Does soccer headgear reduce the incidence of sport-related concussion? A cluster, randomised controlled trial of adolescent athletes

Abstract

BackgroundThere have been no large randomised controlled trials to determine whether soccer headgear reduces the incidence or severity of sport-related concussion (SRC) in US high school athletes.ObjectiveWe aimed to determine whether headgear reduces the incidence or severity (days out from soccer) of SRCs in soccer players.Methods2766 participants (67% female, age 15.6±1.2) (who undertook 3050 participant years) participated in this cluster randomised trial. Athletes in the headgear (HG) group wore headgear during the season, while those in the no headgear (NoHG) group did not. Staff recorded SRC and non-SRC injuries and soccer exposures. Multivariate Cox proportional hazards models were used to examine time-to-SRC between groups, while severity was compared with a Wilcoxon rank-sum test.Results130 participants (5.3% female, 2.2% male) sustained an SRC. The incidence of SRC was not different between the HG and NoHG groups for males (HR: 2.00 (0.63–6.43) p=0.242) and females (HR: 0.86 (0.54–1.36) p=0.520). Days lost from SRC were not different (p=0.583) between the HG group (13.5 (11.0–018.8) days) and the NoHG group (13.0 (9.0–18.8) days).ConclusionsSoccer headgear did not reduce the incidence or severity of SRC in high school soccer players.Trial registration numberNCT02850926.

Concussion-Prevention Strategies Used in National Collegiate Athletic Association Divisions I and II Women's Soccer

“…[5][6][7]11,12 Whereas a single retrospective survey showed that not wearing headgear was associated with a 2.65 times greater relative risk of concussion than wearing headgear, the study lacked validity due to a lack of randomization and the researchers' reliance on athlete recall of the diagnosis. 12 In a more recent study, 11 headgear had no influence on concussion rate or severity. Authors 5,7,10,24 of systematic reviews and position statements have stressed that research remains inconclusive on the effect of headgear on concussion risk, and limited evidence supports the use of headgear in preventing concussion.…”

Are high school girls’ lacrosse players at increased risk of concussion because they are not allowed to wear the same helmet boys’ lacrosse players are required to wear?

“…Rather, a body of refuting evidence concludes there is no increase in risk taking behavior and/or injury rates associated with use of protective equipment (Lund and O'Neil 1986;Scott et al 2007;Cusimano and Kwok 2010;Ouellet 2011;Haider et al 2012;Ruedl et al 2012;Brunner et al 2015;Ruedl et al 2019). The most pertinent examples include an RCT which found no increase in injuries, including concussion, among high school soccer players randomized to wear headgear (McGuine et al 2019) and a study of the eyewear mandate in girls' LAX which concluded "overall injury rates do not indicate rougher play with introduction of protective equipment" (Lincoln et al 2012). Additionally, because hard shell helmets are still mandated in boys' LAX, no appreciable gladiator effect resulting from their adoption must have occurred.…”

Soccer-Related Concussions Among Swedish Elite Soccer Players: A Descriptive Study of 1,030 Players

“…In previous studies, women have been shown to be more prone to sustain sports-related concussions in soccer and other contact sports where the rules are the same for both sexes (9)(10)(11)(12)(22)(23)(24). Possible contributing factors are differences in neck strength and head acceleration.…”

“…Methods to protect players from sustaining concussions have been discussed more frequently in the last years. As a way to reduce incidence of sport-related concussions, the use of headgear was recently evaluated, although no reduction in concussion incidence was observed (24).…”