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Player-to-Player Contact Found to Cause Most Concussions in H.S. Soccer

Banning headers in high school soccer may not be the most effective way to limit concussions among players, suggests a study published online Monday in the journal JAMA Pediatrics, as athlete-to-athlete contact was at fault far more often.

The study authors analyzed data from 2005-06 through 2013-14 in the National High School Sports-Related Injury Surveillance Study's online database, which taps a nationally representative sample of 100 schools with one or more National Athletic Trainers' Association-affiliated certified athletic trainers. Using that data, the authors compared the number of concussions boys and girls sustained while playing soccer to the number of athletic exposures—defined as one high school athlete participating in one school-sanctioned soccer practice or competition.

During the study period, girls sustained 627 concussions during 1,393,753 athlete exposures (a rate of 4.50 concussions per 10,000 AEs), while boys sustained 442 concussions during 1,592,238 athlete exposures (2.78 concussions per 10,000 AEs). Among athletes of both genders, contact with another player was the injury mechanism most often at fault for concussions. For boys, 296 of the 442 concussions (68.8 percent) occurred following contact with another player, while 326 of the girls' 627 concussions (51.3 percent) were after athlete-to-athlete contact.

In terms of soccer-specific activities, however, heading the ball was the activity most commonly associated with concussions. For girls, 157 concussions (25.3 percent) occurred following a header, while 137 of boys' concussions (30.6 percent) resulted from headers. The injury mechanism most commonly associated with heading-related concussions was contact with another player, representing 107 of 137 concussions for boys (78.1 percent) and 100 of 157 for girls (61.9 percent).

Effect on Proposed Header Bans

The results led the authors to suggest "previous researchers discussing the safety and risk of soccer headers may have been asking the wrong question," as "banning heading is unlikely to eliminate athlete-athlete contact or the resultant injuries."

"We postulate that banning heading from soccer will have limited effectiveness as a primary prevention mechanism (i.e., in preventing concussion injuries) unless such a ban is combined with concurrent efforts to reduce athlete-athlete contact throughout the game," the authors concluded.

They concede that banning heading "may be a secondary prevention mechanism (i.e., as a way to reduce the severity of the soccer concussions that occur)," but insist reducing player-to-player contact would have more wide-reaching effects.

Last year, a group of former U.S. women's soccer stars, including Brandi Chastain, Cindy Parlow Cone, and Joy Fawcett, teamed with the Sports Legacy Institute and the Institute of Sports Law and Ethics to announce an initiative calling for all middle school soccer teams and under-14 youth-soccer leagues to ban headers.

"As a professional and now a parent and coach, I believe that the benefits of developing heading skills as children are not worth the thousands of additional concussions that youth-soccer players will suffer," said Chastain, who hammered home the game-winning penalty shot in the 1999 FIFA Women's World Cup final, in a statement at the time. "As a parent, I won't allow my children to head the ball before high school, and as a coach I would prefer my players had focused solely on foot skills as they develop their love of the game. I believe this change will create better and safer soccer."

The JAMA Pediatrics study only examined data from high school soccer teams, which wouldn't fall under the header ban that Chastain and Co. have endorsed. The findings of this study certainly provide some additional food for thought, however.

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