Are There Differences in Concussion-related Characteristics and Return-to-play in Soccer Positions?

Background: Previous studies in American football players have demonstrated varying risks of sport-related concussions (SRC) among differing positions. With the high incidence of SRC in soccer, it is important to determine whether any soccer positions carry increased risk of concussion. The purpose of this study is to determine if injury-related characteristics and return-to-play (RTP) differences exist between soccer positions following SRC.

Methods: Data were prospectively collected from participants enrolled in the North Texas Concussion Network Registry (ConTex) between August 2015-April 2021. Participants aged 5-18 diagnosed with SRC in an organized soccer event with documented position were included. Participants were separated into 4 groups based on position: Forward, Midfielder, Defender, and Goalkeeper. Demographics, medical history, injury-related details, and outcomes of symptom resolution (≤30, >30 days) and RTP were reviewed. All comparisons are reported as Forward vs Midfielder vs Defender vs Goalkeeper.

Results: 299 participants were included: 77 Forwards, 91 Midfielders, 82 Defenders, 49 Goalkeepers. There were no significant differences between the groups in age, sex, race, ethnicity, history of learning disorders and anxiety, or previous concussion history. History of depression was found to be the highest amongst Goalkeepers when comparing the 4 soccer positions (p=0.001; Table 1). The majority of all concussions in each group occurred in Games (85.7 vs 85.7 vs 86.6 vs 79.6%, p=0.61) and on Club teams (50.7 vs 55.0 vs 69.5 vs 61.2%, p=0.24). Head to Ball and Head to Surface were the most common mechanisms of injury reported, except for Goalkeepers who most commonly reported Head to Body Part (p < 0.0001). The location of head impact varied depending on what position the athlete was playing (p=0.44). There were no significant differences in the athletes reporting loss of consciousness or amnesia following SRC. In our population, 16.4% of the concussions occurred in Goalkeepers; however, Goalkeepers only make up 9.1% of the players on the field.

At 3-month post-enrollment, there were no significant differences in prolonged symptom resolution (>30 days: 30.4 vs 26.2 vs 32.7 vs 25.0%, p=0.83). However, there was a significant difference in RTP, with Midfielders having the highest rate of RTP (88.2 vs 95.4 vs 81.9 vs 81.8%, p=0.04). Amongst those who RTP within 3 months, Forwards were able to initiate RTP quickest (29.8±21.7 vs 37.9±48.3 vs 33.8±29.8 vs 38.5±41.8 days, p=0.98).

Conclusion: Of the few differences seen comparing concussion characteristics among soccer positions, most were seen among Goalkeepers. Goalkeepers showed higher rates of depression, disproportionately suffered more concussions, and underwent different mechanism of injury as well as had the lowest rate of RTP at 3-months. This information may aid providers in educating on the risks of concussion of soccer positions and may play a future role in injury prevention.