Significant Increase in Concussion Rates Among High School Soccer Players in the US


Concussion rates increased in male and female athletes over 9-year study period.

A majority of injuries among high school soccer players in the United States occur in competitions as a result of player—player contact. Furthermore, concussion rates are increasing among both male and female soccer players.

Studies examining high school soccer injuries are sparse, with a majority conducted more than 10 years ago. Most of the studies focused on emergency department visits, were conducted during tournaments, or were restricted to specific geographic areas.

Concern is growing among parents and coaches regarding the risk of concussion associated with heading a soccer ball. As participation in high school soccer programs rises and as the potential long-term effects of injury continue to unfold, a need exists to understand the epidemiology of these injuries in order to direct targeted intervention strategies.

In a study published in theBritish Journal of Sports Medicine, investigators analyzed soccer injuries sustained by a nationally representative sample of high school athletes in the United States from 2005/2006 to 2013/2014. The primary goals of the study were to compare injury rates and patterns by type of athlete exposure, compare injury rates and patterns by gender, and evaluate injury trends over time.1

For the study, investigators used data obtained from the National High School Sports-Related Injury Surveillance System, High School Reporting Information Online (RIO). The prospective surveillance study included high schools with National Athletic Trainers’ Association (NATA)-affiliated, board certified athletic trainers (ATs), to report exposure and injury data for athletes participating in school-sanctioned high school sports.

Adverse events (AEs) are defined in High School RIO as a single athlete participating in a single practice or competition. These reportable injuries occurred as the result of an organized high school practice or competition, they required medical attention by an AT of physician, and they resulted in restriction of the athlete’s participation for at least 1 day beyond the data of injury, or since 2007/2008 were fractures, concussions, heat illness/injuries, or dental injuries. Injury rates were calculated per 1000 adverse events.

Overall, the results of the study showed that 6154 soccer injuries occurred over 2,985,991 AEs (injury rate of 2.06 per 1000 AEs). The rates of injury were found to be higher during competition than practice, and higher in girls compared with boys.

Nonconcussion injury rates among boys decreased significantly during the study period, while reported concussion rates increase significantly. Nonconcussion rates among girls were relatively stable, and reported concussion rates also increased significantly.

The most common injury mechanism that led to the most competition injuries were player—player contact, whereas noncontact injuries were the most common mechanisms among practice injuries.

In one-third of cases, recovery from concussions took less than 7 days. Injury patterns were similar between the genders with respect to the position played and location on the field at the time the injury took place.

The findings indicate that injury rates have changed over time, and injury rates and patterns vary by type of AE and by gender. The concussion rates increased significantly over the study period in both boys and girls. According to the authors, this may be due to better recognition of concussion symptoms and signs by medical and coaching staff, or the implementation of state concussion laws in the later years of the study. However, more research needs to be done to determine the precise reason for the increasing concussion rates.

Gaining a better understanding of the epidemiology of high school soccer injuries will drive more effective targeted injury prevention efforts, the study authors concluded.


1. Khodaee M, Currie DW, Asif IM, Comstock RD. Nine-year study of US high school soccer injuries: data from a national sports injury surveillance programme.British Journal of Sports Medicine.2016; pii: bjsports-2015-095946. doi: 10.1136/bjsports-2015-095946. [Epub ahead of print].

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