Heading takes the heat in youth soccer, but limiting rough play might be a better way to prevent concussions and other injuries, a nine-year study of U.S. high school games suggests.
More than 1 in 4 concussions studied occurred when players used their heads to hit the ball. But more than half of these heading-related concussions were caused by collisions with another player rather than with the ball.
These collisions included head-to-head, elbow-to-head and shoulder-to-head contact, said Dawn Comstock, a University of Colorado public health researcher who led the study.
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There have been recent calls to ban or limit heading in youth soccer, particular among players younger than 14, because of concerns about long-term effects of concussions and repeated brain trauma. Women's soccer stars including 1999 World Cup star Brandi Chastain are among supporters of a ban in kids' soccer.
But says Comstock: "If the rules of soccer were simply enforced better, we would actually be more successful in reducing concussion rates."
Rough play has become more common at all levels of soccer, but it violates rules that prohibit most player-to-player contact on the field, she said.
At the Game On Arena in far west Fort Worth on Monday, soccer players from youngsters to teenagers were taking part in the Fort Worth Football Club's summer soccer camp. The dozens of soccer players worked on their skills and drills.
Frank Remmel runs the camp and agrees with the study's findings that enforcing the rules will greatly improve player safety.
"Enforcing the rules is a critical part of their safety," Remmel said. "What referees are finding out and coaches are aware at this point is let’s be sure that we enforce the rules. That way we can make sure concussions aren’t prevalent in our sport."
Remmel says in addition to enforcement of the rules is the training of players to know how to play correctly and safely.
"How to go into a tackle, what part of the body is used in a tackle," Remmel said. "You know, fair play. Referees enforcing the dangerous play, the rough play."
Remmel finds the study is just another tool to help make the game safer as it continues to grow in popularity.
"I think the more education we get the off better we’re going to be as coaches, referees and parents," he said.
Five things to know about the study, published Monday in the journal JAMA Pediatrics:
The researchers looked at 2005-14 nationwide sports-injury data from a nationally representative sample of 100 public and private high schools. The study included older teens and some middle-school aged kids younger than 14 who played at the high school level.
More than 1,000 concussions occurred in boys and girls during soccer games and practices in the study years. Concussions in girls were more common, with a rate of almost 5 per 10,000 games and practices, versus almost 3 per 10,000 for boys.
Heading was the most common activity during which concussions occurred, followed by defending, general play, goaltending and chasing loose balls. Player contact caused almost 70 percent of boys' concussions and just over half of those injuries among girls. Close to 30 percent of girls' concussions were caused by heading, versus almost 17 percent for boys.
Concussion rates increased during most study years among girls and boys. Rates of concussions resulting from heading increased among girls but not boys.
The researchers note that soccer has long been considered safer than other youth sports and has increased in popularity since 1969, when only boys played at the high school level.
Bob Colgate, sports medicine director for the National Federation of State High School Associations, said the study highlights why soccer rules need to be enforced. He said caution against fighting and reckless play will be highlighted by the group's soccer rules committee for the upcoming season. "Players, coaches, game officials and spectators must work together to model and demonstrate sportsmanship and fair play, to minimize risk and maximize participation," Colgate said.
Chris Nowinski, co-founder of the Sports Legacy Institute, noted that a degenerative brain disease linked with repeated head blows and more often associated with football has recently been found in autopsies of professional soccer players. The new study adds to concerns that have been raised about rough play, he said.
The Boston-based institute is a nonprofit education and advocacy group that funds research on preventing and treating concussions and other brain trauma. It also advises the National Football League and groups involving other contact sports including rugby and lacrosse.
"It's important that we take a close look at how we can make the game of soccer safer," Nowinski said.