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U.S. Soccer Federation Finds Padded Headgear Ineffective in Reducing Concussion Risk

New Study Throws Position Into Doubt

February 2005). An emerging issue in the world of soccer is the use of padded headgear by players to prevent concussions. There have been a number of conflicting claims and reports about the medical benefits and risks of this headgear, and USSF has received a number of inquiries from its members about whether use of headgear is either appropriate or recommended.

USSF's Sports Medicine Committee has reviewed a great deal of scientific literature relating to head injuries in soccer and the safety benefits of padded headgear. After careful review, the Sports Medicine Committee finds no evidence that wearing this sort of headgear is beneficial to players, and is concerned that it might actually lead to more injuries.

The Sports Medicine Committee's conclusion is based upon an understanding of the mechanism by which concussions occur in soccer and other sports. Concussions are frequently caused by the force by which the head and neck snap back after impact, with the brain impacting on the inside of the hard skull - not the actual force of the impact. These injuries are common in American football and hockey despite elaborate helmets and padding. Padded headgear designed to decrease impact will not reduce the prevalence of these types of concussions.

The Sports Medicine Committee is also concerned that the use of headgear in soccer may alter the game in ways that would be detrimental. For example, players may develop a false sense of security, play more aggressively, and not learn proper technique - thus potentially increasing the frequency of concussions. As an example, head and neck injuries have increased in ice hockey and football since the introduction of helmets in those sports.

Headgear should not be a substitute for proper medical evaluation

Yet another concern with this equipment is that parents and coaches are using headgear to return players to play who have already suffered a concussion. Headgear should not be a substitute for proper medical evaluation and treatment of concussions, and should not be used to hasten return to play after a concussion. Again, the Sports Medicine Committee is concerned that this headgear gives players a false sense of security.

Ironically, the major push for use of headgear has been within the community of players least likely to need head protection. There appears to be a significant increase in the use of headgear by youth players 12 and under, even though players at this level are the least likely to engage in play that would lead to concussions.

USSF issued a memorandum last year indicating that players may be permitted to wear headgear as long as the referee does not have reason to believe it is dangerous to the player or other players. USSF stands by this statement. However, this should not be taken as an indication that USSF recommends use of this equipment to prevent concussions. To the contrary, USSF is concerned that there are some experts that believe that use of this headgear may make the game less safe, and USSF intends to continue to monitor this issue. Further, members of the Sports Medicine Committee have also been informed that FMARC, FIFA's sports medicine committee, has concluded that this headgear does not tangibly improve safety for players.

Finally, USSF has received inquiries as to whether it is appropriate for USSF members to pass rules requiring use of headgear by players. Such a rule is impermissible. USSF Bylaw 104 states that FIFA Laws of the Game shall apply to soccer games that occur under the purview of USSF. FIFA Laws of the Game, Law 4, provides a specific list of mandatory equipment (including jersey, shorts, socks, shoes, and shin guards). Headgear is not on this list, and it is not within the authority of USSF's members to amend the Laws of the Game in this way.

Concussions in sports are significant injuries that USSF takes quite seriously. In addressing this issue, USSF recommends that an effort be made to obtain proper medical evaluation of head injuries. USSF also believes that this issue can be addressed through further research, a focus on proper technique, and responsible officiating of soccer games.

Editor's Note: On August 25, 2005, the US Soccer Federation, in apparent recognition of the finding in an article in the July 2005 British Journal of Sports Medicine entitled "Effectiveness of Headgear in Football" finding that "soccer headgear provided measurable benefit during head to head impacts," the US Soccer Federation replaced this position statement with a new statement titled "U.S. Soccer on Head Injuries and Padded Headgear" in which it states that "A recent study sponsored by FIFA's sports medicine committee concluded that headgear provides no measurable benefit in head-to-ball impacts, but does provide measurable benefit in sub concussive head-to-head impacts."

Another more recent study reported in the July 2007 issue of the British Journal of Sports Medicine says protective headgear reduces the risk of concussions from head-to-head or head-to-ground impacts by 50%.