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Concussive head injuries feature highly in women's football 


Concussion features highly in most injury audits of the women's game...


In women’s football, a great deal of the literature focusses on injuries to the ACL; but it is important to consider injuries to other areas of the body as well. 

Although there is a known high incidence of ankle injuries in women’s football along with other non-ACL related knee injuries, concussion features highly in most injury audits. 

The reasons for this are unclear.  Although we know that concussive head injuries have been recorded to be more prevalent in the female game than in the men’s, we still don’t know exactly why.

That there is an increased risk factor for concussive head injury among female footballers has been identified by various authors (Bauer et al, 2001, Dvorak et al, 2007; Colvin et al, 2009; Dick, 2009) but to date, no single specific reason for this has been clearly proposed. 

Various suggestions have been made ranging from hormonal factors to female players having weaker neck muscles; and although there is evidence to support the potential for each, no single cause or effect has been identified which would account for the high incidences of concussive head injuries in female footballers.

Previous research has suggested that contact to contact injury is the single greatest risk factor for concussive head injury (Comstock et al, 2015) .


But this still doesn’t answer why there is a greater incidence of concussion in female players.  Clearly, further study is required in this case.

We also need to remember that football is by nature a contact sport; and as such the potential for concussive head injury is always present. 

Making direct contact with an opponent and then falling or landing awkwardly forms the greatest risk factor for head and neck injury (Bruzzone et al, 2000; Kirkendall et al, 2001; Andersen et al, 2004; Mehnert et al, 2005) and the two are often linked.

Additionally, repetitive heading of the ball (Mehnert et al, 2005), clashes of heads (Andersen et al, 2004), deliberate elbow to head contact (Fuller et al, 2004) and collision with goalposts (Janda et al,1995; Blond and Hansen, 1999) have all been shown to be significant risk factors for concussive head injury.

It is also essential to acknowledge that direct contact injury cannot be easily controlled without fundamentally changing the laws of the game. 

In order to significantly reduce the incidence of injury resulting from illegal elbow use, stricter enforcement of the rules by referees is now not only acknowledged as necessary but supported by recent evidence.

Bjørneboe et al (2013) reported a lower incidence of arm to head contact injuries with stricter interpretation of the laws of the game in Norwegian (male) professional football. 

Introducing a straight red card also seemed to reduce the incidence of head injuries in German football (Beaudouin et al, 2017).

The current focus in football is all about injury prevention; as referred to in other pages of this web-blog; but it remains difficult to legislate for those injuries that are pre-meditated. 

An accidental clash of heads is one thing; but a deliberately inflicted assault on another player is something else and if it can happen in the men’s game it can happen in women’s football as well.  

Let’s focus on the positives, though.  The FIFA Women’s World Cup in Canada 2015 failed to produce the high number of injuries anticipated due to playing on an artificial surface and it will be interesting to see the stats from France 2019. 

Although ACL injuries in women’s football carry the highest frequency of injury incidence compared to the men’s game, injuries in women’s football are not purely confined to ACLs as much of the literature suggests.

Injuries in football tend to be specific to the game; and therein lies the key; both to predicting the type of injuries we would expect to sustain and matching them with the pre-requisites of the game. 

So we would still expect to find the knee and ankle injuries, the concussions and the bruised thighs. But in dealing with injuries to female athletes, we need to remember the gender differences that are thought to pre-dispose women players to injury and focus on prevention. 

Anatomical, biomechanical and hormonal influences proposed by Renstrom et al (2008) that have since been supported by other researchers, all need due consideration in terms of injury risk and management.

References:

Anderson T, Arnason A, Engebretsen L, Bahr R (2004).  Mechanisms of head injuries in elite football.  British Journal of Sports Medicine.  Vol. 38 (6); 690 – 696.

Bauer JA, Thomas TS, Cauraugh JH, Kaminski TW, Hass CJ (2001).  Impact forces and neck muscle activity in heading by collegiate female soccer players.  Journal of Sports Sciences.    Vol. 19; 171 – 179 

Beaudouin F, aus der Funten K, Troß T, Reinsberger C, Meyer T (2017).  Head injuries in professional male football (soccer) over 13 years: 29% lower incidence rates after a rule change (red card).  British Journal of Sports Medicine. Published Online First: 23 June 2017. doi: 10.1136/bjsports-2016-097217  

Bjørnboe J, Bahr R, Dvorak J, Andersen TE (2013).  Lower Incidence of arm to head contact injuries with stricter interpretation of the Laws of the Game in Norwegian (male) professional football.  British Journal of Sports Medicine.  Vol. 47 (8); 508 – 514.

Blond L, Hansen LB (1999).  Injuries caused by falling soccer goalposts in Denmark British Journal of Sports Medicine.  Vol. 33;  110 – 112.

Bruzzone E, Cocito L, Pisani R (2000).  Intracranial delayed epidural haematoma in a soccer player; a case report.   American Journal of Sports Medicine.  Vol. 28 (1); 901 – 903.

Colvin AC, Mullen J, Lovell MR, Vereeke West R, Collins MW, Groh M (2009).  The Role of Concussion History and Gender in Recovery from Soccer-Related Concussion. American Journal of Sports Medicine.  Vol. 37 (19);  1699 – 1704.

Comstock RD, Currie DW, Pierpoint LA (2015).  An evidence-based discussion of heading the ball and concussions in high-school soccer.  JAMA Pediatrics 2015;169(9):830-837. doi:10.1001/jamapediatrics.2015.1062   Accessed 15th July, 2017.  
Dick RW (2009). Is there a gender difference in concussion incidence and outcomes?   British Journal of Sports Medicine.  Vol. 43;  i46 – i50.

Dvorak J, McCrory P, Kirkendall DT (2007).  Head injuries in the female football player: incidence, mechanisms, risk factors and management.  British Journal of Sports Medicine.  Vol. 41;  i44 – i46.

Fuller CW, Junge A, Dvorak (2004).  An assessment of Football Referees’ decisions in incidents leading to player injuries.  American Journal of Sports Medicine.  Vol. 32 (1);  Suppl 175 – 225.

Janda DH, Bir C, Wild B (1995).  Goal post injuries in soccer.  A laboratory and field testing analysis of a preventative intervention.  American Journal of Sports Medicine.  Vol. 23; 340 – 344.

Kirkendall, DT, Jordan SE, Garrett WE (2001).  Heading and head injuries in soccer.  Sports Medicine.  Vol. 31; 369 – 386.

Mehnert MJ,  Agesen, T, Malanga, GA (2005).  “Heading” and Neck Injuries in Soccer: A Review of Biomechanics and Potential Long-Term Effects.   Pain Physician.  Vol. 8 (4); 391 – 397.

Renstrom P, Ljunngvist A, Arendt E, Benynnon B, Fukubayashi, Garret W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, Mandelbaum B, Micheli L, Myklebust, Roos E, Roos H, Schamasch P, Shultz S, Werner S, Wojtys E, Engebretsen L (2008).   Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement.  British Journal of Sports Medicine.  Vol. 42; 394 – 412.



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