Has soccer become more dangerous?

Scoring a decisive 2-1 win over England in a dramatic Women’s World Cup semifinal match – and netting both of their goals via skillful “header” shots, no less – defending champions Team USA advance to play for their fourth World Cup title in the tournament final this Sunday, July 7.

Fan excitement for Women’s World Cup soccer is reaching a fever pitch – drawing record numbers of viewers for this year’s tournament in France, with a total of 1 billion viewers expected across platforms worldwide – and enthusiasm for playing the game is reflected in the breadth and depth of talented athletes taking the field. Globally, an estimated 30 million women play soccer today, and the elite-level players selected for World Cup competition are considered by some experts to be “the deepest and most talented” group ever.

As women’s soccer has become even more dynamic and fun to watch, has it also become more dangerous to play? Specifically with regard to concussions and head injuries?

In the United States, conversations around sports-related concussions often focus on athletes who play American football. To gain insight and answers about head injuries related to the sport the rest of the world calls “football,” we spoke with Dawn Comstock, PhD, associate professor of epidemiology at the Colorado School of Public Health.

Comstock has spent over a decade researching sports injuries across America in an effort to make sports safer for adolescent athletes. In 2014, she was one of five experts invited by the White House to meet President Obama and speak at the Healthy Kids and Safe Sports Concussion Summit. As part of her extensive research, Comstock developed High School RIO (Reporting Information Online), the country’s first national high school sports injury surveillance system, which collects athletic trainer-reported data from a large, nationally representative sample of U.S. high schools.

How prevalent are soccer-related injuries compared to injuries incurred by playing other sports? 

A soccer player goes down with a head injury in a game.

In 2017-2018, out of the 22 sports included in High School RIO, girls’ soccer had the second highest competition-related injury rate after football. The football competition injury rate was 14 injuries per 1,000 Athletic Exposures. (One high school athlete participating in any one practice or competition equals one Athletic Exposure, or “AE.”) The competition injury rate for girls’ soccer was 6 injuries per 1,000 AE, while boys’ wrestling, boys’ lacrosse, boys’ ice hockey, boys’ soccer, and girls’ basketball all had injury rates between 4 and 5 injuries per 1,000 AE.  However, during practice, the injury rate was lower in girls’ soccer than in football or wrestling and, again, similar to several other sports. So soccer simply is not as dangerous as the recent media has made it out to be.

Do youth soccer players suffer higher concussion rates than adolescents who play other sports?

In 2017-2018, girls’ soccer had the third highest competition concussion rate among the 22 sports in High School RIO (20.4 concussions per 10,000AE), but only the 5th highest practice concussion rate (1.9 concussions per 10,000 AE). Boys’ soccer had the 7th highest competition concussion rate (8.7 concussions per 10,000AE) and the 6th highest practice concussion rate (1.9 concussions per 10,000 AE).

To put this in perspective, football had a competition concussion rate of 39.1 per 10,000 AE and a practice concussion rate of 4.4 per 10,000 AE. Also, in all gender comparable sports, girls have higher concussion rates than boys.

Do soccer players who suffer concussions have longer recovery times than athletes who get concussions from playing other sports?

No. While we, and other researchers, have noted gender-related differences in the type of signs and symptoms athletes with concussions present with, and some researchers have reported that girls take longer to recover from concussions than boys, we have not seen any significant difference in type, number, or length of concussion signs and symptoms by sport.

Are soccer players more likely to suffer a concussion from “heading” the ball, or from head-to-head or head-to-body contact?

While heading the ball is the most common soccer-specific activity during which concussions occur (30.6 percent of all boys’ soccer concussions and 25.3 percent of all girls’ soccer concussions occurred when the player was heading the ball), the true culprit is actually athlete-to-athlete contact, which occurs in other phases of play as well as during heading. In fact, 78.1 percent of all boys’ soccer concussions and 61.9 percent of all girls’ soccer concussions resulted from athlete-to-athlete contact.

Remember, although soccer has become more and more aggressively played over time, most contact is still illegal by the rules of the game. Thus, if you really want to reduce concussions in soccer, you would be much more successful if you simply enforced the rules of play and decreased the amount of athlete-to-athlete contact than if you banned heading.

Have you recorded any data that show a change in concussion rates in states that have implemented guidelines to prevent/limit these types of injuries in soccer practice and matches?

We are conducting that study right now, but we don’t have results ready to share.

Are there any recommendations you would make, based on your research, for minimizing injuries and improving overall soccer safety for youth athletes?

Lower extremity (e.g., ankle and knee) sprains and strains are very common in soccer. Athletes should be well conditioned, as proficient as possible in soccer skills, and must be encouraged to follow the rules of the game and avoid foul play. Parents can make sure coaches are well trained and don’t run dangerous drills or push athletes beyond a safe limit. They can also be sure the league in which their child plays has well-trained refs who enforce the rules of the game.

Additionally, exertional heat events, while rare, are a concern. Athletes must stay hydrated and breaks must be provided in extreme temperatures. Athletes who experience any heat event must be cooled as quickly as possible; for minor events, moving them into shade/air conditioning and giving them cold fluids will likely be sufficient, but for serious events they should be immersed in ice water or have their armpits and groin packed with ice while EMS services make their way onto the field.