While much attention is paid to head injuries in football, the increased popularity of soccer, combined with some alarming injury statistics, has some saying that protective headgear should be a requirement in the sport.

In May, the mothers of two teenagers filed suit U.S. District Court in Pittsburgh after their daughters suffered concussions playing soccer.

The suit contends that the U.S. Youth Soccer Association failed to protect its players by mandating headgear of some kind, even after data showed headgear may have prevented injury.

Other states and organizations have taken steps to either mandate soccer headgear or tweaked rules so players can wear protective equipment if they so choose.

In 2013, the Princeton School District in New Jersey made headgear a requirement for several middle-school sports, including soccer.

In 2015 U.S. Soccer took measures to try and protect players by eliminating headers for players under 11 years old in practices and limiting practice time for headers to 30 minutes for players at the 12- and 13-year-old levels without making headgear a requirement.

Prior to the 2017-2018 school year, the National Federation of State High School Associations, governing body for athletic regulations for more than 19,000 schools in the country, allowed the use of soft-padded headgear, as long as it meets American Section of the International Association for Testing Materials standards.

Delaware acknowledged in 2008 the overall issue of concussions and head injuries in youth sports. It became one of the first states to pass a law pertaining to youth head injuries with the Concussions Protection in Youth Athletic Activities Act. The provisions include several protocols, including mandatory training for coaches, mandates on when a player should be removed from a game to be examined for a possible head injury and also when a player may return to practice or play.

What the numbers say

 

A long-term study of data from the U.S. Consumer Product Safety Commission done by the Center for Injury Research and Nationwide Children’s Hospital found that between 1990 and 2014 there was a 1,600 percent increase in concussions and head injuries among youth soccer players ages 7 to 17.

 

At the high school level, girls in particular are more likely to suffer a concussion in soccer than boys. An American Academy of Orthopaedic Surgeons study, beginning in 2006, found that while concussions were on the rise among boys and girls playing soccer, girls are more susceptible to concussions than their male counterparts. When the study began, more than 15 percent of injuries in girls soccer were documented as concussions, nearly double that for boys. 

 

Another study from High School Reporting Information Online found that girls are 25 percent more likely to suffer a concussion while playing soccer, compared to just 9 percent for boys.

 Preliminary findings in a University of Delaware study found repeated headers could cause balance difficulties. The study found that players who head the ball often may be susceptible to slight balance problems and other neurological deficits.

Led by John Jeka, a professor and chair of the Department of Kinesiology and Applied Physiology in the College of Health Sciences, the researchers studied 20 recreational and club soccer players from the university community, and players from Wilmington and Newark.

After answering questions on the amount of time they play and how many times they head the ball, players were tested under two conditions, one with electrodes placed behind their ears to make them feel like they were falling sideways and another without the stimulation.

The study found that players who were exposed to more repetitive head affects, such as headers, were more affected by the vestibular stimulation while walking.

 

What has caused the spike?

 

Many factors led to the increased number of head injuries in soccer.

For one, there are more players on the fields than ever before. The Youth Soccer Association reported recently that the number of youth soccer players nationwide has nearly doubled since 1990. In Delaware, according to Delaware Youth Soccer Association executive director Laura Sturdivant, there are about 8,000 registered players.

While many head injuries through contact with other players or with the ground, they can also come from the ball itself, according to Rob Vito, CEO of Unequal, a company that has made protective equipment since 2009.

“The soccer ball has been clocked from 40 to 80 miles per hour, even 90 miles per hour, which leaves players susceptible to sub-concussive hits,” Vito said. “It’s like hitting a hammer on a granite countertop, by the ninth or tenth hit you start to see the cracks, just like each time you’re getting hit by the ball.”

Another possibility, backed by some coaches, is how players are taught to play, especially in situations where they might use their head.

Sean McGuigan, boys head coach at Woodbridge Middle School, said players need to be taught the proper technique.

“They should also be taught to identify the difference between a ball that should be played with the head or settled with another part of the body,” he said.

Ivan Lay, girls varsity head coach at McKean High School, had similar thoughts and shared a way of training he and his staff employ.

“The safety of our athletes is our number one concern,” Lay said. “We spend at least one week of training, teaching our athletes how to approach and how to properly hit a ball with the head. We use balloons then transition to a deflated soccer ball. Next we use a fully blown soccer ball. We practice bouncing the ball off the wall and letting it bounce before we approach with the head.”

Lay is a proponent of allowing players to use headgear, and calls for relaxing penalties in certain situations.

“We let the athletes know that they have the choice of using headgear if they feel they need it," Lay said. “Accidental hits can happen. I suggest that protective use of the hands penalties such as yellow and red cards should be relaxed by the officials, especially during free kicks where a barrier is employed.”

 

Patrick Kilby is the head coach of varsity boys and girls soccer at Cape Henlopen, head coach of the SC Riptide U12 team, and the Henlopen Soccer Club player development program director. He said causes are tough to gauge.

At some levels, rules put in place to protect players may be hindering them when it comes to the maturation of skills, he said.

“I’m not opposed to [using headgear], if the coaches, player or parents think they need the extra protection, but it’s an issue that hasn’t really come up,” Kilby said. “Nationwide, U.S. Soccer has put in a rule that players aren’t able to head the ball until age 12. As a coach, you’re not really able to instruct heading of the ball until they’re of age.”

Kilby said at a young age, it might not be possible to teach players the proper techniques.

“Having the right posture and ability to do those things is so hard to do when you’re a younger player, you wonder if they’re going to be able to absorb the teachings,” Kilby said. “It’s really tough when you’re in that transition year and you start to instruct the use of heading for our players, but I respect the rule that says they can’t head the ball until age 12. At that age they can take the instruction.”

But without a firm handle on what has caused increased head injuries, Kilby believes it’s too hard to compare soccer to other sports.

“I’ve heard there’s statistics that say cheerleaders have just as many or even more concussions than football players. It’s really apples to oranges when you start comparing the concussions in soccer and, say, football,” Kilby said. “It’s hard to get a read on it, but if they did put a rule in requiring headgear we’d have to respect the rule. I’m not opposed to it, but I’m not going to come out and say it’s really needed.”

Brian Hurd, the boys soccer coach at Smyrna Middle School, is a parent of a player.

As his son grows with the game, the concerns about safety also grow. Hurd believes headgear shouldn’t be mandatory, but a choice by players or their parents until more information is in.

“Before we can make them mandatory we need to have a rating system or performance levels evaluated by an organization,” Hurd said. “Our shin guards are required to be certified, I’m not sure if this is being done for headgear, but it should be before it’s required.”

Hurd’s son suffered a concussion this past fall while playing soccer when he fell and hit his head on the ground. Incidents like this have Hurd and other parents looking for ways to protect their children.

“This made me think, as a parent, why is my child not wearing headgear?” Hurd said. “So we are discussing as a family; my wife is concerned of peer pressure, my son is concerned about comfort. So, we’ll be working through this as a family. Mandatory requirement would make my wife’s concerns go away, research in the different headgear would hopefully address my son’s concerns.”

 

Any downside?

 

While many believe headgear will only help players, those that have played the game and are around it daily believe making something like headgear mandatory won’t come without drawbacks.

Brad Mundy, a former player at St. Mark’s High School and High Point University, has his own experience with concussions. He has children of his own playing youth soccer in New Castle County.

Even after suffering several concussions in college due to head-to-head collisions, Mundy thinks headgear might exacerbate the problem.

“My opinion is that headgear would make the numbers higher as players would freely put their heads in harm’s way knowing they had the protection,” Mundy said. “Little kids, in my opinion, do not need the headgear just as much as they don’t need it in sports like basketball.”

Mundy acknowledges it could be useful at some positions.

“If anyone would be required to wear headgear in soccer, maybe the goalies,” Mundy said. “Most of their collisions are in the air and around the posts.”

McGuigan has his own thoughts. Because of the added cost, some players couldn’t afford to play if headgear is mandatory.

“It would be another piece of equipment for the players to buy,” McGuigan said. “Also, players who cannot afford the equipment will stop using their head when playing the game, which will hinder their development as a soccer player.”

 

Headgear studies

 

Representatives of Unequal Sports Technology believe their Halo headgear can help bring the tally of head injuries down.

Unequal’s big break came in 2010. It was asked to provide a sternum protector for Philadelphia Eagles quarterback Michael Vick. That weekend, Vick threw six touchdown passes in a 59-28 victory over Washington. After the game, Vick said the equipment made him feel “invincible.”

Unequal’s Halo headgear was first used by the United States Women’s Soccer team. They contacted the company about creating some kind of head protection after two players were knocked out of the lineup by concussions.

“They asked us to come up with a product. We came up with the Halo, found out what they liked and what they didn’t like,” said Vito. “The major challenge was it could not look like head protection, it had to look like a headband.”

After several years of trials, Vito believes the Halo now offers the best protection possible.

The headgear offers protection on the front, sides and back of the head, providing a cushion that can help absorb or spread out an effect.

“Our original headband was two inches wider and now it’s an inch and a quarter, so we slimmed it down,” Vito said. “Also, the players didn’t like the Velcro, so we eliminated that and made it just one piece so it will stretch into place instead of having to be adjusted.”

The Halo has also been studied independently, he said. Virginia Tech recently did a study testing 22 pieces of soccer protective headgear. Three were awarded the highest rating, five stars. Two of the three were different versions of the Halo. Virginia Tech concluded that both products reduced concussion rates by more than 70 percent. Overall, Unequal products filled five of the top seven spots in the tests.

According to Vito, the University of Wisconsin will publish findings in September where 3,000 soccer players using the Halo were studied. The researchers concluded it reduced concussion risk, he said.

Dr. Julian E. Bailes, a founding member of the Brain Injury Research Institute and Chairman of the Department of Neurosurgery and co-director of the NorthShore Neurological Institute in Evanston, Illinois, has endorsed the product after examining studies done by McGill University, Northern Kentucky University, the University of Pittsburgh, Virginia Tech and Wake Forest Center for Injury Biomechanics, among others.

Vito knows he is promoting a product his company sells. However, he said, it’s more than just another piece of equipment, it’s about players’ long-term health.

“These kids, many aren’t going to be pro soccer players, so our goal here is to allow them to do long division math with their grandchildren,” Vito said. “Among the e-mails and messages I get from people, they’re happy their daughter isn’t complaining about her head anymore; their son isn’t coming home and sitting in a dark room all night.”