Mechanisms of Injury Leading to Concussions in Collegiate Soccer Players: A CARE Consortium Study

Jacob Jo, Adrian J. Boltz, Kristen L. Williams, Paul F. Pasquina, Thomas W. McAllister, Michael A. McCrea, Steven P. Broglio, Scott L. Zuckerman, Douglas P. Terry*, Kristy Arbogast, Holly J. Benjamin, Alison Brooks, Kenneth L. Cameron, Sara P.D. Chrisman, James R. Clugston, Micky Collins, John DiFiori, James T. Eckner, Carlos Estevez, Luis A. FeigenbaumJoshua T. Goldman, April Hoy, Thomas W. Kaminski, Louise A. Kelly, Anthony P. Kontos, Dianne Langford, Laura J. Lintner, Christina L. Master, Jane McDevitt, Gerald McGinty, Chris Miles, Justus Ortega, Nicholas Port, Steve Rowson, Julianne Schmidt, Adam Susmarski, Steven Svoboda

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Few previous studies have investigated how different injury mechanisms leading to sport-related concussion (SRC) in soccer may affect outcomes. Purpose: To describe injury mechanisms and evaluate injury mechanisms as predictors of symptom severity, return to play (RTP) initiation, and unrestricted RTP (URTP) in a cohort of collegiate soccer players. Study Design: Cohort study; Level of evidence, 2. Methods: The Concussion Assessment, Research and Education (CARE) Consortium database was used. The mechanism of injury was categorized into head-to-ball, head-to-head, head-to-body, and head-to-ground/equipment. Baseline/acute injury characteristics—including Sports Concussion Assessment Tool–3 total symptom severity (TSS), loss of consciousness (LOC), and altered mental status (AMS); descriptive data; and recovery (RTP and URTP)—were compared. Multivariable regression and Weibull models were used to assess the predictive value of the mechanism of injury on TSS and RTP/URTP, respectively. Results: Among 391 soccer SRCs, 32.7% were attributed to a head-to-ball mechanism, 27.9% to a head-to-body mechanism, 21.7% to a head-to-head mechanism, and 17.6% to a head-to-ground/equipment mechanism. Event type was significantly associated with injury mechanism [χ2(3) = 63; P <.001), such that more head-to-ball concussions occurred in practice sessions (n = 92 [51.1%] vs n = 36 [17.1%]) and more head-to-head (n = 65 [30.8%] vs n = 20 [11.1]) and head-to-body (n = 76 [36%] vs n = 33 [18.3%]) concussions occurred in competition. The primary position was significantly associated with injury mechanism [χ2(3) = 24; P <.004], with goalkeepers having no SRCs from the head-to-head mechanism (n = 0 [0%]) and forward players having the least head-to-body mechanism (n = 15 [19.2%]). LOC was also associated with injury mechanism (P =.034), with LOC being most prevalent in head-to-ground/equipment. Finally, AMS was most prevalent in head-to-ball (n = 54 [34.2%]) and head-to-body (n = 48 [30.4%]) mechanisms [χ2(3) = 9; P =.029]. In our multivariable models, the mechanism was not a predictor of TSS or RTP; however, it was associated with URTP (P =.044), with head-to-equipment/ground injuries resulting in the shortest mean number of days (14 ± 9.1 days) to URTP and the head-to-ball mechanism the longest (18.6 ± 21.6 days). Conclusion: The mechanism of injury differed by event type and primary position, and LOC and AMS were different across mechanisms. Even though the mechanism of injury was not a significant predictor of acute symptom burden or time until RTP initiation, those with head-to-equipment/ground injuries spent the shortest time until URTP, and those with head-to-ball injuries had the longest time until URTP.

Original languageEnglish
Pages (from-to)1585-1595
Number of pages11
JournalAmerican Journal of Sports Medicine
Issue number6
StatePublished - May 2024
Externally publishedYes


  • outcome
  • return to play
  • soccer
  • sport-related concussion


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