A Shot to the Head: How Concussions Affect Pro Female Soccer Players

Feb 3, 2020

The FIFA Women’s World Cup brings a wave of excitement and inspiration for millions of soccer fans worldwide. This year will be no different. However, in recent years, each competition digs up a concerning topic that continues to gather steam - concussions and head injuries in women’s soccer.

Numerous sports have received negative press for their head and brain injury risks, but women’s soccer has recently become a bigger focus. According to some recent studies, head injury rates in women’s soccer are even greater than those of American football.

It’s a troubling reality since soccer is one of the most popular youth sports globally, with growing popularity both in the United States and abroad, especially for girls. With an estimated rate of concussion of roughly 6% and global participation in the millions, hundreds of thousands of young brains are at risk of injury each year. It feels like it’s time for the soccer world to do more to protect both current and future players from harm.

Head Injuries at the 2015 FIFA Women’s World Cup

One of the most infamous and concerning moments at the 2015 FIFA Women’s World Cup involved the head collision of United States’ Morgan Brian and Germany’s Alexandra Popp in the semifinal match. At the 28th minute of play, both Brian and Popp jumped for the ball, with Brian heading the ball away. However, Popp struck from behind, unintentionally bashing into Brian head-on.

The game was paused for four minutes while the players laid on the floor.

The two players eventually gathered themselves together. Brian walked dazedly off the field, repeatedly putting her hand to her face. Popp’s head continued to bleed, and she used a water bottle to wash off her blood-stained hair.

However, as quickly as it all happened, the ordeal ended when Brian and Popp returned to the game. No rest was ordered as Brian played 89 minutes and Popp, a full 90.

Both Morgan Brian and Alexandra Popp illustrate the power of mental toughness by rebounding from a painful injury. However, the collision demonstrates FIFA’s lax management of an injury that should have been evaluated far deeper than how it was handled when the two collided.

The sight of Brian and Popp returning to the pitch so quickly encouraged former players such as Taylor Twellman and Briana Scurry to tweet their concerns about the lack of thorough evaluation.

FIFA has drawn considerable criticism for their insufficient concussion protocol. In the case of Morgan Brian and Alexandra Popp, no neutral doctors evaluated the two players beyond very basic tests from their team medics. Also, there were no substitutions given, which many argued should have been deployed for the sake of resting them after the collision. FIFA’s lax response towards head injuries is troubling, especially for female players, which according to research, are more prone to concussions.

Female vs. Male Athletes: Head Trauma Differences

Mayumi Prins, a professor of neurosurgery at UCLA’s David Geffen School of Medicine, emphasized the fact that scientists have observed higher rates of concussions among female athletes for more than a decade.

Prins admitted, “There’s been little basic science research done on adolescents, females and concussions.” However, she noted that some studies have spotted differences in how female and male soccer players head the ball. Generally, female soccer players, when heading the ball, put more stress on their neck muscles than males.

This could be the result of women generally having weaker neck muscles and smaller heads than men. Therefore, heading a ball speeding through the air at 80 mph with a more delicate skeleton could indeed raise the concussion risk for a player.

Brain scans also show that heading a ball triggers more noticeable brain tissue changes in women than they do in men. One study, which involved the MRI imaging of players’ brains, identified a higher level of white matter brain alterations in women as opposed to men. In essence, white matter tissue becomes disorganized, which often leads to reduced cognitive function in the areas of memory and attention.

Women are also more likely to report their concussion-related symptoms than men are. This skews the data as scientists aren’t sure whether women are actually more susceptible to head trauma, or if they are just more vocal about it.

The Research is Murky, The Anecdotes are Telling

The science of concussions in female soccer players (as well as women in other sports) is emerging with more findings each year. There are still major gaps that researchers need to cross before they’re able to draw more definitive conclusions. Nevertheless, the personal stories of the players themselves paint a vivid picture.

Going back to science, it’s important to consider the research that has found athletes who suffer concussions face up to a 4x greater risk of lower-body injuries than athletes who have not had a concussion. This may occur due to a reduction of cognitive function that leads to a loss of gait-related tasks such as obstacle navigation and obstacle clearance.

Morgan Brian may be an example of how this long-term damage of a head injury can result in chronic injury. When Brian collided with Popp in 2015, she was cleared of having any concussion symptoms. Coach Jill Ellis said “...they assessed her on the field, they assessed her at halftime. They go through a strict regimen of protocols that is set forth by US Soccer. You know, she was fine, no symptoms”.

Brian’s near-instant return to the pitch could support the theory that brain injuries affect the whole body in the long-term.

She has since suffered a long string of chronic injuries for the last few years including knee, groin, back and hamstring problems. This has resulted in her absence from several matches and tournaments throughout 2017 and 2018. To make matters worse, she suffered another head injury at the 2018 CONCACAF Women’s Championship against Jamaica, which forced her to leave the match. Her situation has turned into a curious one because, as her club coach Rory Dames admits, no has been able to figure out what’s causing her injuries.

“She’s had tests done, she’s had scans, she’s had MRIs and nobody’s been able to find anything conclusive”, Dames says. Could her 2015 head collision with Alexandra Popp have triggered her new injury-prone state? No one can say for sure. However, given the findings on the ripple effect triggered by concussions and head trauma, it could be a possibility.

How Do We Protect Players from Head Injuries?

The “prevention is better than cure” motto applies when it comes to protecting girls and women from head injuries. Ultimately, league organizers from the youth level right up to the professional stage need to carefully monitor their players and train them on how to head the ball more safely (or to rely on other skills). Coaches need to teach players how to rely more on skill as opposed to brute force.

Young players in the US, both boys and girls, are prohibited from heading the ball at ages 10 and under. For boys and girls aged 11-13, heading the ball is only permitted during practice games. The reaction to these new regulations has been divided, with some saying that it will inhibit youth players’ skill development while others have praised it for its potential to make players focus on their foot skills.

However, it’s an open game for the players who are in their mid-to-late teens and early twenties, who can head the ball as they see fit. They need some sort of protection or guidelines since their brains are still developing and more susceptible to brain injuries.

Can Soccer Headgear Reduce Brain Injuries?

The plain truth is that soccer, as well as any sport for that matter, will always carry a risk of injury to those who play it, including concussions and head trauma. However, in recent months the use of specific equipment (ie. headgear) has been linked to reductions in the occurrence and severity of head injuries.

For example, a study by the Virginia Tech Helmet Lab concluded that protective soccer headgear could reduce risks of head injuries, including concussions. The researchers tested up to 22 models of soccer helmets, all of which earned ratings ranging from two to five stars. They used an impact simulator that mimics two players bashing heads in an actual match, visualizing three different impact speeds and two impact locations.

Storelli’s Exo-Shield head guard scored the highest among the 22 headband models, reducing concussion risks by as much as 84% according to Virginia Tech’s model. Storelli’s Head Guard earned high scores due to its patented design and protective foam, the same used in the helmets of U.S. Marines and Special Forces.

Furthermore, a 2-year study of high school soccer players by University of Wisconsin Madison showed that- while the "average" headgear did not significantly reduce the risk of concussions- the Storelli ExoShield Head Guard statistically reduced the relative risk of concussions by 60%, the only product studied to achieve a statistical benefit.

Soccer headgear is by no means a perfect solution against head injuries. At best, it may help reduce risks. But for parents and players who prefer to play it safe, it may represent a practical option.

We’re unlikely to see headgear consistently in the professional leagues anytime soon. However, soccer headgear is likely to be increasingly adopted by amateur players, especially those in their mid-teens to early twenties whose developing brains are more susceptible to brain injuries.

The Future of Head Injury Prevention

As women’s soccer continues to grow in popularity, a new generation of girls and young women will aspire to play at the professional level. However, FIFA and all other organizations that develop young women to be tomorrow’s superstars will have to provide them with safer conditions and protocols.

Coaches, executives, and managers have an ethical duty to see that their players are safe and healthy. Failing to ignore that duty will have a damaging ripple effect on the sport’s appeal and image.

More importantly, it will create a generation of talented women who will face long-term health effects due to poorly managed head injuries. Just as it takes a village to raise young female soccer stars, it will take a collaborative effort from all those involved in women’s soccer to protect players from head injuries on the pitch.

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