Redirecting the Debate about Concussions among Soccer Players

By Melissa Moore
Friday, January 1, 2016

For soccer players, reducing the likelihood of concussion goes well beyond avoiding ball heading — a research finding that can inform physicians’ recommendations to players and parents.

The risk of concussion in soccer is significant, and discussions as to the wisdom of frequent ball heading have circulated in the athletic and medical communities for years. A new study suggests, however, that a different focus could hold greater promise for injury prevention.

For a study published in JAMA Pediatrics in September, scientists at the University of Colorado examined longitudinal surveillance data collected from the 2005–06 through 2013–2014 academic years in a large, nationally representative sample of American high schools. Among reported concussions sustained during high school-sanctioned soccer games and practices, researchers found that although heading the ball was the most common soccer-specific activity related to concussion, athlete-to-athlete contact was the most frequent mechanism of concussion, accounting for 68.8 percent of concussions in males and 51.3 percent of females.

“You would reduce the number of concussions if you banned heading,” says Dawn Comstock, PhD, Associate Professor of Epidemiology at the University of Colorado School of Public Health and Associate Professor in the Department of Pediatrics at the University of Colorado School of Medicine. “However, it would be much more effective — and reduce the number of concussions dramatically — if you applied the current rules of the game but reduced athlete-to-athlete contact.”

A Broader Issue

Researchers are also gaining an expanded understanding of the cognitive risks associated with any blow to the head, including ball heading, even when the blow is nonconcussive. Anne B. Sereno, PhD, Professor of Neurobiology and Anatomy at the University of Texas Health Science Center at Houston, and a team of scientists used iPads to measure stimulus-driven reflexive point responses (Pro-Point) and goal-driven voluntary point responses (Anti-Point), both of which are thought to require cognitive function in the frontal lobe, among soccer players and nonplayers. The team found that soccer players, in general, had significantly slower responses than the control group in Anti-Point tasks, suggesting that even sub-concussive head injuries may have a cognitive impact.

“We don’t know the risks for the individual player yet,” Sereno says. “What I measured were small changes immediately following practice. We have the tool for the first time to start answering these basic questions and get a whole host of insights into whether or not these small changes matter.”

Physicians’ Role

Physicians can help parents and athletes understand the implications of concussions and reduce the chance of injury, Comstock says.

“Soccer is a wonderful way for kids to get physical activity and to incorporate movement into their daily lives,” she says. “All of us adults, physicians and parents included, should be working together to limit injuries in playing soccer. One of the main roles that physicians can have is ensuring that educational messages are getting out to parents and young athletes — that a concussion is a brain injury and needs to be taken seriously.”