Effect of Soccer Headgear on Likelihood and Severity of Non-concussive Injuries in High School Athletes

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PURPOSE: In response to the rising awareness and concern over sports related concussions (SRCs) in high school soccer players, some athletes are choosing to wear protective headgear (HG) as a form of defense. One criticism of HG use is that it encourages more aggressive play, potentially increasing the incidence or severity of non-concussive injuries. The purpose of this study was to assess associations between use of HG and non-concussive injury in high school athletes. METHODS: In a randomized control study of n=1577 Wisconsin high school soccer players, athletes were assigned to a HG group (n=925), or a control group, without the use of HG (n=652) for the 2016-2017 interscholastic seasons. Each athlete provided an SRC history and baseline survey of their concussion symptoms. Athletic trainers at each school recorded the SRCs and non-concussive injuries weekly, as well as additional information about the injuries such as days lost to play. Chi-square tests and logistic regression methods were used to assess for potential associations using intention to treat analyses. RESULTS: 440 non-concussive injuries were reported, affecting 352 (22%) unique athletes. No difference in the likelihood of obtaining at least one non-concussive injury between the control group (21.9%) and the HG group (22.8%) was detected (p=0.157). Further, no difference was detected in the number of days lost between the control group (mean=11.46 days) and the HG group (14.83 days) (p=0.234). While girls were 2.53 (95% CI: 1.80, 3.55) times more likely to sustain a non-concussive injury than boys (p=0.001), after adjusting for HG use there was no significant interaction between the sex of the player and use of headgear on sustaining a non-concussive injury (p=0.21). CONCLUSION: Wearing HG designed to prevent SRCs does not influence the likelihood of obtaining a non-concussive injury, or the severity of that injury as defined by number of days lost, both of which would be expected if players with HG were competing more aggressively.