‘Protective’ headgear does not prevent sport-related concussions in soccer players, UW study shows

Published this week in the British Journal of Sports Medicine, the study is the first of its kind to provide rigorous, scientific evidence to guide clinical recommendations about the use of protective headgear to reduce sports-related concussions in adolescent soccer players.

“Decisions about the health and well-being of our student athletes should always be based on strong scientific evidence instead of strategic marketing messages designed to sell products,” says Tim McGuine, PhD, principal investigator of the study and distinguished scientist in the Department of Orthopedics and Rehabilitation at the UW School of Medicine and Public Health. “While it may seem reasonable to assume that using headgear in a contact sport like soccer is better than wearing no headgear at all, our study proves that assumption may not be accurate.”

Researchers enrolled 2,766 high-school soccer players (ages 14-18, grades 9-12) from 88 high schools in the Midwest, with a total of 62 male teams and 88 female teams participating in over 151,000 soccer practices and games. Half of the schools were assigned to the intervention group, which required players to wear protective soccer headgear for all practice and competitions. Players had the choice of five different models of headgear, all of which met specific laboratory testing standards. The control group did not wear any headgear at all.

Of the 130 athletes who sustained a sport-related concussion during the study, 68 were part of the intervention group and 62 were from the control group. The total days off from playing soccer due to a concussion did not significantly differ between the two groups either.

It should be noted, however, that even though all of the headgear used in this study is currently allowed for use in high school players, the rate of a sport-related concussions sustained by male and female players wearing specific headgear models varied a great deal. The authors found that the rate of these injuries ranged from 2.7% to 5.9% depending on the type of headgear worn by the players.

Head-to-player contact results in more concussions

Most previous studies that examined the efficacy of soccer headgear were carried out in laboratory settings, during which researchers used the impact of a soccer ball to the head as the possible injury-causing mechanism. But McGuine says that study design may not accurately capture what actually happens on the soccer field. During the UW study, only 35 percent of the sport-related concussions recorded were a result of a player heading a soccer ball, while head-to-player contact was by far the most common mechanism of the injuries.

“Our results are noteworthy not just because of the large sample size and the multiple styles of headgear we used, but also because we used licensed medical professionals in the field to record the onset, duration and resolution of each of the concussions sustained by study participants,” McGuine says. “This gave us the most realistic data possible, which will also give parents and coaches the info they need to make the most responsible and well-informed decisions before sending their kids out onto the pitch.”

A concern for many soccer purists is that wearing headgear would change the game and cause players to sustain other injuries because they take more risks than if they were not protecting their head. The authors did not find any difference in the frequency and severity of other soccer injuries between the players in the two groups.

Concussions more frequent among females

An important finding that was not part of the study’s initial focus is that sports-related concussions occurred at more than twice the rate among females than males. McGuine says he hopes this study will inform future research efforts that examine this topic in greater detail.

“The soccer community needs to fully recognize the high rate of these concussions in female players and take steps to address this issue. If headgear isn’t the answer, then the soccer community needs to examine whether rule changes, stricter penalty enforcement, fewer matches or specific player training can reduce the high number of [sports-related concussions] that occur in female players.”

Funding for this study was provided by a $300,000 grant from the National Operating Committee on Standards for Athletic Equipment.

Other researchers in the study include:

• Eric Post, PhD, School of Exercise and Nutritional Sciences at San Diego State University
• Alison Brooks, MD, MPH, Stephanie A. Kliethermes, PhD, Adam Pfaller and Allison Schwarz, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison
• Scott Hetzel, Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison.