Authors: Dr. Stephen A. Stache, Jr., Chief of Non-Operative Sports Medicine, Rothman Orthopaedics, and Dr. Carolyn Miller, Sports Medicine Fellow at Rothman Orthopaedics
When most people think about concussions in youth soccer, they assume heading the ball is the biggest cause. Surprisingly, the evidence tells a different story.
A concussion is a mild traumatic brain injury caused by a blow to the head or body that causes the brain to move rapidly within the skull. Symptoms can affect memory, concentration, balance, mood, sleep, behavior, and emotional well-being. Although most athletes recover completely, early recognition and proper management are essential to ensure a safe recovery.
With more than 2.5 million youth soccer players participating annually in the United States, concussion prevention remains an important priority. In fact, girls’ soccer has one of the highest concussion rates among all girls’ sports.
Rothman Orthopaedics is proud to serve as the official orthopedic partner of the Eastern Pennsylvania Youth Soccer Association and continues to be a leader in the management of sports-related concussions, including evaluating the impact of heading restrictions in youth soccer.
In 2016, U.S. Soccer banned heading for players younger than 10 years old and limited heading during practice for players ages 11 through 13. These changes were designed to reduce concussion risk while still allowing young athletes to develop the technical skills needed to play the game safely.
To better understand the effect of these rule changes, researchers at Rothman Orthopaedics analyzed more than 50,000 youth soccer concussion-related emergency department visits between 2010 and 2023. Despite the implementation of heading restrictions, concussion rates did not significantly decline. The reason is that heading itself is not responsible for most concussions. Instead, the majority result from player-to-player contact, including head-to-head collisions, elbows while competing for the ball, and impacts with the ground following a collision. These findings reinforce that preventing concussions requires a much broader approach than simply limiting heading.
Concussion Prevention and Recognition
Heading restrictions represent only one part of concussion prevention. Although no single strategy can eliminate concussion risk, combining several evidence-based approaches can help make the game safer.
Education is one of the most powerful prevention tools. Parents, coaches, athletes, and officials should all understand how concussions occur, recognize the warning signs, and appreciate the importance of reporting symptoms immediately. Creating a culture where athletes feel comfortable speaking up without fear of losing playing time is critical.
Teaching safe play is equally important. Coaches should emphasize proper technique when challenging for the ball and discourage unnecessary or dangerous contact. Officials also play a vital role by consistently enforcing rules that reduce reckless play and protect athletes from avoidable collisions.
Neck strengthening may also play a supportive role in concussion prevention. Several studies suggest that stronger neck muscles may help reduce the amount of force transmitted to the brain during impact. One study found that each additional pound of neck strength was associated with approximately a 5% reduction in concussion risk. While neck strengthening alone will not prevent every concussion, it may modestly reduce overall risk when incorporated into a comprehensive injury prevention program.
Using appropriate equipment is another important step. Players should always use an age-appropriate soccer ball that is properly inflated. Although mouthguards are primarily designed to prevent dental injuries, emerging evidence suggests they may also provide a modest reduction in concussion risk, although research remains mixed.
Despite these preventive measures, concussions can still occur. One of the greatest challenges is that they are often invisible injuries. Every concussion presents differently. Some athletes develop symptoms immediately, while others may not notice symptoms for several hours after the injury.
Common symptoms include headache, dizziness, nausea, confusion, feeling “foggy,” difficulty concentrating, sensitivity to light or noise, balance problems, blurred vision, and changes in mood or behavior. On the field, an athlete may stumble, appear dazed, have a blank stare, answer questions slowly, forget plays, or simply behave differently than normal.
One of the biggest misconceptions is that an athlete must lose consciousness to sustain a concussion. In reality, fewer than 5% of sports-related concussions involve a loss of consciousness.
If there is ever concern that an athlete may have suffered a concussion, remember one simple rule: When in doubt, sit them out. Continuing to play while symptomatic may prolong recovery and increase the risk of additional injury. Missing part of one game is always preferable to risking a more serious or prolonged recovery.
Return to Play Following a Concussion
Any athlete suspected of sustaining a concussion should be removed from play immediately. There should never be a same-day return to play, regardless of the score, the importance of the game, or how well the athlete believes they feel.
Recovery from a concussion is individualized, and returning to sport follows a gradual, stepwise progression under the supervision of a qualified healthcare professional. Athletes should only progress to the next stage if they remain symptom-free. If symptoms return during activity, progression should stop until symptoms are resolved.
Returning to school is often the first milestone before returning to sports. Temporary academic accommodations may be appropriate depending on the athlete’s symptoms. For example, some students may tolerate printed class materials better than prolonged computer use, while others may benefit from reduced homework, extended testing time, or scheduled rest breaks. Accommodations should always be individualized based on the athlete’s specific symptoms and recovery.
Concussion management has changed considerably over the past decade. Complete bed rest and avoidance of nearly all physical and cognitive activity were once considered standard treatment. Current evidence now supports an early return to light, symptom-limited aerobic exercise, such as walking or riding a stationary bicycle, as long as symptoms are not significantly worsened. Prolonged strict rest may actually delay recovery in some athletes.
Before returning to unrestricted soccer participation, athletes should be completely symptom-free, have returned successfully to normal academic activities, and have completed a supervised return-to-play progression. Most young athletes recover within two to four weeks, although those with prolonged symptoms may benefit from evaluation by a concussion specialist.
While heading often receives the greatest attention, most concussions in youth soccer actually result from player-to-player contact rather than purposeful heading. Making soccer safer requires a comprehensive approach that includes education, proper technique, neck strengthening, appropriate equipment, consistent rule enforcement, and prompt recognition of injuries.
Parents, coaches, officials, healthcare providers, and athletes all play an important role in concussion prevention. Creating an environment where athletes feel comfortable reporting symptoms and where those symptoms are taken seriously remains one of the most effective ways to protect young players.
Early recognition, honest symptom reporting, and evidence-based management are the best tools for helping young athletes recover safely and continue participating in the sport they love.
Even with the best preparation, injuries can still happen. When they do, Rothman Orthopedics offers fast, convenient access to expert concussion care.
Families can connect with our VIP Scheduling team by filling out our Fast Scheduler form online.
For immediate orthopedic care you can visit one of our Rothman urgent care/walk-in center locations for prompt evaluation and treatment.