New research is out from the Pediatrics Journal (Journal of the American Academy of Pediatrics)! There is insufficient evidence to support the uniform use of headgear or mouth guards to prevent concussions in youth soccer athletes.
Snip-its below were taken from the original article.
Participation in youth soccer in the United States continues to increase steadily, with a greater percentage of preadolescent participants than perhaps any other youth sport. Despite the wide-ranging health benefits of participation in organized sports, injuries occur and represent a threat to the health and performance of young athletes. Youth soccer has a greater reported injury rate than many other contact sports, and recent studies suggest that injury rates are increasing. Large increases in the incidence of concussions in youth soccer have been reported, and anterior cruciate ligament injuries remain a significant problem in this sport, particularly among female athletes. Considerable new research has identified a number of modifiable risk factors for lower-extremity injuries and concussion, and several prevention programs have been identified to reduce the risk of injury. Rule enforcement and fair play also serve an important role in reducing the risk of injury among youth soccer participants. This report provides an updated review of the relevant literature as well as recommendations to promote the safe participation of children and adolescents in soccer.
Soccer is the most popular youth sport in the world and is 1 of the most popular team sports in the United States.1 It is estimated that 3.9 million children and adolescents participate in soccer annually,2 and from 1990 to 2014, the number of youth officially registered with US youth soccer programs increased by almost 90%.3 Despite the wide-ranging health benefits of participation in organized sports, injuries occur and represent a threat to both athlete health and performance.4 Unfortunately, recent studies suggest that injury rates in youth soccer may be increasing. Sports-related injuries represent a significant and increasing economic burden to the health care system, and the prevention of sports-related injuries in children has far-reaching health and economic benefits to the patient, the family, and the health care system as a whole. Given the number of children and youth participating in youth soccer, reducing the risk of injury among such a large group of participants has the potential to reduce attrition rates, promote lifelong participation in sport, and facilitate the improvements in public health associated with regular exercise. By providing this updated clinical report, the American Academy of Pediatrics (AAP) intends to familiarize pediatric health care providers with current information regarding the risk of injury in youth sport participation, strategies for injury prevention, legislative changes aimed at reducing injury risk in youth soccer, and important concepts with which pediatricians can guide families and sport governing bodies to reduce risk and facilitate participation.
Injury Incidence in Youth Soccer
Injury incidence rates in youth soccer vary considerably between studies and have been reported to be anywhere from 2.0 to 19.4 injuries per 1000 hours of exposure.5–7 Injury incidence has been consistently documented to be much greater during games than during training in adolescents5,8 as well as 7- to 12-year-olds.5 In a recent systematic review of injury incidence in male soccer players, injury rates among adolescent athletes was found to range from 3.7 to 11.1 injuries per 1000 hours in training but 9.5 to 48.7 injuries per 1000 hours during games.5 Injury incidence appears to increase with age, such that injuries to players younger than 12 years have been reported to be 1.0 to 1.6 per 1000 hours, whereas adolescents have demonstrated an injury rate of 2.6 to 15.3 per 1000 hours.6,7,9 Incidence rates may vary depending on the specific reporting mechanism, however, and self-reporting mechanisms may identify an even greater proportion of injuries than those identified through traditional injury reporting mechanisms involving a health care provider.4,9
Despite ongoing efforts to reduce the risk of injury in youth sports, injury rates among youth soccer participants may be increasing and are greater than those for a number of other team and individual sports (see Table 1). In a recent retrospective study of 25 years of emergency department visits, Smith et al10 found that the annual number of soccer-related injuries among 7- to 17-year-olds per 10 000 soccer participants increased 111% from 1990 to 2014. Although it is unclear whether this increase is attributable to greater incidence, increased recognition, or both; a considerable portion of this increase was attributed to a greater number of concussions, with a relatively higher overall injury incidence among girls and adolescent athletes. A similar study also revealed a significant increase in pediatric soccer-related injuries evaluated in the emergency department between 2000 and 2012, with significantly greater numbers of injuries for male youth soccer participants throughout the study.11
Concussion
Recent data suggest that concussion rates may be increasing among youth soccer athletes, and concussion remains more common among girls than boys.28–30 In a recent 9-year study of high school soccer players, concussion incidence was found to be 0.28 and 0.45 per 1000 athletic exposures for boys and girls, respectively. For both sexes, concussion incidence has been found to be greater during games than during practice, and concussion rates during both practices and games increased significantly during the study period.30 Finally, a recent study of soccer-related injuries among 7- to 17-year-old children presenting to the emergency department revealed that concussion incidence increased nearly 1600% between 1990 and 2014.10 It is unclear, however, whether this increase in concussion rates is the result of a greater number of concussions sustained or of increased recognition and diagnosis of concussions as a result of previous education efforts.
Heading is the most common sport-specific activity during which concussions occur, although the majority of injuries are attributable to contact with another player while heading rather than contact with the ball itself.30,31 Concussions are a result of brain acceleration after contact. Theoretically, concussion incidence could be reduced if the magnitude of horizontal head acceleration could be reduced. In addition to the mass and velocity of the player, factors that affect horizontal acceleration include the mass, size, speed, and inflation pressure of the ball. Therefore, balls that are overinflated or inappropriately large for the age and size of the athletes may increase the risk of head injury in young soccer players.32 Data are insufficient to determine if concussions or subconcussive impacts (repetitive heading or blows to the head that do not result in concussive symptoms) result in potentially detrimental long-term cognitive effects.33
Concussion
Eliminating all concussions from soccer is unattainable; however, implementation of prevention strategies may reduce the number and severity of concussive injuries.
All 50 states and the District of Columbia have passed concussion legislation mandating schools to develop concussion protocols and restrict participation after suffering a head injury.33 Most are modeled after Washington State’s Lystedt Law, which mandates automatic removal from play for any suspected concussion, medical clearance before returning to sport, and education for parents, athletes, and coaches. Pediatricians and other health care providers are encouraged to familiarize themselves with the precise language and requirements in the legislation regarding concussion in their individual states.
As mentioned previously, the majority of concussions in soccer occur during the act of heading but are attributable to player-player contact, not player-ball contact.30 In a recent study, contact with another player was the most common mechanism of injury in heading-related concussions among boys (68.8%) and girls (51.3%).28 Because of concerns regarding heading, the US Soccer Federation unveiled an initiative aimed at reducing concussions by banning heading for children 10 years and younger and limiting the amount of heading in practice for children between the ages of 11 and 13 years.94 More research is needed to evaluate whether this program will reduce the number of concussions in these age groups. Instructing young soccer players in proper heading techniques once the athletes demonstrate body awareness and visual tracking skills and have developed the requisite core and cervical strength is imperative. Following manufacturer recommendations for proper ball inflation and size for the age of the players also is recommended. Finally, adherence to fair-play practice and enforcement of rules may reduce the number of foul plays and dangerous contacts and may, therefore, reduce the risk of concussive injuries.30
Current evidence is insufficient to support the uniform use of headgear or mouth guards to prevent concussion.95,96 Mouthguards have been shown to prevent orofacial injuries; however, the evidence is mixed regarding risk reduction in sports-related concussion.95,97 The use of soft headgear has been studied more extensively in rugby, in which it has been shown to reduce superficial abrasions but not affect the overall rate of concussion.98 In laboratory testing, by using head forms, soccer headgear has not been shown to attenuate the head impacts during simulated soccer ball heading.99 Although Delaney et al100 concluded that headgear use in youth soccer players may reduce the risk of concussion, the national governing body for soccer in the United States does not permit its members or affiliates to require the use of headgear by players.101 Use of padded headgear is controversial because of the paucity of rigorous medical studies as well as concern for possible increased risk of injury resulting from a false sense of security.96