Characterization of Head Impact Exposure in Women’s Collegiate Soccer

in Journal of Applied Biomechanics
View More View Less
  • 1 Wake Forest School of Medicine
  • | 2 Virginia Tech–Wake Forest University
Restricted access

Soccer players are regularly exposed to head impacts by intentionally heading the ball. Evidence suggests repetitive subconcussive head impacts may affect the brain, and females may be more vulnerable to brain injury than males. This study aimed to characterize head impact exposure among National Collegiate Athletic Association women’s soccer players using a previously validated mouthpiece-based sensor. Sixteen players were instrumented during 72 practices and 24 games. Head impact rate and rate of risk-weighted cumulative exposure were compared across session type and player position. Head kinematics were compared across session type, impact type, player position, impact location, and ball delivery method. Players experienced a mean (95% confidence interval) head impact rate of 0.468 (0.289 to 0.647) head impacts per hour, and exposure rates varied by session type and player position. Headers accounted for 89% of head impacts and were associated with higher linear accelerations and rotational accelerations than nonheader impacts. Headers in which the ball was delivered by a long kick had greater peak kinematics (all P < .001) than headers in which the ball was delivered by any other method. Results provide increased understanding of head impact frequency and magnitude in women’s collegiate soccer and may help inform efforts to prevent brain injury.

Filben, Pritchard, Miller, Woods, Hayden, Miles, Urban, and Stitzel are with the Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA. Filben, Pritchard, Miller, Urban, and Stitzel are with the Virginia Tech–Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA. Miles is also with the Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Filben (tfilben@wakehealth.edu) is corresponding author.

Supplementary Materials

    • Supplementary Figure S1 (PDF 203 KB)
    • Supplementary Figure S2 (PDF 239 KB)
    • Supplementary Figure S3 (PDF 299 KB)
    • Supplementary Figure S4 (PDF 274 KB)
    • Supplementary Figure S5 (PDF 258 KB)
    • Supplementary Table S1 (PDF 10 KB)
    • Supplementary Table S2 (PDF 17 KB)
  • 1.

    Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375378. PubMed ID: 16983222 doi:10.1097/00001199-200609000-00001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Zuckerman SL, Kerr ZY, Yengo-Kahn A, Wasserman E, Covassin T, Solomon GS. Epidemiology of sports-related concussion in NCAA athletes from 2009–2010 to 2013–2014. Am J Sports Med. 2015;43(11):26542662. PubMed ID: 26330572 doi:10.1177/0363546515599634

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Covassin T, Swankik CB, Sachs ML. Sex differences and the incidence of concussions among collegiate athletes. J Athl Train. 2003;38(3):238244. www.journalofathletictraining.org. Accessed January 24, 2019.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Gessel LM, Fields SK, Collins CL, Dick RW, Dawn Comstock R. Concussions among United States high school and collegiate athletes. J Athl Train. 2007;42(4):495503. www.journalofathletictraining.org. Accessed January 24, 2019.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    FIFA Communications Division. FIFA Big Count 2006: 270 Million People Active in Football. 2007. https://www.fifa.com/mm/document/fifafacts/bcoffsurv/bigcount.statspackage_7024.pdf.

    • Search Google Scholar
    • Export Citation
  • 6.

    O’Kane JW, Spieker A, Levy MR, Neradilek M, Polissar NL, Schiff MA. Concussion among female middle-school soccer players. JAMA Pediatr. 2014;168(3):258264. PubMed ID: 24446018 doi:10.1001/jamapediatrics.2013.4518

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    O’Kane JW. Is heading in youth soccer dangerous play? Phys Sportsmed. 2016;44(2):190194. PubMed ID: 26831407 doi:10.1080/00913847.2016.1149423

  • 8.

    Mainwaring L, Ferdinand Pennock KM, Mylabathula S, Alavie BZ. Subconcussive head impacts in sport: a systematic review of the evidence. Int J Psychophysiol. 2018;132(2018):3954. doi:10.1016/j.ijpsycho.2018.01.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Caccese JB, Best C, Lamond LC, et al. Effects of repetitive head impacts on a concussion assessment battery. Med Sci Sport Exerc. 2019;51(7):13551361. doi:10.1249/MSS.0000000000001905

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Mulligan I, Boland M, Payette J. Prevalence of neurocognitive and balance deficits in collegiate football players without clinically diagnosed concussion. J Orthop Sports Phys Ther. 2012;42(7):625633. PubMed ID: 22531476 doi:10.2519/jospt.2012.3798

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Levitch CF, Zimmerman ME, Lubin N, et al. Recent and long-term soccer heading exposure is differentially associated with neuropsychological function in amateur players. J Int Neuropsychol Soc. 2018;24(2):147155. PubMed ID: 28829004 doi:10.1017/S1355617717000790

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Lipton ML, Kim N, Zimmerman ME, et al. Soccer heading is associated with white matter microstructural and cognitive abnormalities. Neuroradiology. 2013;268(3)850857. doi:10.1148/radiol.13130545

    • Search Google Scholar
    • Export Citation
  • 13.

    Hwang S, Ma L, Kawata K, Tierney R, Jeka JJ. Vestibular dysfunction after subconcussive head impact. J Neurotrauma. 2017;34(1):815. PubMed ID: 26885560 doi:10.1089/neu.2015.4238

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Guskiewicz KM, Marshall SW, Broglio SP, Cantu RC, Kirkendall DT. No evidence of impaired neurocognitive performance in collegiate soccer players. Am J Sports Med. 2002;30(2):157162. PubMed ID: 11912081 doi:10.1177/03635465020300020201

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Kaminski TW, Wikstrom AM, Gutierrez GM, Glutting JJ. Purposeful heading during a season does not influence cognitive function or balance in female soccer players. J Clin Exp Neuropsychol. 2007;29(7):742751. PubMed ID: 17852597 doi:10.1080/13825580600976911

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Greenwald RM, Chu JJ, Crisco JJ, Finkelstein JA. Head Impact Telemetry System (HITS) for measurement of head acceleration in the field. Presented at the American Society of Biomechanics Annual Meeting, Toledo, OH; 2003.

    • Search Google Scholar
    • Export Citation
  • 17.

    Hanlon EM, Bir CA. Real-time head acceleration measurement in girls’ youth soccer. Med Sci Sports Exerc. 2012;44(6):11021108. PubMed ID: 22592278 doi:10.1249/MSS.0b013e3182444d7d

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Nevins D, Smith L, Kensrud J. Laboratory evaluation of wireless head impact sensor. Procedia Eng. 2015;112:175179.

  • 19.

    Bartsch A, Samorezov S, Benzel E, Miele V, Brett D. Validation of an intelligent mouthguard single event head impact dosimeter. Stapp Car Crash J. 2014;58:127. http://www.ncbi.nlm.nih.gov/pubmed/26192948. Accessed March 16, 2019.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Camarillo DB, Shull PB, Mattson J, Shultz R, Garza D. An instrumented mouthguard for measuring linear and angular head impact kinematics in American football. Ann Biomed Eng. 2013;85(1):127. doi:10.1016/j.neuroimage.2013.08.045.The

    • Search Google Scholar
    • Export Citation
  • 21.

    Miller LE, Kuo C, Wu LC, Urban JE, Camarillo DB, Stitzel JD. Validation of a custom instrumented retainer form factor for measuring linear and angular head impact kinematics. J Biomech Eng. 2018;140(5):16. doi:10.1115/1.4039165

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Wu LC, Zarnescu L, Nangia V, Cam B, Camarillo DB. A head impact detection system using SVM classification and proximity sensing in an instrumented mouthguard. IEEE Trans Biomed Eng. 2014;61(11):26592668. PubMed ID: 24800918 doi:10.1109/TBME.2014.2320153

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Siegmund GP, Guskiewicz KM, Marshall SW, DeMarco AL, Bonin SJ. Laboratory validation of two wearable sensor systems for measuring head impact severity in football players. Ann Biomed Eng. 2016;44(4):12571274. PubMed ID: 26268586 doi:10.1007/s10439-015-1420-6

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Lamond LC, Caccese JB, Buckley TA, Glutting J, Kaminski TW. Linear acceleration in direct head contact across impact type, player position, and playing scenario in collegiate women’s soccer players. J Athl Train. 2018;53(2):115121. PubMed ID: 29373056 doi:10.4085/1062-6050-90-17

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Chrisman SPD, Donald CLM, Friedman S, et al. Head impact exposure during a weekend youth soccer tournament. J Child Neurol. 2016;31(8):971978. PubMed ID: 26951540 doi:10.1177/0883073816634857

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Chrisman SPD, Ebel BE, Stein E, Lowry SJ, Rivara FP. Head impact exposure in youth soccer and variation by age and sex. Clin J Sport Med. 2019;29(1):1. doi:10.1097/JSM.0000000000000497

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Press JN, Rowson S. Quantifying head impact exposure in collegiate women’s soccer. Clin J Sport Med. 2017;27(2):104110. PubMed ID: 26978008 doi:10.1097/JSM.0000000000000313

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Sandmo SB, Mcintosh AS, Andersen TE, Koerte IK, Bahr R. Evaluation of an in-ear sensor for quantifying head impacts in youth soccer. Am J Sports Med. 2019;47(4):974981. PubMed ID: 30802147 doi:10.1177/0363546519826953

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Mihalik JP, Amalfe SA, Roby PR, et al. Sex and sport differences in college lacrosse and soccer head impact biomechanics. Med Sci Sports Exerc. 2020;52(11):23492356. PubMed ID: 33064408 doi:10.1249/MSS.0000000000002382

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Wu LC, Nangia V, Bui K, et al. In vivo evaluation of wearable head impact sensors. Ann Biomed Eng. 2016;44(4):12341245. PubMed ID: 26289941 doi:10.1007/s10439-015-1423-3

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Kuo C, Wu LC, Hammoor BT, et al. Effect of the mandible on mouthguard measurements of head kinematics. J Biomech. 2016;49(9):18451853. PubMed ID: 27155744 doi:10.1016/j.jbiomech.2016.04.017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Reynolds BB, Patrie J, Henry EJ, et al. Effects of sex and event type on head impact in collegiate soccer. Orthop J Sport Med. 2017;5(4):110. doi:10.1177/2325967117701708

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Saunders TD, Le RK, Breedlove KM, Bradney DA, Bowman TG. Sex differences in mechanisms of head impacts in collegiate soccer athletes. Clin Biomech. 2020;74:1420. doi:10.1016/j.clinbiomech.2020.02.003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Lynall RC, Clark MD, Grand EE, et al. Head impact biomechanics in women’s college soccer. Med Sci Sports Exerc. 2016;48(9):17721778. PubMed ID: 27187102 doi:10.1249/MSS.0000000000000951

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Rowson S, Duma SM. Brain injury prediction: assessing the combined probability of concussion using linear and rotational head acceleration. Ann Biomed Eng. 2013;41(5):873882. PubMed ID: 23299827 doi:10.1007/s10439-012-0731-0

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Kleiven S. Predictors for traumatic brain injuries evaluated through accident reconstructions. Stapp Car Crash J. 2007;51:81114. PubMed ID: 18278592

  • 37.

    Miller LE, Pinkerton EK, Fabian KC, et al. Characterizing head impact exposure in youth female soccer with a custom-instrumented mouthpiece. Res Sport Med. 2020;28(1):5571.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    Rich AM, Filben TM, Miller LE, et al. Development, validation and pilot field deployment of a custom mouthpiece for head impact measurement. Ann Biomed Eng. 2019;47(10):21092121. PubMed ID: 31297724 doi:10.1007/s10439-019-02313-1

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Urban JE, Davenport EM, Golman AJ, et al. Head impact exposure in youth football: high school ages 14 to 18 years and cumulative impact analysis. Ann Biomed Eng. 2013;41(12):24742487. PubMed ID: 23864337 doi:10.1007/s10439-013-0861-z

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Quintero LM, Moore JW, Yeager MG, et al. Reducing risk of head injury in youth soccer: an extension of behavioral skills training for heading. J Appl Behav Anal. 2020;53(1):237248. PubMed ID: 30924148 doi:10.1002/jaba.557

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Gallant C, Drumheller A, McKelvie SJ. Effect of improper soccer heading on serial reaction time task performance. Curr Psychol. 2016;36(2):286296. doi:10.1007/s12144-016-9414-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42.

    Harriss A, Johnson AM, Walton DM, Dickey JP. Head impact magnitudes that occur from purposeful soccer heading depend on the game scenario and head impact location. Musculoskelet Sci Pract. 2019;40:5357. PubMed ID: 30708266 doi:10.1016/j.msksp.2019.01.009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Miller LE, Urban JE, Whelan VM, Baxter WW, Tatter SB, Stitzel JD. An envelope of linear and rotational head motion during everyday activities. Biomech Model Mechanobiol. 2020;19(3):10031014. PubMed ID: 31786677 doi:10.1007/s10237-019-01267-6

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 1114 1114 229
Full Text Views 192 192 12
PDF Downloads 182 182 15