Soccer is an active contact sport with a recognized risk of injury, including concussions. In American youth soccer there has been growing interest in trying to reduce the incidence of injury on the part of U.S. Soccer, soccer parents and also vendors of protective equipment. The challenge is to make the sport safer, without changing the game so much that soccer in America no longer fits in with the rest of the world.
Head-to-ball contact while heading was thought to be a potential cause of serious and persistent brain injury. It is obvious, however, that the act of heading presents other sources of blows to the head including blows imparted by both the ground and the heads, feet and elbows of opponents; it has become apparent by recent analysis that concussions due to contact with these obstacles are more important causes of brain injury. Studies are now funded and underway to determine which game circumstances and tactical factors are the most important causes of injurious head contact. After scientific analysis, appropriate preventative measures may be designed. As it stands today, after preliminary analysis, many injurious contacts occur after blows to the face, eyebrow and nose; none of the available forms of headgear which have been examined by U.S. Soccer appear to effectively address this form of injury.
What works in other sports and what works in laboratory crash dummies may have little relevance to what happens on the soccer pitch. There is substantial concern that wearing headgear may give a player unfounded feelings of invincibility, encouraging dangerous challenges, and, thereby, increasing the risk of head and neck injury. At this time there is no convincing "real life" evidence that the overall risk of head, facial and neck injury is positively influenced by the use of any of the headgear on the market which has been examined by U.S. Soccer. At this time, there is no better action regarding headgear than the present interpretation of Rule 4 which leaves the use of head gear or any other protective equipment up to the discretion of the referee.
It has been argued that shin guards have been adopted without requiring a higher standard of proof, which is suggested for any rule, which would specifically address the uniform requirement for headgear. This requirement would appear to be justified, because the risks involved of persistent brain injury and spinal cord injury are likely to be more disabling that those risks that shin guards are designed to mitigate. There needs to be proof of effectiveness from a large "real life" trial. Until the latter is accomplished, U.S. Soccer would not want to pre-maturely and inadvertently endorse any protective headgear that might potentially worsen the risk of brain or spinal cord injury.
There are also numerous ways in which U.S. Soccer and local entities may act at present to reduce the incidence of brain and spinal injury. These suggestions would also not require any rules changes nor would they negatively affect the nature of play, and include some of the following:
· Coaches can include neck and abdominal muscle exercises in any conditioning program; improved neck and abdominal muscles should allow for better stabilization of the neck and minimize of any snapping action to the head and neck while trying to head the ball.
· Use of mouth guards can absorb impact to the lower face and teeth. The ability to clench the teeth also can be shown to increase the power imparted with heading a ball.
· Referees can be more aware of calling a "dangerous play" foul for any backwards charge or backwards head flick when an opponent is immediately behind a player. Likewise, more cautions can be given for forwards charging into goalies.
· Older players need to play on fields which are the appropriate size. Smaller fields pack in the older players and increase the chance of dangerous contacts. Proper fixation of goalposts, removal of obstacles and spectators from the immediate sidelines are other important factors to consider.
· Proper instruction for recognition and proper management of the head-injured player must be given to a coach or responsible adult on the sidelines. Training tapes and better instruction are needed for licensing examinations.
· Coaches, referees and club officials should discourage rough play that is designed to intimidate. Many leagues of competition have already increased sanctions for rough play.