Should Soccer Goalkeepers Wear Helmets?

Received an email from a colleague asking my opinion on her 9 year-old son wearing a helmet when playing goalkeeper in soccer.

When it comes to soccer helmets and preventing concussions, my usual response is that there is inadequate science to support risk reduction. I am also concerned that some players wearing a helmet may be over aggressive, or that opponents may target a player wearing a helmet.

However, these thoughts are mostly for field players.

When it comes to goalkeepers, there are some similar and yet different thoughts.

Decent evidence that soft helmet use could reduce lacerations, bruising, and potentially skull fractures that may result from the diving actions or contact with the goalposts.

However, we do not have sufficient evidence documenting helmet use can lead to less rotational injury to the brain after close-range impact.

Would still be cautious about goalkeepers feeling a false sense of over-confidence using helmets and then putting their heads in risky positions.

Helmet or not, would strongly recommend the following head injury risk reduction techniques for goalkeepers:

• Do recommend going feet first rather than head first into a challenged ground ball situation.
• Raising elbows and knees to protect the head when in challenge situations can also be protective, as long as not done with intent to harm another player.
• Keeping the hands up near the face while in the ready position to anticipate a shot allows quicker reaction of hands protecting the head.
• Using a fist to punch the ball rather than attempt to make a catch in traffic may reduce the risk of either direct contact with other players or limit chance of feet being taken out from below leading to uncontrolled head impact with the ground.
• Officials should enforce a reasonable protective halo distance around diving goalkeepers trying to collect balls to reduce risk of kicks or other direct blows to the head.

If selecting a helmet, I do recommend finding one that doesn't adversely affect peripheral vision and also one that properly fits and continues to fit with use. A recent study indicated that improper football helmet fit may lead to more complicated concussion outcomes. Changes in liner, sweat pattern, and  hairstyle among other things were found to affect helmet fit. While study was done in football, do think it would apply to helmet use of all types.

Click here for more injury prevention tips for soccer goalkeepers

More Dr. Koutures Thoughts on Heading and Helmet Use in Youth Soccer

The United States Soccer Federation decision to not have players under age 12 engage in heading activities and to limit heading exposure in players between age 12 to 13 has fueled many interesting exam room discussions about soccer-related concussions that have led me to develop particular thoughts on the topic, including a very unexpected and somewhat troubling take on the use of of soft helmets.

Many of my ideas have been incorporated in two thoughtful articles written by Lindsey Barton Straus, JD  from Mom'sTEAM.  Highly recommend taking the time to read both, as she very adeptly captures my experience and research with this important topic:

• U.S. Soccer Bans Soccer Heading At Age 10 And Below, Practice Limits for 11- to 13-year-olds
• Heading in Youth Soccer: The Debate Continues

One of the main take-home points that underlies my philosophy and is echoed by several other interviewed authorities emphasized an individualized approach to determining readiness to initiate heading.

While certain categorical age-based decisions are far easier to implement, as we are continually taught in pediatric medicine, the focus should more often be placed on each child's developmental age rather than their chronologic age.

Another maxim in pediatrics- never hesitate to have  a realistic discussion about a difficult topic- in this case, a dialogue between player, coach, family and medical professionals as needed to make the best decision for each athlete.

Having several such realistic discussions about preventing head injuries and making return to play decisions after concussion has also brought a unique, if not cynical insight into a related controversial topic, the use of soft helmets to reduce head injuries in soccer.

From a professional standpoint, I have always been somewhat unconvinced about the true protective value of soft helmets in soccer, and have never mandated that an athlete must wear one in order to continue playing the sport. 

It didn't take long for me to learn that most of my young athletes shared my apprehension about helmet use.

However, their lack of interest wasn't due to their reading of the medical literature, or a more typical adolescent rebellion against parent/coach/medical professional authority. 

Rather, they were afraid to wear them for fear of being a target.

"If I am the only one, or only one of a few that are on the field with a helmet, my opponents will come after me."

After hearing this concern several times over, I must admit that now when asked by a parent about my opinion on helmet use, I reflexively turn to the child and ask them to truthfully tell me their opinion.

Sure enough, I get reminded of the fear of being a target. Definitely makes the parents think a bit differently about helmet use, and given the lack of consistent evidence supporting their use, definitely influences my decision.

This may not be the most scientific way to form a response, and definitely is a sobering reflection on the competitive environment faced by many young players, but it does provide a practical and necessary real-world platform to best address each individual player's needs, concerns, and future expectations.

Curious if others have encountered hesitation to wear soft helmets based on perceived risk of being singled out on the playing field? Does this information change opinion on possible helmet use?