid.

Sport has consequences.

You could break bones while skateboarding. You could suffer a shark bite while surfing. You could dislocate joints during ju-jitsu.

Does it stop us from doing what we love? NO.

The consequence of withholding happiness is far worse than the potential consequence of an injury.

Injury risk should not deter you from sport. Just take precautions to ensure your own longevity.

Be smart. Use your resources. Advocate for safety. Respect your sport.

Citations

1. Alosco, M.L., Mariani, M.L., Adler, C.H. et al. Developing methods to detect and diagnose chronic traumatic encephalopathy during life: rationale, design, and methodology for the DIAGNOSE CTE Research Project. Alz Res Therapy 13, 136 (2021). https://doi.org/10.1186/s13195-021-00872-x
2. Bailes JE, Petraglia AL, Omalu BI, Nauman E, Talavage T. Role of subconcussion in repetitive mild traumatic brain injury. J Neurosurg (2013) 119:1235–45. doi:10.3171/2013.7.JNS121822
3. Comstock RD, Currie DW, Pierpoint LA, Grubenhoff JA, Fields SK. An evidence-based discussion of heading the ball and concussions in high-school soccer. JAMA Pediatr (2015) 169:830–7. doi:10.1001/jamapediatrics.2015.1062
4. Covassin, Tracey, C. Buz Swanik, and Michael L. Sachs. “Epidemiological considerations of concussions among intercollegiate athletes.” Applied neuropsychology 10.1 (2003): 12-22.
5. O’Kane JW, Spieker A, Levy MR, Neradilek M, Polissar NL, Schiff MA. Concussions among female middle-school soccer players. JAMA Pediatr (2014) 168:258–64. doi:10.1001/jamapediatrics.2013.4518
6. Pfister T, Pfister K, Hagel B, et al. The incidence of concussion in youth sports: a systematic review and meta-analysis. British Journal of Sports Medicine 2016;50:292-297.