A unique aspect of soccer is the use of the head for directing the bal
l. The potential for resultant head injuries has been the focus of dis
cussions worldwide. Prior work-has attributed neuropsychologic deficit
s to the cumulative effects of heading, without evaluating concussion
rates in soccer players. We prospectively studied the seven men's and
eight women's varsity soccer teams in the Atlantic Coast Conference du
ring two seasons to document concussion incidence. The 29 concussions
diagnosed over the 2 years in 26 athletes, 17 (59%) concussions in men
and 12 (41%) in women, resulted from contact with an opponent's head
(8, 28%), elbow (4, 14%), knee (1, 3%), or foot (1, 3%), the ball (7,
24%); the ground (3, 10%); concrete sidelines (1, 3%); goalpost (1, 3%
); or a combination of objects (3, 10%). Twenty concussions (69%) occu
rred in games; none resulted from intentional heading of the ball. The
basic incidence was 0.96 concussions per team per season. The overall
incidence was 0.6 per 1000 athlete-exposures for men, and 0.4 per 100
0 athlete-exposures for women. By concussion grade, there were 21 (72%
) grade 1, 8 (28%) grade 2, and no grade 3 concussions. These findings
suggest that concussions are more common in soccer than anticipated a
nd that acute head injuries may have potential for long-term neuropsyc
hologic changes.