Acta Neurochirurgica

, Volume 161, Issue 3, pp 425–433 | Cite as

Management of concussion in soccer

  • Vanessa Hubertus
  • Niklas Marklund
  • Peter VajkoczyEmail author
Review Article - Brain trauma
Part of the following topical collections:
  1. Brain trauma



When participating in contact sports, (mild) head trauma is a common incident—observed in both professional and amateur sports. When head trauma results in transient neurological impairment, a sports-related concussion has occurred. Acute concussion, repetitive concussions, as well as cumulative “sub-concussive” head impacts may increase the risk of developing cognitive and behavioral deficits for athletes, as well as accelerated cerebral degeneration. While this concept has been well established for classic contact sports like American Football, Rugby, or Boxing, there is still an awareness gap for the role of sports-related concussion in the context of the world’s most popular sport—Soccer.


Here, we review the relevance of sport-related concussion for Soccer as well as its diagnosis and management. Finally, we provide insight into future directions for research in this field.


Soccer fulfills the criteria of a contact sport and is characterized by a high incidence of concussion. There is ample evidence that these events cause functional and structural cerebral disorders. Furthermore, heading, as a repeat sub-concussive impact, has been linked to structural brain changes and neurocognitive impairment. As a consequence, recommendations for the diagnosis and management of concussion in soccer have been formulated by consensus groups. In order to minimize the risk of repetitive concussion in soccer the rapid and reliable side-line diagnosis of concussion with adoption of a strict remove-from-play protocol is essential, followed by a supervised, graduated return-to-play protocol. Recent studies, however, demonstrate that adherence to these recommendations by players, coaches, clubs, and officials is insufficient, calling for stricter enforcement. In addition, future research to solidify the pathophysiological relevance of concussion for soccer athletes seems to be needed. Advanced neuroimaging and neurochemical biomarker analyses (e.g. S100β, tau and neurofilament light (NfL)) may assist in detecting concussion-related structural brain changes and selecting athletes at risk for irreversible damage.


Sports-related concussion represents a genuine neurosurgical field of interest. Given the high socioeconomic relevance, neurosurgeons should get involved in prevention and management of concussion in soccer.


Brain imaging Chronic traumatic encephalopathy Concussion Concussion biomarkers Functional brain imaging Post-concussion syndrome Repetitive head trauma Return to sport Soccer Standard concussion assessment tool Sports-related concussion Tau Traumatic brain injury 



Concussion in Sports Group


Cerebrospinal fluid


Computed tomography


Chronic traumatic encephalopathy


Default mode network


Diffusion tensor imaging


Fédération Internationale de Football Association


Functional magnetic resonance imaging


Glial fibrillary acidic protein


Magnetic resonance imaging


Magnetic resonance perfusion


Magnetic resonance spectroscopy




National Football League


Neurofilament light


Neuron specific enolase


Post-concussion syndrome


Positron emission tomography


Return to sport


Sport Concussion Assessment Tool


Second impact syndrome


Sports-related concussion


Traumatic brain injury


Transcranial magnetic stimulation


Compliance with ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Vanessa Hubertus
    • 1
  • Niklas Marklund
    • 2
  • Peter Vajkoczy
    • 1
    Email author
  1. 1.Department of NeurosurgeryCharité Universitätsmedizin BerlinBerlinGermany
  2. 2.Skane University Hospital, Department of Clinical Sciences Lund, NeurosurgeryLund UniversityLundSweden

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