Published 6/26/2025
A study presented at the AAOS 2025 Annual Meeting examined the impact of a policy implemented by the U.S. Soccer Federation (USSF) to address youth players heading the soccer ball. Researchers found that the policy was associated with a decrease in soccer-related concussions; however, female players experienced a higher proportion of concussions than their male counterparts.
“We wanted to assess the impact of this policy on our patients,” said coauthor Eugenia Lin, MD, resident at Mayo Clinic Arizona. “While policies are important, we don’t always have the data to determine the effectiveness. This study aimed to analyze the long-term implications of the policy across different age groups, especially in light of growing concerns about traumatic brain injury and chronic traumatic encephalopathy, a progressive brain disease linked to repeated head injuries, in contact sports like football.”
Dr. Lin and colleagues conducted an epidemiological analysis utilizing data from the National Electronic Injury Surveillance System to analyze trends in soccer-related injuries relative to other injuries from soccer. The research team identified a 25.6 percent relative risk reduction in soccer-related concussions as a percentage of all soccer-related injuries presenting to the emergency department from 2020 to 2023 compared with 2012 to 2015.
Further breakdown of the data revealed distinct concussion trends before and after policy implementation, as well as changes in concussion trends from 2012 to 2023 based on age and gender, providing insight into the policy’s differential impact across demographic subgroups.
Prior to the policy being enacted, from 2012 to 2015, there was an 8 percent proportion of concussions. From 2020 to 2023, the proportion of concussions decreased to 6 percent, indicating a relative risk reduction between time periods.
The researchers stratified soccer-related injuries and concussions by three age cohorts from 2012 to 2023, and data demonstrated an increase in soccer-related injuries and concussions as players got older:
- There were 8,793 total soccer-related injuries and 431 concussions (4.9 percent) in players 6 to 9 years old.
- A total of 23,275 soccer-related injuries were reported in players 10 to 13 years old, of which 1,527 were concussions (6.6 percent).
- A total of 26,907 soccer-related injuries were reported in players 14 to 17 years old, of which 2,397 were concussions (8.9 percent).
Additionally, female players experienced fewer overall soccer-related injuries than male players, but a greater proportion of their injuries were concussions. Female players presented to the ED for 21,040 soccer-related injuries between 2012 and 2023, of which 2,010 were concussions (9.6 percent). Male players were seen for 37,935 soccer-related injuries, of which 2,345 were concussions (6.2 percent). The proportions of concussion diagnoses for both male and female players were lowest in 2023, at 4.3 percent and 7.8 percent, respectively. The highest annual proportions of concussion diagnoses were 8.4 percent for male players and 10.5 percent for female players, both in 2012.
“Although not all concussions result from headers, a measurable percentage still do, and it is encouraging to observe a trend indicating a decline in concussion rates,” said Anikar Chhabra, MD, MS, FAAOS, senior author and associate professor and director of sports medicine at Mayo Clinic Arizona. “While we cannot attribute this reduction solely to policy changes, these data suggest that these regulations may positively impact different age groups and time periods. Now that physicians, athletic trainers, coaches and parents understand the long-term implications of concussions, it is crucial to continue refining and reinforcing evidence-based policies that prioritize player safety and injury prevention.”
Drs. Lin’s and Chhabra’s coauthors of “Pediatric Concussion Injuries in Soccer: Emergency Department Trends in the United States from 2012 to 2023” are Alex Hoffer, MD; Georgia R. Sullivan, MS; and Meghan Richardson, MD.