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Abstract and Introduction
Abstract
Object. The goal of this study was to evaluate the incidence and mechanisms of head injury during soccer games and to describe the results after spontaneous resolution of symptoms or after treatment.
Methods. In a retrospective study from 2005, records on 451 players from the German Soccer Association who had suffered various injuries were collected. The study used a questionnaire in which the player described the accident and the playing situation as well as the clinical course after trauma. This questionnaire also included information about the physical symptoms of the players and the length of their rehabilitation. Two groups were formed: one with head injuries (case group), and the other with injuries of other body parts (control group).
Results. Of the injuries reported, 108 (23.9%) were related to the head, 114 (25.3%) to the knee, 58 (13%) to the ankle, 56 (12%) to the calf, and 30 (7%) to the shoulder. The areas of the head most frequently involved were the facial and occipital regions. In the head injury group, the head duel was the most common playing action to lead to trauma. In those cases, the body part that hit the injured player was the elbow, arm, or head of the opponent. The most common playing situation was combat in the penalty area. The median hospitalization time after the trauma was 2 days for the case group and 5 days for the control group. The rehabilitation time for the case group was also shorter (median 6.5 days) than for the control group (median 30 days).
Conclusions. Trivial head injuries in soccer can have a long and complicated course. Nevertheless, the temporary disability is shorter in most cases than for players with injuries to other parts of the body. Modifying the rules of play would be necessary to reduce the incidence of head trauma.
Introduction
Soccer is the most popular sport in the world, with approximately 200,000 professional and 240 million amateur players. In the last 16 years, a variety of studies have reported on injuries to the head and other parts of the body. Head injuries can be the result of the contact of one head with another head, with the upper extremity of the opponent (usually the elbow), with the ground, with the ball, with the foot or knee, and (rarely) with goalposts. Head injuries were reported to amount to 4%–22% of all injuries in soccer, although the severity of all the injuries and the mechanisms involved have not been well documented.
In 1991, Tysvaer and Løchen postulated that "heading" the ball could lead to chronic brain injuries such as those noticed in boxers. Since the publication of these results, several cross-sectional studies have indicated that soccer can cause measurable sustained brain impairment, and this has raised significant concerns about the effects of repetitive heading in soccer.
The frequency of soccer injuries overall is estimated to be approximately 10–35 injuries per 1000 playing hours. The majority of injuries occurred at the lower extremities, mainly in the knees and ankles, although, as Dvorak and Junge mentioned, the number of head injuries was probably underestimated. This is due to the fact that the player is afraid to mention his or her symptoms to a trainer for fear of being prevented from returning to play. In an anonymous study done by Delaney et al., more than 46% of university soccer players experienced a concussion in just one fall season, and almost two-thirds of the same group experienced a concussion over the 12-month period while playing soccer. Serious head injuries are well documented, whereas mild head injuries are often not examined. Usually only players who had concussions with severe symptoms presented for evaluation and diagnosis in the emergency department.
Most of the head injuries are skull fractures or an internal head injury like intracranial hemorrhage, epidural or subdural hematoma, or cerebral contusion. Delaney et al. reported that the side of the head seems to be the most vulnerable area for concussions, because most concussive blows occur to the side or temporal part of the head. These results differed from our study.
The acute injuries occur in a split second, and it is difficult for medical staff to provide exact information about the injury mechanisms to avoid their consequences. Therefore, based on a series of cross-sectional studies in active and older retired soccer players of the Hessian soccer association (Hessischer Fußball Verband), and using a standardized questionnaire, we tried to describe the most common mechanisms and consequences of head injuries in soccer in a study of 451 amateur players.
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