Reducing concussions for female soccer players
Soccer is most certainly a contact sport… and that might be the understatement of the year.
Photo licensed from IMAGO
Female soccer players are nearly twice as likely to suffer from concussions as their male peers (1). Women in sport also appear to have a longer recovery period after sustaining one— sometimes twice as long (2).
As a result, the 2023 FIFA Women’s World Cup has independent concussion monitors present for the first time in history. They monitor to all the video angles in matches, and slow down the speeds to identify athletes that need to be evaluated for concussions. Their job is to notify the team doctors whenever this is spotted.
It’s encouraging to see this being taken seriously at the professional level. However, female athletes are a dramatically understudied group in sports science. A large data disparity gap has been well-documented between male and female athletes. Thankfully, some in the research community have identified this gap and are working to address it!
What’s the reason that women are twice as likely to suffer concussions as men?
USWNT player Lindsey Horan is tackled by Netherlands national team player Daniëlle van de Donk during their match in the 2023 FIFA World Cup.
Photo licensed from IMAGO
Sports scientists have a couple of theories on why this risk is higher:
Women have a greater ball-to-head size differential (3).
Women have less neck and shoulder strength than male peers, which may influence head stability during impact (3).
Gendered differences in cerebral blood flow may impact cognitive state in different ways (4).
Strength and conditioning coaches have advocated that increasing neck strength may increase head stabilization (5), but the research on the whole is split down the middle. The conclusions are almost as mixed as the research done on athletes and the effects of training in relation menstrual cycles. We don’t have all the answers on brain health— we’re learning more and more over time.
Clearly, head injuries, their causes, and their reduction are a complex thing. Let’s dig into what we can act on to try and reduce concussions as the science continues to develop.
Strategies to reduce concussions
While there may be some biological differences behind this risk, we can still try to decrease concussions by focusing on what we can control. Let’s go over two training tactics to reduce concussions and one way to improve concussions identification/recovery when they occur.
1. Improve athlete agility and proprioception
While contact events can cause head injury in soccer (more often for men), women seem to suffer concussions more often through non-contact events in high school soccer (1). If we can improve athlete agility and proprioception (body awareness), perhaps they can avoid these situations, both contact and non-contact, more often through fast reflexes and deft movement.
Improving athlete agility is so much more than ladder drills. Those drills can be effective at increasing body awareness, but they do not improve athletes agility.
Agility is made up of 4 components:
Acceleration
Deceleration
Change of Direction
Reaction to a Stimulus (this is the reflex part!)
If you want to improve agility, throw your pre-planned footwork drills out the window and embrace adding a little chaos that forces the athletes to make quick decisions. Playing multiple sports is a great way to naturally increase this skill as well!
Learn more about how we train agility.
2. Improve athletes’ stabilizing muscle strength and kinetic chain
According to a 2018 study that focused on heading the ball in soccer, “head and neck size and neck strength predict peak linear acceleration and peak rotational acceleration” (6). This data supports the idea that stabilizing muscles can better set up athletes (male or female, any sport) for absorbing, producing, and directing force in this area (5).
The key muscles are the sternocleidomastoid (“SCM”) and the trapezius (“traps”). The SCM is a cervical muscle that controls the rotation, bend, and tilt of the head. The traps help move the head, neck, arms, shoulders and torso while they also stabilize the spine.
The trapezius muscles (commonly known as “traps”)
Image courtesy of Biology Dictionary
The sternocleidomastoid (“SCM”)
Image courtesy of Wikipedia
We strengthen these muscles using their full range of motion as well as through isometric movements. Research has been showing that full range of motion training is more effective, so we favor those movements for athletes that only see us once a week. We add in isometric training for those that come in more often to make sure we’re checking all the boxes.
4 Way Neck Crunch
Rear Iso Neck Hold
3. Educate the soccer community on concussion protocols to improve identification and recovery
Women’s soccer has one of the highest concussion incidence rate in collegiate sports, let alone high school (3). Because women can sometimes take longer to recover from concussions, identifying and effectively treating concussions is vital to the health and recovery of athletes.
Education on concussions, their identification, and return to play protocols vary from youth levels to professional. Even in leagues where education is available, adherence to the guidelines and policies have been inconsistent (7). This includes behavior from players, coaches, clubs, and officials. Not only is more education needed, but so is stricter enforcement.
Washington State has done an effective job at educating football and soccer coaches on concussions and protocols, but athlete and parent education was severely lacking (8). Much like what we tell our softball pitchers and their parents, the child and their guardians have to be educated and advocate for the proper treatment in their clubs in order to change this behavior at a grassroots level.
Learn how we Measure the 4 Components of Athlete Knee Health
Let’s bring this to a… head.
Women soccer players can suffer concussions more often then men and can take a longer time to recover. Knowing what we know now about brain health, it’s imperative that we do everything we can to reduce this risk. Today, that risk is best addressed through improved agility and proprioception as well as strengthening the neck and associated kinetic chain.
Parents, if your child is doing soccer skill training only, you need to think about enrolling them in qualified sports performance training where these needs can be addressed to better protect your athlete. And not just for their brain health, but for their overall body health. If your child’s body isn’t prepared for the demands of their sport, they are more likely to suffer injury.
Interested in training with us?
References
Bretzin AC, Covassin T, Wiebe DJ, Stewart W. Association of Sex With Adolescent Soccer Concussion Incidence and Characteristics. JAMA Netw Open. 2021 Apr 1;4(4):e218191. doi: 10.1001/jamanetworkopen.2021.8191. PMID: 33904911; PMCID: PMC8080231.
Baker JG, Leddy JJ, Darling SR, Shucard J, Makdissi M, Willer BS. Gender Differences in Recovery From Sports-Related Concussion in Adolescents. Clin Pediatr (Phila). 2016 Jul;55(8):771-5. doi: 10.1177/0009922815606417. Epub 2015 Sep 15. PMID: 26378093.
Covassin T, Swanik CB, Sachs ML. Sex Differences and the Incidence of Concussions Among Collegiate Athletes. J Athl Train. 2003 Sep;38(3):238-244. PMID: 14608434; PMCID: PMC233178.
Esposito G, Van Horn JD, Weinberger DR, Berman KF. Gender differences in cerebral blood flow as a function of cognitive state with PET. J Nucl Med. 1996; 37 (4): 559 – 564
Collins CL, Fletcher EN, Fields SK, Kluchurosky L, Rohrkemper MK, Comstock RD, Cantu RC. Neck strength: a protective factor reducing risk for concussion in high school sports. J Prim Prev. 2014 Oct;35(5):309-19. doi: 10.1007/s10935-014-0355-2. PMID: 24930131.
Caccese JB, Buckley TA, Tierney RT, Arbogast KB, Rose WC, Glutting JJ, Kaminski TW. Head and neck size and neck strength predict linear and rotational acceleration during purposeful soccer heading. Sports Biomech. 2018 Nov;17(4):462-476. doi: 10.1080/14763141.2017.1360385. Epub 2017 Oct 16. PMID: 29037111.
Hubertus V, Marklund N, Vajkoczy P. Management of concussion in soccer. Acta Neurochir (Wien). 2019 Mar;161(3):425-433. doi: 10.1007/s00701-019-03807-6. Epub 2019 Jan 28. PMID: 30687899.