A first-of-its-kind national study of youth soccer injuries recently found that soccer is a relatively safe sport, but that the frequency and type of injuries varied by gender, with boys injured more frequently than girls but suffering fewer ankle and knee injuries.

The study, reported in the February 2007 issue of American Journal of Sports Medicine, investigated soccer-related injuries suffered by 2- to 18-year olds over a thirteen year period from 1990 to 2003 sufficiently serious to require a trip to a hospital emergency room.

Researchers at the Center for Injury Research and Policy, the Columbus Children's Research Institute, Children's Hospital (Columbus, OH), and the Department of Pediatrics of Ohio State University's College of Medicine and Public Health, found that the overall injury rate in youth soccer of 1.7 per 1,000 players was fairly low compared to sports like basketball and football (the same researchers concluded in study published in the fall of 2006 that football players were almost twice as likely to be injured as soccer players). Extrapolating from the two reported deaths, the study estimated a total of 79 soccer deaths over the reporting period.

The most common injuries were to the wrist/finger/hand (20.3%)(a result that some coaches and players found surprising), ankle (18.2%), and knee (11.4%). The most common diagnoses were sprains and strains (35.9%), contusion/abrasion (24.1%), and fracture (23.2%).

That the study only counted emergency room visits, and did not track less severe injuries requiring medical attention in other health care settings, may skew the data. For example, a player who suffers a knee injury may not go to an emergency room but, when the knee swells up, will visit an orthopedist. 

Differences in Injuries by Gender

While no significant overall increase in the injury rate was reported over the study period, there was a sharp increase in the injury rate among girls, a jump the authors attributed to the increase in participation of girls in soccer (the number of girls playing high school soccer, for instance, increased from 121,722 to 309,032 over the study period).

Boys accounted for 58.6% of the estimated 1,597,528 emergency room visits for soccer-related injuries during the 13 year period, a finding at odds with other studies which reported an overall male/female injury ratio of 1 to 2.  Boys were also about twice as likely to be hospitalized as girls (1.9% versus 1.0%). Pre-school boys were five times more likely to be hospitalized as girls of same age.

The study found that boys are more likely than girls to suffer face and head/neck injuries, and laceration/puncture wounds than girls, differences that may be explained by the tendency of boys to leave the ground more often than girls to fight for head balls, with their elbows flying to face.

Girls were more likely than boys to suffer sprains (ankle, knee), strains  (groin, hamstrings, quadriceps, and hips) and knee injuries (torn ACL).

While the study found that the likelihood of sustaining a concussion was about the same for boys and girls (2.0% versus 1.7%), two other studies, one from 2007 and one from 2011, have reported that the concussion risk for girls playing high school soccer is significantly higher than for boys (almost double in the 2011 study). Both studies, however, covered all concussions reported by certified athletic trainers, not just those serious enough to require an emergency room visit. 

Differences in Injuries by Age

Nearly half (49%) of all injuries were suffered by 10 to 14 year olds (possibly because middle-school aged children are bigger, stronger and playing harder; the great variation in the size of children in this age group may also be a factor, i.e. injuries resulting from collisions between bigger and smaller players of the same age).

The number of sprains/strains and lower extremity injuries increased with age, with upper extremity injuries most common among 5 to 9 and 10 to 14 year old soccer players.

Pre-school children (ages 2 to 4) were almost three times more likely to sustain face and head/neck injuries (41%) versus older children (15.5%), and much more likely to be hospitalized than older children (5.2%) versus 1.5% for children 5 to 18 (possibly because boys engage in more backyard play than girls or because children at this age have difficulty articulating symptoms, resulting in admissions out of an exercise of caution). 

Safety recommendations

Based on their findings, the study authors recommended:

• Closer supervision of children 2 to 4 years of age because of the risk of head injuries and the high rate of hospitalization;
• Additional research on soccer helmets to see if the risk of concussion and other head injuries could be decreased;
• Possible age limitations for participation in competitive soccer; and
• Minimizing heading among younger players.