Rule changes have reduced the risk of head injuries in football

Rule changes have proven to be an effective way to reduce the risk of injury across a range of sports. In football one such change has been a mandatory red card for elbow-to-head strikes. This week’s FastFact examines an article that has measured the impact of this rule change in the German Bundesliga1.

In 2006 the Laws of the Game were changed with the goal of reducing the incidence of head injuries. Epidemiological studies had shown that a large proportion of all head injuries in football were caused by a blow to the head from a raised elbow, frequently during a heading duel. Based on this observation the rules were changed to mandate that players receive a red card (sent off field) for intentional elbow-head contact. The aim of this study was to further describe the head injury mechanisms in football (before and after this rule change) and examine the effectiveness of the change.

Based on continuously recorded data from the German football magazine “kicker”, a database of all head injuries in the 1st German male Bundesliga was generated. Data was collected from the seasons 2000/01-2012/13. Injury mechanisms were analysed from video recordings. Injury incidence rates (IR) and 95% confidence intervals (95% CI) as well as incidence rate ratios (IRR) to assess differences before and after the rule change were calculated. In total 356 head injuries were recorded (IR 2.22, 95% CI 2.00 to 2.46 per 1000 match hours) during the study period. Contact with another player caused most head injuries, more specifically because of head-head (34%) or elbow-head (17%) contacts. After the rule change, head injuries were reduced by 29% (IRR 0.71, 95% CI 0.57 to 0.86, p=0.002). Lacerations/abrasions declined by 42% (95% CI 0.39 to 0.85), concussions by 29% (95% CI 0.46 to 1.09), contusions by 18% (95% CI 0.43 to 1.55) and facial fractures by 16% (95% CI 0.55 to 1.28).

Based on the results of this analysis the introduction of a mandatory red card for elbow-to-head strikes appears to have reduced the risk of head injuries in men’s professional football. While this injury reduction has not been established in recreational football (or in women’s professional football) the results of this study are encouraging. The study does have some methodological flaws including its retrospective nature. It does however highlight the potential value of rule changes for preventing or limiting injury. It is also possible that the actual extent of the reduction is greater given that football is more physical than ever before.

To learn more about head injuries in football please complete the concussion module in the FIFA Diploma in Football Medicine.

Reference
1. Beaudouin F, aus der Fünten K, Tröß T et al. Head injuries in professional male football (soccer) over 13 years – 29% lower incidence rates after a rule change (red card). Br J Sports Med 53, 2019: 948-952.

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Mark HerrickstevengriffithbangouraDr. ANIEMENA- GEORGE CHIDI CHINENYE Recent comment authors
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Dr Aniemena-George Chidi Chinenye
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Dr Aniemena-George Chidi Chinenye

It is very welcomed, but other causes of head injuries during play such as Heading of the ball should be given more clarity. Football without heading will be like eating a cake without icing, that is a fact. We know heading adds to the beauty of the game, but safety and the lives of players matter most. Different school of thoughts have various views with regard to the impact of heading in head injuries example Concussion. FIFA should ensure clarity about how safe heading is in football. Moreover, I have personally witnessed a 26yrs old player who developed Concussion 10… Read more »

bangoura
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bangoura

DANS LE SPORT EN GENERAL ET LE FOOT BALL EN PARTICULIER L UNES DES PARTIES LES PLUS EXPOSEES EST LA TETE. LES TRAUMAS CRANIENS SONT LEGIONS DANS LES COMPETITIONS DE LA FIFA ET LES LOIS DU FOOT BALL PROTEGENT ACTIELLEMENT LES SPOTIFS DE CERTAINS COMPORTEMENTS QUI SONT SANCTIONNES PAR DES CARTONS ROUGES OU JAUNES EN FONCTION DE LA SEVERITE DE L ACTE. AINSI TOUS LES COUPS VOLONTAIRES SONT SANCTONNES PAR LES ARBITRES ET LES JOUEURS SONT CONTRAINTS A UNE DISCIPLINE DE FAIR PLAY. AVEC LE CHANGEMENT DES REGLES DU JEU ET L APPLICATION PAR LES ARBITRES NOS SPORTIFS ßERONT PROTEGES… Read more »

stevengriffith
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We now get trauma research from journalist and biased magazine articles to affect sport. Sad. This is based on what 1 referree catches. I would suggest unreported head injuries to referree is 100 times more to what trainers and first aid find. When assessing neurological deficit in players and former players 20 points of neurological loss is standard As an arbitrator what stops injury is punishment. Example: if we were to refer to head injury in China the success is 98%. There you get 1 days incarceration immediately for assault by a judge in anything including sport and football. China… Read more »

Mark Herrick
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A very interesting debate and a subject that I have been following for several years. The problem with heading is practice. Timing and technique are needed for safety and proficiency. Some repititions are needed in order to get good at heading “for every goal I scored with my head I practiced 1000 times in training” Alan Shearer. The work we have done in this area with research, product development and field testing has culminated in 28 clubs in Ireland adopting our heading program. At the centre of our offering is the use of 290gram foam footballs for practice. Our program… Read more »