Spike in Reported Youth Soccer Concussions a Sign of Better Diagnosis

 Two youth soccer players landed in the orthopaedic office of Steven E. Rokito, MD, last week. Their circumstances couldn’t have been more different.

A 13-year-old boy fell and hit his head hard against the ground while a girl, 17, collided with an opposing player as they launched skyward to head the soccer ball in the same instant.

The result: Each was diagnosed with a concussion.

Nothing has done more to illuminate the concussion problem in sports than the attention it has gotten in football, and the result has been a broad range of awareness and safety initiatives from the NFL on down to Pop Warner. But you don’t have to be broadsided by a charging linebacker to suffer a debilitating head injury.

Now researchers have uncovered a spike in the number of concussions reported among youth soccer players nationwide over a 25-year period ending in 2014, sounding the alarm for a sport that can be as physically-jarring as football – just without the pads.  

“The spike in numbers makes you think more about what preventative efforts we can look into to lower the incidence,” said Dr. Rokito, chief of sports medicine at Long Island Jewish (LIJ) Medical Center in New Hyde Park.

The study, published this month in the American Academy of Pediatrics, examined data from emergency departments nationwide culled by the National Electronic Injury Surveillance System and soccer participation numbers.

It found about 2,995,765 soccer players between ages 7-17 went to emergency departments from 1990-2014 to get treatment for soccer-related injuries. Contact injuries – either with a player or the ball – were the most common at 35 percent.

While concussions were found seven percent of the time, the annual rate of youth soccer players diagnosed with concussions overall has spiked a whopping 1,596 percent, according to researchers at the Center for Injury Research and Policy and The Ohio State University College of Medicine.

“You read the article and go, ‘Whoa! How are kids getting so many more concussions?’” said Randy Cohn, MD, an orthopaedic surgeon at Northwell Health. Dr. Cohn also serves as the associate head orthopaedist for the New York Cosmos of the North American Soccer League and works with several New York high schools.

“I will counter that point,” Dr. Cohn said. “It’s not that soccer is getting more dangerous. It’s not that there’s a drastic increase in head injuries. A big part of it is diagnosis. In 1990, we were not diagnosing concussions on youth soccer players.”

Concussion diagnosis and management was in its infancy nearly three decades ago, Dr. Cohn explained.

“In 1990, unless there was a loss of consciousness, we weren’t calling it a concussion,” said Dr. Cohn, who will lead a seminar on common musculoskeletal athletic injuries Oct. 27 at Long Island Jewish Valley Stream Hospital. To Register Click Here. “It wasn’t being diagnosed. Our threshold for diagnosing and treating a concussion is so much more precise now. Everything is on the side of caution.”   

Yet the study numbers are alarming. There were 250,000 sports/recreation-related concussions logged at emergency departments nationwide in 2007, double the number from a decade earlier, the study found.

Dr. Cohn and Dr. Rokito believe the jump in reported concussions is at least partly attributable to better diagnostics and awareness.

“I think we’re all acutely more sensitive to evaluating and understanding what a concussion is now than we did 20 years ago. So that could be a factor,” Dr. Rokito said. “The sheer number of kids playing soccer could also be a factor.”

he sport has grown dramatically. About 3 million participants 19 and younger played organized soccer in 2014, nearly double that of 1990. Governing bodies such as U.S. Soccer, cognizant of the concussion crisis, recommended new rules this year that ban headers for players 10 and under and limit the maneuver in practice for 11- to 13-year-olds.   

While headgear is another innovation that may come to youth soccer in time – helmets are worn in football, hockey and lacrosse – there’s not enough evidence to suggest it can prevent concussions, according to U.S. Soccer Chief Medical Officer George Chiampas. 

Injury prevention comes down to teaching proper technique on everything from slide tackles to headers. But that’s balanced by the fact that the game has changed in a quarter century. Youth soccer players in America are more skilled, better trained and play at a higher level today, according to Dr. Cohn.

“What we’ve seen in the last 25 years is sports specialization amongst our youth,” Dr. Cohn said. “Kids that play soccer are not just playing fall soccer. They’re playing spring soccer. They’re doing travel soccer. They’re playing for their school. They’re playing for a club team. While the study controls for the number of people, presumably the more someone plays increases the chance of that person getting injured. So injury rates as a whole are up for one reason: Kids who play soccer are playing more soccer and playing more often. And that explains a lot of the increase in injury.”


Jason Molinet
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