title: An Evidence-Based Discussion of Heading the Ball and Concussions in High School Soccer.
abstract: OBJECTIVE
  Soccer, originally introduced as a safer sport for children and adolescents, has seen a rapid increase in popularity in the United States over the past 3 decades. Recently, concerns have been raised regarding the safety of soccer ball heading (when an athlete attempts to play the ball in the air with his or her head) given the rise in concussion rates, with some calling for a ban on heading among soccer players younger than 14 years.
  
  
  OBJECTIVE
  To evaluate trends over time in boys' and girls' soccer concussions, to identify injury mechanisms commonly leading to concussions, to delineate soccer-specific activities during which most concussions occur, to detail heading-related soccer concussion mechanisms, and to compare concussion symptom patterns by injury mechanism.
  
  
  METHODS
  Retrospective analysis of longitudinal surveillance data collected from 2005-2006 through 2013-2014 in a large, nationally representative sample of US high schools. Participants were boys and girls who were high school soccer players.
  
  
  METHODS
  Concussions sustained during high school-sanctioned soccer games and practices.
  
  
  METHODS
  Mechanism and sport-specific activity of concussion.
  
  
  RESULTS
  Overall, 627 concussions were sustained during 1,393,753 athlete exposures (AEs) among girls (4.50 concussions per 10,000 AEs), and 442 concussions were sustained during 1,592,238 AEs among boys (2.78 concussions per 10,000 AEs). For boys (68.8%) and girls (51.3%), contact with another player was the most common concussion mechanism. Heading was the most common soccer-specific activity, responsible for 30.6% of boys' concussions and 25.3% of girls' concussions. Contact with another player was the most common mechanism of injury in heading-related concussions among boys (78.1%) and girls (61.9%). There were few differences in concussion symptom patterns by injury mechanism.
  
  
  CONCLUSIONS
  Although heading is the most common activity associated with concussions, the most frequent mechanism was athlete-athlete contact. Such information is needed to drive evidence-based, targeted prevention efforts to effectively reduce soccer-related concussions. Although banning heading from youth soccer would likely prevent some concussions, reducing athlete-athlete contact across all phases of play would likely be a more effective way to prevent concussions as well as other injuries.
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora2Department of Pediatrics, University of Colorado School of Medicine, Aurora.
authors.forename: R Dawn
authors.initials: RD
authors.lastname: Comstock
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora.
authors.forename: Dustin W
authors.initials: DW
authors.lastname: Currie
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Pierpoint
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, Aurora.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Grubenhoff
authors.affiliation: Department of Communication, University of Colorado Denver.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Fields
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000453:epidemiology / Q000209:etiology* / Q000534:rehabilitation; D001924:Brain Concussion / Q000453:epidemiology / Q000209:etiology* / Q000534:rehabilitation; D002648:Child; D019317:Evidence-Based Medicine / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012916:Soccer / Q000293:injuries*; D013997:Time Factors; D014481:United States / Q000453:epidemiology