Protective Soccer Headgear

The question of protective soccer headgear is often distilled into a single question: To Dork Out or Not To Dork Out?

You’ve heard the discussions on the soccer sidelines, with one party defiantly stating, “Nobody wears soccer headgear” versus the other party saying, “You are going to be safe and wear a soccer helmet, whether you like it or not!”

Let’s try and remove the emotion, and fashion, aspect from this and look at a couple of scientific studies. Glance down and read the bold highlights to draw your own conclusions on the safety of soccer headgear.

Protective Soccer Headgear in Four Easy Steps

If you don’t want to read it all, here is the short-attention span version:

1. Wear a protective soccer headband

2. Use proper technique when heading a soccer ball

3. Don’t argue with your parents

4. Use some commonsense, anything hitting your head isn’t good for you or your brain

Soccer Head Injuries And Female Players

First, a study entitled, “The effect of protective headgear on head injuries and concussions in adolescent football (soccer) players,” by Delaney JS, et al at the McGill Sport Medicine Clinic in Montreal Canada studied female soccer players aged 12-17 years.

In the population studied, 47.8% had experienced symptoms of a concussion during the current football year. 26.9% of athletes who wore headgear (HG) and 52.8% of those who did not wear headgear (No-HG) had concussions. Approximately 4 out of 5 athletes in each group did not realize they had suffered a concussion. More than one concussion was experienced by 50.0% of the concussed HG athletes and 69.3% of the concussed No-HG group. 23.9% of all concussed players experienced symptoms for at least 1 day or longer. Variables that increased the risk of suffering a concussion during the 2006 football year included being female and not wearing headgear. Being female and not wearing football / soccer headgear increased the risk of suffering an abrasion, laceration or contusion on areas of the head covered by football headgear.

Delaney concluded that adolescent football players experience a significant number of concussions. Being female may increase the risk of suffering a concussion and injuries on the head and face, while the use of soccer headgear may decrease the risk of sustaining these injuries.

The Use Of Soccer Headgear In Soccer Players

Second, the Journal of Athletic Training discussed the use of headgear for soccer players. And, to quote their soccer head gear findings, this is what they said: “ The use of headgear for soccer athletes is a controversial topic. Although some advocate the use of protective headgear for goalkeepers, others have stated that protection for all athletes on the field should be a lightweight, soft-shell material. This equipment should fit snugly across the scalp and “absorb and dissipate energy” from soccer-ball impact. The Protector headband showed the greatest dissipation of force through decreased time to peak force and impulse. In spite of these findings, several other factors, such as ball size and proper heading technique, warrant attention when considering the safety of the soccer athlete. The younger soccer athlete should use the smallest ball size, size 3, up to the age of 9 years, at which point a size-4 ball can be used. Once the athlete has turned 14 years old, use of the largest size, a size-5 ball, can begin.  The smaller ball size not only protects the athlete from impact with a heavier object, but it also affords greater control of the ball for the athlete who is still developing physically.

In all age groups, however, proper heading technique is the athlete’s greatest defense against injury from heading a ball. Many coaching books do not address soccer heading until the age of 12 years, and some physicians recommend waiting until 14.  The younger soccer athlete who performs head balls may be at greater risk for injury because of smaller size, less muscular development, and a less skillful heading technique. Once soccer athletes begin heading, coaches should instruct them to strike the ball just below the hairline on the frontal bone, the thickest part of the cranium, while simultaneously isometrically contracting the neck musculature.30 To counteract the force of the impacting ball, the athlete should apply a counterforce generated by moving the trunk into flexion.  By performing the maneuver as described, the body of the athlete becomes a single, rigid unit that lowers the risk of injury by decreasing the linear and rotational accelerations on the head as forces generated by the ball are dispersed across the athlete’s body.

If a forcefully kicked soccer ball collides with the head of an unprepared athlete, he or she may be at risk for concussion. In this scenario, the neck musculature does not maintain the head in a rigid position at ball impact, forcing the cranium into the brain and resulting in a coup injury. If the brain then rebounds into the opposite side of the inner cranium, a contrecoup injury can result.

Although our findings indicate that headgear designed for the soccer athlete may be effective at reducing the peak force and impulse from an impact, further testing is warranted before soccer officials require them for regular play. The flat surface of the force platform is not representative of the human head, and the distance between the Soccer Machine and the force platform was closer than what normally occurs in practice and game situations. Finally, we tested only a limited number of variables for these soccer headbands under one speed. Collection of both linear and rotational acceleration variables may provide beneficial information on the headbands’ ability to protect the brain from trauma. As such, conducting in vivo studies during both soccer games and practices in which accelerations of the head are recorded and analyzed is warranted.

Soccer officials should also consider several other questions that may alter game play should soccer headgear be mandated. The potential exists for the headgear to influence game outcomes by altering heading ball control or even player comfort. Also, soccer athletes may gain a false sense of security while wearing the headband and become overly aggressive when heading, thereby increasing their risk of injury.

Soccer is played at all age and skill levels around the world. The ball speed at which data on headband efficacy we collected seems to support the use of headbands in decreasing the force of an impacting soccer ball. Under the conditions of this study, the Protector headband appeared to perform the best across all variables. This headband, however, may be the most effective at decreasing the measured variables. Before a recommendation or mandate of soccer headgear use by all players on the field is made, further investigations of these products should be conducted to directly address their clinical utility.

Protective Headgear for Soccer Players: An Overview

Michael Gray et al, at  Northern Kentucky University, did a review of soccer headgear safety. In part, they found the following when studying soccer protective headgear and soccer:

Protective soccer headgear gained international visibility during the 2003 Women’s World Cup and the 2004 Athens Olympics.   In the United States itself, the United States Soccer Federation, National Collegiate Athletic Association, and National Federation of State High School Associations all now permit the use of protective headgear in soccer (Parents, tell your kids that soccer headgear is approved).

The U.S. Soccer Federation, which permits protective headgear but does not endorse it, fears that wide use of the gear would undermine the assertion that soccer is a safe alternative to football. (Ahh, the politics of soccer) Jeff Skeen, founder of one soccer headgear company, states “Soccer officials are trying to thwart the evolution of headgear in soccer because they think it will scare soccer moms away from the sign-up table. And they also think [headgear use] could be viewed as an admission that heading the ball itself is dangerous.”

Of course, money is always an issue in that some headgear manufacturers pay professional players the equivalent of $50–$100 per game to endorse their products and furthermore have paid some state soccer associations $4,000–$10,000 for endorsements.  But several independent studies have shown that head injuries, particularly concussions, have become a significant issue in soccer. The Centers for Disease Control and Prevention has reported that doctors treat more than 200,000 children annually for soccer-related injuries including concussions.

A survey of college-age players (athletes 18 to 22 years old) conducted by Boden et al (cited in Kirkendall & Garrett, 2001). demonstrated that a team can anticipate having one player each season sustain a concussion. However, concussions reported for Boden and colleagues’ survey were largely due to game situations not involving purposeful heading of the ball. Kirkendall and Garrett have stated (2001) that 4%–20% of all injuries in soccer are “head injuries,” under which term they include concussions, nasal fractures, injuries of the eye, lacerations, and contusions.

Powell and Barber-Foss (cited in Kirkendall & Garrett, 2001) reported that mild traumatic brain injuries account for 3.9% of all injuries in boys’ scholastic soccer and 4.3% of all injuries in girls’ scholastic soccer. Powell and Barber-Foss’s ongoing survey of high-level youth soccer players (12 to 18 years old) in North Carolina to date shows that about 15% of all injuries were to the head (though these were not solely concussions) and involved player-to-player or player-to-ground contact (Kirkendall & Garrett, 2001). The researchers noted that, “The most frequent mechanism of injury was head-to-head contact, followed by head-to-ground and then head-to-other body part (e.g., foot, knee, and elbow). Importantly, purposeful heading was never a mechanism of injury, but injuries did occur when the player was accidentally struck by the ball (the head and neck were not stabilized).”

Delaney’s study of 328 Canadian university football players and 201 university soccer players reporting for training in fall 1999 found that 70.4 % of the football players and 62.7% of the soccer players had experienced symptoms of a concussion in the previous year. Delaney said that concussions are a proven problem, one that, in the lab, protective headgear alleviates. He questioned why players are not being offered the protection (Longman, 2004). “Girls, in general, are more prone to concussions in soccer, and they may be more aware of the possible benefits of wearing headgear,” Delaney, who practices at McGill University’s sports medicine clinic, has noted (Delaney, 2008).

It appears that definitive evidence for one side or the other in the soccer headgear controversy is not available. But there does seem to be solid evidence that more concussions occur as the level of play and competition advances (Kirkendall & Garrett, 2001). The use of protective headgear has grown most significantly, however, among youth players (age 12 and younger), even though players at this level are least likely to engage in play that would lead to concussions (U.S. Soccer Federation Statement on Head Injuries, 2005). The U.S. Soccer Federation has said marketing of protective headgear is primarily to children, even though the incidence of concussion in players under 12 is low.

Manufacturers of soccer headgear have designed the gear to decrease the forces associated with heading and assume that doing so reduces the risk of head trauma. To date, however, only one study has been conducted to evaluate the gear’s efficacy. The most substantial finding of that study was that application of the headgear was linked to a decrease in the peak force of impact from a soccer ball traveling at 56.4 kph (35 mph). This force was approximately 112.5% lower (nearly 400 N), as compared to the unprotected force platform (Broglio, Ju, Broglio, & Sell, 2003). No differences were seen among the different brands of headgear; the decrease measured in the peak force suggests that a soccer player using any of the tested brands of headgear would be subjected to lower forces. Naunheim et al. (cited in Broglio et al., 2003) reported a similar decrease, when soccer headgear was used, in peak acceleration from a high-pressure soccer ball traveling at 34 mph (54.72 kph).

The founder of a company based in San Diego, California, said he had sold 100,000 pieces of headgear. The gear resembles an enlarged headband and covers the forehead, temples, and occipital bone in back of the head. Made of shock-absorbing foam between an outer layer of Lycra and an inner layer of sweat-absorbing polypropylene, the device weighs less than 2 oz. The company does not claim the gear prevents concussions, but rather that it can reduce by up to 50% the peak impact forces occurring in typical collisions when a player’s head strikes the ground or goal post or another’s head or elbow (Longman, 2004).

Delaney has argued that such headgear could also protect those players who are designated as headers, particularly at the elite level (at that level, such a player may head the ball up to 10 times per game). Delaney has been involved in drafting the Canadian Academy of Sports Medicine’s position paper on the prevention of head injuries in soccer (Robillard, 2004). But Ottawa-based orthopedic surgeon Rudy Gittens, who chairs the Canadian Soccer Association’s sports medicine committee and is furthermore a member of FIFA’s sports-medical committee, said to date no scientific evidence “conclusively” shows that purposefully heading the ball leads to concussions. Gittens, head of the medical commission of one of the six FIFA continental governing bodies, the Confederation of North, Central American and Caribbean Association Football or CONCACAF, said he is unaware of any scientific studies supporting use of soccer protective headgear to prevent concussions (Robillard, 2004).

A clinical professor of sports medicine at UCLA, Gary Green, has pointed out that, while there is “no evidence” headgear helps, there are theoretical grounds for questioning whether headgear use might actually hurt some players. For example, the headgear could produce a false sense of security in players, leading them to rely on a device instead of proper medical evaluation after suffering a possible concussion. Or headgear use could contribute to feelings of being invincible that promote recklessly aggressive play, a phenomenon known as the Superman effect. Green, who serves on the U.S. Soccer Federation’s medical advisory committee, said headgear use should be better studied before players “take a chance” by using it (Longman, 2004).

There is much to learn about headgear. A recent study sponsored by FIFA’s sports medicine committee concluded that headgear has a negligible effect in head-to-ball impacts but does provide “measurable benefit” in subconcussive head-to-head impacts. One still-unanswered question—and the most important—is the extent to which soccer protective headgear diminishes risk of concussion, if indeed it does. The U.S. Soccer Federation’s own sports medicine committee continues to monitor the available literature and encourage further research into, for example, whether decreasing impact force translates into decreasing concussions or whether using headgear gives players a false sense of security or causes them to play unusually aggressively (U.S. Soccer Federation Statement on Use of Padded Headgear, 2005). In the mean time, for those who do use protective headgear, it is important to remind players, coaches, and parents that headgear is not a substitute for proper medical evaluation and treatment of possible concussions. Consultation with a doctor is always a best first step when any sort of head injury occurs (U.S. Soccer Federation Statement on Use of Padded Headgear, 2005).

Around the world, players of all ages and skill levels play soccer. Available data on the efficacy of soccer protective headgear may suggest, in light of the relatively ordinary ball speed employed in the research, that use of headgear decreases the force of an impacting soccer ball and thus offers typical players protection. But before any recommendation or mandate is issued for all players to use soccer protective headgear on the field, further investigation of these products should directly address their clinical utility (Broglio et al., 2003).

Here are references on protective headgear for soccer players:

References

Broglio, S. P., Ju, Y., Broglio, M. D., & Sell, T. C. (2003). The efficacy of soccer headgear. Journal of Athletic Training, 38(3), 220–224.

Delaney, J. S. (2008). Canadian study examined more than 260 adolescents playing club soccer. British Journal of Sports Medicine, 42, 110–115.

Dick, R., Putukian, M., Agel, J., Evans, T. A., & Marshall, S. W. (2007). Descriptive epidemiology of collegiate women’s soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 through 2002–2003. Journal of Athletic Training, 42(2), 278–285.

Francois, M. (2006). DJ Orthopedics to offer soccer headgear in response to new ASTM [American Society for Testing and Materials] Sports Safety Equipment Standard. Retrieved February 23, 2008, from http://investors.djortho.com/releasedetail.cfm?ReleaseID=221887

Kirkendall, D. T., & Garrett, E., Jr. (2001). Heading in soccer: Integral skill or grounds for cognitive dysfunction? Journal of Athletic Training, 36(3), 328–333.

Longman, J. (2004, November 27). Soccer headgear: Does it do any good? The New York Times. Retrieved December 30, 2008, from http://www.nytimes.com/2004/11/27/sports/soccer/27soccer.html?pagewanted…

Robillard, S. (2004). Safety in soccer: Protective headgear gets kicked around by advocates and critics. Living Safety, 48(2). Retrieved February 25, 2008, from http://www.safety-council.org/info/sport/soccer-ls.html

To avoid soccer head injuries, soft protective headgear is only effective solution, study shows. (2007, July 14). Science Daily. Retrieved February 24, 2008, from http://www.sciencedaily.com/releases/2007/07/070712134638.htm

U.S. Soccer Federation statement on head injuries in soccer and padded headgear. (2005). Retrieved March 11, 2008, from the U.S. Soccer Federation website: http://www.ussoccer.com/articles/viewArticle.jsp_145974.html