Which Are the Worst Sports for Concussions?

Head injuries are a serious concern in sports, particularly concussions, which can have both immediate and long-term effects on brain health. While protective gear and rule changes aim to reduce risk, certain sports still carry a higher likelihood of head trauma due to their physical nature.

Mechanisms Of Injury In Contact Based Sports

Concussions occur when external forces cause the brain to move rapidly within the skull, leading to neurological impairment. These injuries result from sudden acceleration and deceleration of the head due to direct impacts, whiplash-like motions, or rotational forces. Unlike other musculoskeletal injuries, concussions don’t always involve visible trauma, making them harder to diagnose and manage. The brain, suspended in cerebrospinal fluid, is vulnerable to shearing forces that stretch and damage neuronal axons, disrupting communication between brain cells.

The type of force applied plays a significant role in concussion severity. Linear impacts, such as a direct blow to the forehead or back of the skull, can cause the brain to collide with the inner cranium, leading to focal injuries at the site of impact (coup) and on the opposite side due to rebound forces (contrecoup). Rotational forces are particularly concerning because they induce twisting motions that strain the brainstem and midbrain, affecting motor control, balance, and consciousness. Studies using diffusion tensor imaging (DTI) have shown that rotational forces contribute to widespread microstructural damage, which may explain prolonged post-concussion symptoms in some athletes.

Repetitive sub-concussive blows—impacts that don’t cause immediate symptoms but still generate brain movement—have been linked to long-term neurological consequences, including chronic traumatic encephalopathy (CTE). Research published in JAMA Neurology highlights that athletes in high-contact sports experience hundreds to thousands of these impacts per season, raising concerns about cumulative brain damage. The threshold for sustaining a concussion varies among individuals, with factors like neck strength, previous head injuries, and genetic predisposition influencing susceptibility.

Contact Sports Frequently Associated With Concussions

Certain contact sports have a well-documented association with concussions due to frequent and intense collisions. While protective equipment and rule modifications help mitigate risks, head injuries remain common.

American Football

American football has one of the highest concussion rates, largely due to frequent high-speed collisions. A study published in JAMA (2017) found that 99% of examined brains from deceased NFL players showed signs of CTE, a neurodegenerative disease linked to repeated head trauma. Concussions often result from helmet-to-helmet contact, tackles, and falls. Despite advancements in helmet technology, no equipment can fully prevent the rapid forces that cause brain injuries.

Position plays a role in concussion risk, with linemen experiencing frequent sub-concussive impacts, while wide receivers and defensive backs are more prone to high-impact collisions. The NCAA and NFL have implemented rule changes, such as targeting penalties and concussion protocols, to reduce head injuries. However, data from the NFL’s 2023 injury report still recorded over 100 concussions during the season, highlighting the sport’s persistent risks.

Ice Hockey

Ice hockey presents a significant concussion risk due to high-speed skating, body checking, and collisions with the boards or ice. A study in the British Journal of Sports Medicine (2021) found that concussions accounted for 22% of all injuries in elite-level hockey. Players are particularly vulnerable when receiving body checks, especially if unaware of an impending hit. Additionally, fights remain a factor in professional hockey-related head trauma.

Forwards, who engage in more physical battles along the boards, tend to have higher concussion rates than defensemen or goaltenders. The NHL and other leagues have introduced rule changes, such as banning blindside hits to the head and mandating concussion spotters, to improve player safety. Despite these efforts, concussions remain a concern, particularly at the youth and amateur levels, where improper checking techniques and inadequate protective gear increase injury risk.

Rugby

Rugby, played without helmets or significant padding, has a high incidence of concussions due to frequent tackles, rucks, and scrums. A systematic review in Sports Medicine (2022) reported that rugby players experience concussion rates comparable to or exceeding those in American football. Unlike football, where players wear helmets, rugby players rely on tackling techniques and neck strength to absorb impacts, though this does not eliminate the risk.

Tackling is the primary cause of concussions, with both the ball carrier and tackler at risk. Studies show that head-to-head and head-to-shoulder collisions are common mechanisms of injury. The introduction of the Head Injury Assessment (HIA) protocol in professional rugby has improved concussion detection, but concerns remain about underreporting, particularly at the amateur level. World Rugby has trialed lowering legal tackle heights to reduce head contact, though the effectiveness of these measures is still being evaluated.

Boxing

Boxing is unique in that head impacts are an inherent part of competition. A study in The American Journal of Sports Medicine (2020) found that amateur boxers experience an average of 13.2 head impacts per round, with professional fighters likely sustaining even more. Unlike other sports where concussions are incidental, boxing involves repeated blows to the head, increasing the risk of both acute concussions and long-term neurological damage.

Knockouts, which occur when a fighter loses consciousness due to a head strike, are a clear indicator of brain trauma. Even when a boxer remains standing, cumulative sub-concussive impacts contribute to conditions such as dementia pugilistica, a form of CTE. Protective headgear, used in amateur boxing, reduces superficial injuries but does not significantly lower concussion risk. Many retired fighters experience cognitive decline, memory loss, and motor impairments due to repeated head trauma.

Soccer

Soccer, while not traditionally considered a contact sport, has a notable concussion risk due to aerial duels, head-to-head collisions, and accidental impacts with the ground or goalposts. A study in JAMA Pediatrics (2019) found that heading the ball accounted for nearly 30% of concussions in youth soccer. While the ball itself is not typically the primary cause, repeated heading can contribute to cumulative brain trauma.

Player-to-player contact is the leading cause of concussions in soccer, particularly during contested headers. Goalkeepers are also at risk when diving for the ball or colliding with opponents. In response to concerns, U.S. Soccer has implemented heading restrictions for players under 11 to limit exposure to repetitive impacts. Some studies suggest a link between frequent headers and cognitive decline later in life.

Other Activities Linked To Head Trauma

While traditional contact sports like football and hockey are well-known for concussion risks, several other activities also pose significant threats. These sports may not involve constant collisions, but their movements, falls, and physical interactions can still lead to head injuries.

Lacrosse

Lacrosse, a fast-paced sport combining elements of hockey and soccer, has a notable concussion risk due to high-speed stick checks, body contact, and errant ball strikes. A study in The American Journal of Sports Medicine (2021) found that concussions accounted for approximately 10% of all injuries in high school lacrosse, with male players experiencing higher rates due to the allowance of body checking.

Head injuries often result from unintentional contact, such as a stick or ball striking the head, or collisions between players. While helmets with face masks are mandatory for male players, female players only wear protective goggles, leaving them more vulnerable. Efforts to reduce concussions include stricter enforcement of illegal hits and improved helmet designs, but the sport’s high-speed nature continues to make head injuries a concern.

Cheerleading

Competitive cheerleading has one of the highest concussion rates among female sports, primarily due to falls from stunts and tumbling routines. A report from the National Center for Catastrophic Sport Injury Research (2022) found that head injuries accounted for nearly 30% of all cheerleading-related injuries, with flyers—athletes lifted into the air—at the greatest risk.

Concussions typically occur when a flyer falls from a stunt and lands on the ground or collides with a teammate. Tumbling passes, which involve high-impact flips and landings, also contribute. Unlike other contact sports, cheerleading lacks protective headgear, making proper technique and spotting crucial for injury prevention. Organizations such as the American Association of Cheerleading Coaches and Administrators (AACCA) have implemented stricter safety guidelines, including limits on stunt height and required matting.

Water Polo

Water polo has a significant concussion risk due to its physical nature. A study in Neurology (2020) found that nearly 36% of collegiate water polo players reported experiencing at least one concussion, with head impacts occurring from elbows, accidental collisions, and ball strikes.

Unlike land-based sports, water polo players cannot brace for impact as effectively, making unexpected blows more dangerous. Goalkeepers are particularly vulnerable, frequently blocking high-speed shots. The lack of protective headgear, aside from soft caps, further increases concussion risks. Stricter officiating on aggressive play and increased awareness of concussion symptoms aim to improve safety, but the sport’s unpredictability remains a challenge.