Article Text

Download PDFPDF
Head injuries in professional male football (soccer) over 13 years: 29% lower incidence rates after a rule change (red card)
  1. Florian Beaudouin1,
  2. Karen aus der Fünten1,
  3. Tobias Tröß1,
  4. Claus Reinsberger2,
  5. Tim Meyer1
  1. 1 Institute of Sports and Preventive Medicine, Saarland University, FIFA - Medical Centre of Excellence, Saarbrücken, Germany
  2. 2 Institute of Sports Medicine, University of Paderborn, Paderborn, Germany
  1. Correspondence to Florian Beaudouin, Institute of Sports and Preventive Medicine, Saarland University, Campus, Building B 8-2, 66123 Saarbrücken, Germany; florian.beaudouin{at}


Background Absolute numbers of head injuries in football (soccer) are considerable because of its high popularity and the large number of players. In 2006 a rule was changed to reduce head injuries. Players were given a red card (sent off) for intentional elbow-head contact.

Aims To describe the head injury mechanism and examine the effect of the rule change.

Methods 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 comprising 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.

Results 356 head injuries were recorded (IR 2.22, 95% CI 2.00 to 2.46 per 1000 match hours). 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).

Conclusions This rule change appeared to reduce the risk of head injuries in men’s professional football.

  • Soccer
  • concussion
  • traumatic brain injury
  • injury patterns
  • epidemiology
  • head impact

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors TM, FB and CR were responsible for the conception and design of the study. FB was responsible for data collection over the study period. FB conducted the statistical analyses. FB, TT and KadF conducted the video analyses. FB wrote the paper. The draft of the paper was critically revised by CR, KadF and TM.

  • Funding This study was funded by the German Federal Institute of Sports Science.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. The funding statement was inadvertently omitted and this has now been reinstated. We would like to apologise to the authors for any inconvenience caused.