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Pop quiz: Which high school sport has the highest rate of concussions?

If you guessed boys’ football, you would be wrong. It is actually girls’ soccer according to new research presented at the 2017 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). In fact, overall, high school girls have a significantly higher concussion rate than boys.

Wellington Hsu, MD, Professor of Orthopaedics at Northwestern University’s Feinberg School of Medicine and lead author of the study says,

“While American football has been both scientifically and colloquially associated with the highest concussion rates, our study found that girls, and especially those who play soccer, may face a higher risk.”

The researchers reviewed a sample of injury data from 2005 to 2015 from the High School Reporting Information Online injury surveillance system. The study compared the years before the enactment of traumatic brain injury (TBI) laws addressing training, return to play, and liability (2005-2009); and the years after such laws were in effect in all 50 states and the District of Columbia (2010 to 2015).

During the identified time periods, high school athletic trainers provided injury data for 9 sports: football, soccer, basketball, wrestling, and baseball for boys; soccer, basketball, volleyball, and softball for girls. The data included detailed information on each player (sport, age, year in school), the athlete’s injury (diagnosis, severity, and return to play), the mechanism of injury, and the situation that leads to the injury.

Here’s what they found:

Overall, there were 40,843 reported high school athlete injuries, including 6,399 concussions. Among the findings:

  • Although the total participation rate for the 9 sports increased by 1.04 fold, the number of diagnosed concussions increased 2.2 fold from 2005 to 2015.
  • In gender-matched sports, girls experienced significantly higher concussion rates than boys.
  • During the years after TBI law enactment (2010 to 2015), the concussion rate was higher in girls’ soccer than boys’ football, and during the 2014-2015 school year, concussions were more common in girls’ soccer than any other sport.
  • Boys baseball and girls volleyball had the most significant increase in the rate of concussions during the 10-year study period.

The study authors speculated that girls may face a greater risk of concussions and other injuries in soccer due to a lack of protective gear, an emphasis on in-game contact, and the practice of “headers” (hitting the ball with your head).

The bottom line

Overall, the researchers believe the rise in concussion rates reflects the enactment and enforcement of TBI laws throughout the U.S., which have led to greater awareness of concussions by first responders—coaches, parents, and athletic trainers—as well as better recognition of symptoms by players and a more open culture of communication within teams and school.

Dr. Hsu concludes, “the new knowledge presented in this study can lead to policy and prevention measures to potentially halt these trends.”

Patricia Salber MD, MBA (@docweighsin)

Patricia Salber, MD, MBA is the Founder and Editor-in-Chief of The Doctor Weighs In. Founded in 2005 as a single-author blog, it has evolved into a multiauthored, multi-media health news site with a global audience. She has been honored by LinkedIn as one of ten Top Voices in Healthcare in both 2017 and 2018.

Dr. Salber attended the University of California San Francisco for medical school, internal medicine residency, and endocrine fellowship. She also completed a Pew Fellowship in Health Policy at the affiliated Institute for Health Policy Studies. She earned an MBA with a health focus at the University of California Irvine.

She joined Kaiser Permanente (KP)where she practiced emergency medicine as a board-certified internist and emergency physician before moving into administration. She served as the first Physician Director for National Accounts at the Permanente Federation. She also served as the lead on a dedicated Kaiser Permanente-General Motors team to help GM with its managed care strategy. After leaving KP, she worked as a physician executive including serving as EVP and Chief Medical Officer at Universal American.

She has served as a consultant or advisor to a wide variety of organizations including digital start-ups such as CliniOps, My Safety Nest, Doctor Base. She currently consults with Duty First Consulting as well as Faegre, Drinker, Biddle and Reath, LLP.

Pat serves on the Board of Trustees of MedShare, a global humanitarian organization. She is also Chair of MedShare's Western Regional Council.


  1. I sent this to my sister-in-law. My niece has played competitive soccer for years (she’ll probably be offered college soccer scholarships, she’s very good) and what’s interesting is that they had not wanted their son, my nephew, to play football because of the risks. But back then the focus was on football with respect to traumatic brain injury; girls’ soccer wasn’t really on the radar.

  2. Very interesting article. I have international Rugby players in my family and the founder of Rugby in France was used to catch me when I was a toddler to ask me: Why you are not a boy. My sister was educated as a girl, not me. I walk at 7 months, has to jump and run before I was 1 year old as the boys. I was excellent in sport but got a juvenile polyarthritis, with terrible side effects with phenylbutazone. In fact, I resumed playing tennis for competition when my nutrition corrected my disease and was trained in medical school team until I start the internship. I never had a contusion, whatever I was exhausted with my coach, I think because as a baby I was very challenged as the boys are. I would like to see the same study done in England where girls have the same training in sport than boys from birth.


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