U.S. Soccer


A main component of Recognize to Recover is focused on head injuries, including concussions. U.S. Soccer has taken a lead in education, research and proposing rule changes to improve player safety for several years.

U.S. Soccer Concussion Initiative 2016

In December of 2015, U.S. Soccer unveiled the U.S. Soccer Concussion Initiative that provides information guidelines that have been implemented since January of 2016.

The elements contained in the initiative are intended to give U.S. Soccer Organization Members, as well as players, parents, team/club staff and coaches and referees, guidance and direction when dealing with head injuries and potential head injuries during soccer participation.

Included in the U.S. Soccer Concussion Initiative are specific changes to rules on substitutions and heading for certain age groups. Those changes included:

  • Modify substitution rules to allow players who may have suffered a concussion during games to be evaluated without penalty
  • Eliminating heading for children 10 and under
    • Please note that U11 is listed in the U.S. Soccer Concussion Initiative document because U11 players can be 10 years old at the beginning of the season
  • Limiting the amount of heading in practice for children between the ages of 11 and 13

For more information, please refer to the frequently asked questions, which should help clarify questions regarding the new initiatives.

Concussion Education, Identification and Treatment

As the science of evaluating and managing concussions has advanced, key findings emphasize the need for education of players, their families, coaches, medical staffs and the public at large on the signs and symptoms of concussion. There is also a critical need for early identification and proper management of a concussion.

The goal of the U.S. Soccer Concussion Management Program is to provide state of the art education, evaluation and management of concussions among national teams players. The program includes pre-injury baseline testing with comprehensive post-injury follow-up evaluations and return to play protocols.

At the core of the program is a network of sports neuropsychologists who will serve as referral sources for post-injury evaluations and provide team medical staff with important information about a player's post-injury neurocognitive status.

Concussion Defined
Concussion is a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Several common features that incorporate

  • Concussion may be caused either by a direct blow to the head, face, neck, or elsewhere on the body with an "impulsive" force transmitted to the head.
  • Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously.
  • Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury.
  • Concussion results in a graded set of clinical syndromes that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course.
  • Concussion is typically associated with grossly normal structural neuroimaging studies.

US Soccer National Teams Concussion Testing and Management Process

  • Baseline All Athletes During First National Team Camp
  • Educate self on US Soccer Concussion Protocols
  • Emergency Assessment of Athlete
  • Stabilize Athlete
  • Transport Athlete (if needed)
    • Ambulance
    • Car
  • Evaluate Athlete for Concussion
    • On Field -
    • Immediately Remove Athlete from Participation if concussion is suspected.
  • Contact Parents
  • Contact U.S. Soccer Medical Staff by email
    • Hughie O'Malley
    • Anton Rill
    • Dr Ruben Echemendia
  • Training Room Evaluation
    • SCAT3 Form
  • Graded Return to Play
    • Step 1
  • Impact Concussion Post Injury Test (after Symptom Free for 24-48 hours)
  • Consult Neuropsychologist and Physician
  • If Neuropsych Eval is back to baseline
  • Graded Return to Play
    • Steps 2-4
  • Consult Physician
  • Graded Return to Play
    • Steps 5-7
  • Consult Physician
  • Return To Play

Click the above image to download as a PDF

Additional Education Materials [PDF downloads]: