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With all the talk about the movie Concussion, CTE, the NFL and head trauma, I thought it would be fitting for our first Flashback Friday to be to’s first ever post, Changing as it Grows: Improving Girls’ Soccer.  Many are still unaware that after football, girls’ soccer reports the highest number of concussions in youth sports, so it’s the perfect to bring awareness to the issue and help improve the lives of girls who love soccer.  As usual, read, enjoy, comment and share…

The United States women’s soccer team just won gold in the 2012 Summer Olympics in London. Yay for them! Yay for America! Yay for the sport of women’s soccer! Now what? What’ll we do for the next three years until the World Cup takes us to Canada? Answer: We use the momentum to encourage more girls to get involved with the sport. We promote soccer has a sport that builds skills in leadership and team work. We promote soccer as a sport that helps girls develop lifelong friendships and self-confidence. We teach girls that soccer provides them with an opportunity to be involved with a sport that enjoys worldwide notoriety and support. But outside of growing the sport of girls’ soccer, in the next three years we should be concentrating on making the sport safer. Safer? Yes, safer.

Many of us are aware of the pending legal battles concerning concussions* in professional football. (If you need to catch up, read about them here.) What many people aren’t aware of is the prevalence of concussions in high school sports. A study entitled the Epidemiology of Concussions Among United States High School Athletes in 20 Sports revealed that over a period of two school years, there were 1936 concussions reported during 7,780,064 athletic-exposures (AEs)**, a rate of 2.5 for every 10,000 AEs. Even less known is the fact that other than boys’ football, girls’ soccer has the highest number and greatest rate of concussions in all of high school sports. That’s right, girls’ soccer, not boys’ hockey or lacrosse, but girls’ soccer. The effects of concussions can linger well into adulthood and have debilitating consequences for the adolescences who suffer from them. Sepp Blatter, President of FIFA, said, “The future of football is feminine.” In order to continue the ensure that growth continues for girls, women and the sport as a whole, I believe that it is imperative that athletes and their parents be made aware of the growing problem, so that communities across the country can make concerted efforts to improve the safety of the sport.


Two female soccer players competing for the ball, aerial view.

I’ll start where any campaign for awareness and change should start, with the facts. Over the past five years, many studies on high school sports have concluded the same thing, that girls’ soccer is second to only boys’ football in the number of concussions experienced during AEs. The Epidemiology study showed that from 2008 to 2010, of the 1936 reported concussions, 912 were suffered by boys’ football players (47.1%), 159 were suffered by girls’ soccer players (8.2%), and 112 by boys’ basketball players (5.8%). The Epidemiology study not only proved that girls’ soccer had the second highest occurrence of concussions, but it also proved that girls’ soccer had a higher concussion rate and that concussions represented a greater proportion of all injuries when compared with boys’ soccer. Specifically, girls’ soccer had a concussion rate of 3.4 per 10,000 AEs and concussions made up 15% of all injuries while boys’ soccer had a concussion rate of 1.9 per 10,000 AEs and concussions made up 11.1% of all injuries. Also noteworthy is the fact that girls’ soccer players had a higher proportion of recurrent concussions than boys. This means that girls are more susceptible to second-impact syndrome*** than boys. These results are especially alarming considering the fact that girls’ soccer is classified as an incidental contact sport, not a collision sport like football and ice hockey. (By the way, boys’ ice hockey only reported 80 concussions over the two-year period.)


So what do we make of these numbers? On the one hand, there is evidence that female athletes may be more honest about reporting injuries than their male counterparts. So the numbers of boy concussions may be inaccurate due to failure to self-report. On the other, if in fact the difference in reported injuries is not significant, the questions become why are there significantly greater numbers of girls who suffer concussions in soccer when compared with boys, and why do concussions occur at a greater rate in girls’ soccer than in boys soccer?

One explanation for the greater number of concussions in girls concerns the differences in the biomechanics of girls and boys. Generally, boys have a greater muscle mass. Therefore their necks can absorb more of the impact that results from collisions than girls. Another is technique. Some familiar with girls and boys soccer have suggested that girls may not use the same techniques as boys or that girls may not use the proper techniques when coming in contact with other players and the ball. Yet another possibility for the disparity in concussion rates deals with hormones. Studies have shown that girls take longer to recover from concussions than boys. Whatever the reasons for the disparity may be, one thing is for certain, actions must be taken to protect girls involved in the sport because the scope of the problem will grow as the sport grows.


girls soccer

On initial glance, one might reach the conclusion that if only 15% of injuries in girls’ soccer results in concussions, girls’ soccer is in good shape. That would be an improper conclusion. Concussions can’t be treated like other sports injuries. A sprained ankle or a broken bone usually won’t end a child’s athletic career. Concussions can, and do, place kids on the sidelines indefinitely. Concussions can, and do, cause brain damage in an adolescent brain. Think about it this way, according to the Epidemiology study, at least 159 girls were sidelined between 2008 and 2010, because they suffered potentially brain damaging injuries. We definitely have to do more to protect our girls.

In our parents’ day, a bump on the head every now and then may not have seemed like such a big deal. But gone are the days of putting an ice bag on the forehead and returning to the field of play. We now know that concussions can have detrimental effects on cognitive abilities. Recent research shows that young athletes are more susceptible to concussions than older athletes, and because ongoing neurocognitive development occurs throughout adolescence, concussions can have severe, acute and long-term complications in young athletes. Between 2009 and 2010, 3.1 million girls participated in high school sports. Girls make up 48% of the more than 3 million kids registered in US Youth Soccer leagues. That means, if we want a generation of female athletes to grow into well-rounded, intellectually capable women, we need to protect them from repeated concussions.

Recently on NBC’s Rock Center reporter Kate Snow interviewed a group of girls within the same community outside of Philadelphia, PA who all played soccer in the same league and all suffered concussions as a result of their play, some of whom suffered their first concussion as early as twelve years old. (You can watch the full interviews here, here, and here.) One young lady in particular, Allison, has suffered at least five concussions. Allison’s first three concussions occurred while playing soccer either from heading the ball or colliding with another player. Her final two concussions occurred because the previous concussions altered her spatial awareness causing her to hit her head on a table and other furniture. As a result of her repeated injuries Allison only attends school four days per week, suffers from continual headaches, and sensitivity to light. Other ladies in the group reported suffering from an inability to make it through entire school days, intense headaches, dizziness, nausea, vision problems, and even severe depression.

While the Rock Center report covered a small group in a small area of the country, the research makes it apparent that concussions are affecting a large number of girl soccer players and their families. The effects of the concussions can have very detrimental consequences for cognitive development and therefore has the potential to severely limit development into adulthood.


The Epidemiology study revealed that the activity most frequently associated with concussions in girls’ soccer was heading the ball which accounted for 31.1% (49.4) of all concussions. Researchers from the Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center recently conducted a study that concluded that, “repetitive heading may set off a cascade of responses that can lead to the degeneration of brain.” After players headed the ball in excess of 1,000 to 5,000 times per year (a few times per day); researchers observed “significant injury” to the players’ cognitive abilities. Specifically, the study identified five areas in the frontal lobe brain that were affected by frequent heading. These areas were responsible for attention, memory, executive functioning, and higher-order visual functions. A related study conducted in the Department of Neurology concluded that players with the highest annual heading frequency performed worse on tests of verbal memory and psychomotor speed relative to their peers.

So what’s the answer? Ban heading? Dr. Bob Cantu, chairman of the surgery division and director of sports medicine at Emerson Hospital in Concord, MA, thinks so. Because heading the ball oftentimes results in player-player collisions, Dr. Cantu believes that it is one of the most dangerous parts of the game and should eliminated in youth soccer for kids under the age of 14.

Brandi Chastain, 2-time World Cup Champion and 3-time Olympian (2 golds, 1 silver), and I (former youth league soccer player turned attorney who has no affiliation with Brandi other than an agreement in philosophy) believe that a ban is not the answer. Heading is an essential part of the game that, when done correctly, adds to the artistry and prowess of the sport. We happen to think that the answer is teaching girls the proper way to head the ball. Girls should be taught to create protective spaces between themselves and other players before heading the ball. Girls should be taught to be aware of their surroundings prior to heading the ball. And finally, girls should be taught that heading is just one technique for controlling and moving the ball. Girls should be taught to manipulate the ball, of course with their feet, but also with their knees, thighs and chests in addition to using their heads. As the Einstein report showed, decreasing the frequency of head to can vastly decrease the likelihood of brain damage.

I personally believe that, especially with high school aged players, coaches and trainers should incorporate weight training regimens that increase girls’ muscle masses. Particular focus should also be placed on neck exercises so that players’ heads have a solid foundation with which to absorb the impact of heading the ball. There is a reason that football players tend to have bulky necks. In line with the strength and conditioning routine, schools and leagues should also have certified trainers present at practices and games who are capable of detecting and treating concussions. (It’s probably a good time to note that the Epidemiology study only collected information from schools that had certified trainers on staff, so the numbers of concussions could be higher and just have not been reported.) In districts where schools can’t afford to have trainers at every practice and game, awareness is even more imperative so that girls are able to self-report head collisions.

To this list of practices that falls short of banning heading, I would like to add education and cultural reevaluation. I think that it is important that parents, coaches, team trainers, and players are made aware of the possibility that girls’ soccer players are susceptible to concussions. Beyond general awareness, the community of girls’ soccer should be taught to detect concussions, the proper methods involved with full recovery, and the repercussions for ignoring the signs of concussions and not allowing for full recovery.

Girls’ soccer players are some of the toughest, most dedicated athletes in the world. They love their sport. They love their teammates. And they love to prove their toughness. (Remember the Mia Hamm v. Michael Jordan commercial?) These are all beautiful, admiral characteristics, but girls need to be taught that it’s ok to stop and sit on the sidelines after being hit in the head. Girls should be taught that the dizziness and disorientation that comes after a head collision are not signs of weakness, but are signs that should be reported. Girls should be taught that is ok to take a break to let their body and mind heal. Otherwise, girls could ignore the signs of concussions, insist on playing, and later cause themselves irreparable harm. Girls should be taught that concussion awareness is a sign of strength; a sign that they love their team and their sport so much that they are willing to let themselves properly heal rather than risk a lifetime off of the field.


So I’m sure you now want to know, “Well how do I know if I, or my daughter, may be suffering from a concussion?” Here are some signs:

· Headaches

· Weakness

· Numbness

· Decreased Coordination or Balance

· Confusion

· Nausea

· Slurred Speech

· Vomiting

How are concussions diagnosed and treated?

· Simple physical and cognitive REST (This greatly reduces the risk of second-impact syndrome)

· Physical therapy

· Occupational therapy

· Vocational therapy

· Cognitive therapy

· Acupuncture

· Complementary Medicine


One of the greatest players of all times, Mia Hamm, said, “True champions aren’t always the ones that win, but those with the most guts.” It’s going to take guts for girls’ soccer players and their communities to change their practices and culture in the face of growing numbers of concussions. It’s easy to stick with the status quo or swear off techniques or the game. But change is the answer, not eliminating a key component of the sport or quitting the sport. Change will make the sport better. It will make the sport safer; it will make the players smarter, and it will make the game more exciting to watch. Change will take time. It will take more hours of practice, and it will take more meetings among parents, coaches, and trainers. But the end results, fewer concussions and healthier girls, are well worth the extra time and effort. Change is necessary, not just for the sake of girls’ soccer, but for the sake of the next generation of women soccer players and for the next generation of former players turned professional women.

*Concussion, or mild traumatic brain injury, is defined as a blow or jolt to the head that can change the way the brain normally works.

**Athletic Exposures is defined as one athlete participating in one athletic practice or competition.

***Second Impact Syndrome describes the situation in which an individual sustains a second concussion before the symptoms from the first have resolved. A second brain injury, or cumulative concussions, can be more dangerous than the first one.


Ani, “’Heading’ of soccer ball may harm brain”, The Times of India, Health and Fitness Section, Dec 17, 2011, available at:

Comstock, Fields, Marar, McIlvain, “Epidemiology of Concussions Among United States High School Athletes in 20 Sports”, The America Journal of Sports Medicine, Vol XX, No. X, Jan 27, 2012.

Jancin, “Girls’ Soccer Second to Football for Concussions”, Family Practice News, Neurologic Disorders Section, Jan 2011.

© Cecelia Townes August 2012


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