Head Protection in Soccer: What Studies Tell Us

SUMMARY:

• Historically, soccer head protection helped against cuts and bruises, but was considered ineffective against brain injuries due to outdated technologies and designs.
• As global attention over head injuries mounts, the soccer industry has made important advances in protective technologies and comfort.
• A new 2018 study by the Virginia Tech Helmet Lab argues that the right headgear can dramatically reduce head injuries, including concussions, and stack-ranked all available products to identify the best on the market.
• In 2016, NOCSAE (National Operating Committee on Standards for Athletic Equipment) commissioned the largest multi-year field study to date to determine if headgear reduces concussions. The study focused on 3,000 US high school players (mostly girls) and results were released in 2019 in the British Journal of Sports Medicine by the research team at University of Wisconsin-Madison. 
• The study used 5 different products and found that when the data of all the products were blended together, the results were inconclusive.
• However, the supplemental data with brand-specific results shows a wide gap in how individual products performed. Specifically, one one product- the Storelli headgear- achieved a statistically significant reduction in the relative risk of concussions, with a ~50% overall decrease overall, and a ~60% decrease for girls specifically (vs. players who didn't wear headgear at all). 
• Furthermore, the study found that wearing headgear did not increase the risk of other injuries, signaling that players do not play more recklessly when they wear soccer headgear
• What does this mean? By no means does this represent a "total solution" to soccer concussions. We believe more studies should be conducted to solidify results and deepen understanding, but these positive results from credible institutions are certainly a first step in the right direction. 

FULL ARTICLE:

Head injuries are one of the most debated topics in soccer. In recent years, a number of studies have provided conclusive evidence that head injuries happen frequently and the effects can be quite significant (for a summary of key data points from existing literature, read this post).

FIFA and other institutions are adopting more aggressive concussion protocols, and the US Soccer Federation has tweaked the rules of the game to reduce risks (e.g., banning headers for younger age groups). Most recognize that these initiatives only partially address risks, and all soccer institutions, along with parents and players, face the fact that head injuries in soccer is a serious problem that is here to stay.

What can a player or parent do to reduce the risk of injury?

There is no substitute for proper training and technique. Coaching is a must, but on its own can only go so far. Even world-class players are not immune from risks of concussions and head injuries. 

What about head protection? Head gear is a rarity in soccer today, and many coaches, parents and players are wondering if extra protective gear can reduce risks. Recently, several sports have turned to head protection as a risk reducing measure against head injuries. Take snow sports for example: helmets were not used 20 years ago. Nowadays, it would be reckless to ski without one. American football and hockey are similar examples of sports that went from no (or almost no) head protection to everyone wearing it.

We summarized where the soccer industry stands on head protection and what data it has about the effectiveness in 6 key points below:

1. Historically, soccer head protection has been super-dorky and ineffective. It's no wonder many hold the view that "headgear will not help". Therefore, there has been minimal demand, leading to limited research and innovation, which translates to outdated technologies and designs. 
2. Protective technologies have evolved significantly, and new solutions are available.This new wave of innovation is fueled by growing public attention and concerns about head injuries in soccer. As more dollars and talent focus on solving the issue, new solutions are being released. 
3. New credible studies are being conducted to evaluate the effectiveness of these solutions. More research from expert institutions are focusing on what can prevent head injuries in soccer. For example, in 2018 the Virginia Tech Helmet Lab, a major research institution focused on head protection in sports, introduced a new methodology for assessing the effectiveness of headgear in reducing concussions in soccer, and stack-ranked every product on the market.
4. Virginia Tech concluded in Spring 2018 that the right headgear can indeed "dramatically reduce risks of concussions in soccer". The recent lab study made a case for the positive value of wearing head protection in soccer (read the full press release here). There are two important caveats: a) the results ranged widely, reflecting big differences in the quality of protective materials and constructions of various products; and b) the study was performed via simulated impacts in a lab, which means no humans were involved. Skeptics will note it was a lab study to make light of the results, but the experience of the Virginia Tech Helmet Lab team is extensive and many believe the results to be a strong indicator of value of the products tested. 
5. In May 2019, the largest study ever conducted on soccer headgear and concussions was released.  Does headgear prevent concussions in soccer? And does wearing headgear make players play more recklessly, increasing other types of injuries?

• In 2015, NOCSAE (the National Operating Committee for Standards in Athletic Equipment) sponsored the largest multi-year study in collaboration with Dr. Tim McGuine's research team at the University of Wisconsin Madison (read the details of the clinical study here) to answer the question. The study is the largest and most comprehensive of its kind:
• ~3,000 US high school soccer players (primarily females, as it turned out to be harder to recruit male players), across schools that volunteered to participate in the study.
• To avoid bias, half of the players were randomly selected to wear headgear, half did not wear headgear so injury rates across the two groups can be compared.
• Multiple brands of headgear were included in the study, with a wide range of protective properties (from 3-star rated products to 5-star rated)
• 2 full years of data collection (2016 - 2018)
• Athletic trainers assessing injuries at every game to confirm incidence of concussions
• All types of injuries were tracked to test the hypothesis that wearing headgear would / not lead to more reckless behavior and higher rates of bodily injuries
• Peer-reviewed results published in the British Journal of Sports Medicine.

6. What did the study find?

• A) When the results of both high-performing and low-performing head guards were lumped together, the study found no statistical benefits. This is not surprising considering that 60% of the players who wore headgear wore products with a 3-star rating in the Virginia Tech Helmet Lab rating, with only 40% wearing 5-star rated products. Naturally the inclusion of products with such widely different qualities led to a watering down of the overall results.
• B) The results of specific brands varied greatly- the rate of concussions suffered by players wearing the worst performing product was even higher than that of players wearing no headgear (5.4% vs. 4.9% for players not wearing headgear), and 2.16x higher than the concussion rate experienced by players wearing the top performing product (Storelli). 
• C) Storelli headgear was the only one to achieve a statistically significant reduction in the relative risk of concussions, with a ~50% overall reduction in the risk of concussion. The 1546 players (both male and female) who did not wear any headgear experienced a Soccer Concussion Rate (SRC) of 4.9% overall. Those players who wore Storelli headgear (523 players) suffered an SRC of only 2.5%. This reduction in relative risk (risk ratio) was statistically significant with a ~98% confidence (p-value = 2.3%). 
• D) For female players specifically, Storelli headgear achieved a ~60% reduction in the relative risk of concussions. The 998 female players who did not wear headgear recorded an SRC of 6.5% vs. 2.7% for those who wore Storelli headgear (364 players). This reduction in relative risk was also statistically significant at ~97% (p-value = 2.6%)
• E) The study found NO increased risk of other bodily injury for players wearing headgear. This dispels the notion that wearing headgear may make players more reckless.
• The Supplementary Table 1 with brand-specific results is available for download from the Journal HERE. For further questions specific to the NOCSAE-sponsored study, coaches and soccer administrators may try to contact directly the author of the study (Dr. Tim McGuine, McGuine@ortho.wisc.edu, 608 265 6516).

By no means does this represent a "total solution" to soccer concussions. We believe more studies should be conducted to solidify results and deepen understanding. But this is indeed a positive first step in the right direction and we are proud that are company is at the cutting edge of such an important issue.