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.
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.