In a lifetime of playing soccer, I suffered bruised shins, twisted ankles, balls to the face, balls to the balls, elbows to the ribs, and a torn calf muscle. I also learned that none of the above is a big deal, certainly nothing worth sacrificing something as enjoyable as playing soccer over. If you watch sports you see athletes get hurt and recover all the time, but you almost never hear them wish they hadn’t started in the sport in the first place.
There are many fun things we can do with our bodies. The most fun involve some risk of pain and harm: snowboarding, getting tattoos, climbing trees, having kids, lifting, BDSM, soccer, cliff jumping, punch bug. Sports provides exposure to physical risks, letting you decide which activities are worth the bruises.
It’s possible to live life bruise-free, but I’m not sure you can call that “living”.
Then you can look forward to such exciting consequences as are listed in the “Prognosis” and “Complications” sections of the Wikipedia page I linked (do read them in their entirety—don’t take my word for it; it’s worth being fully aware of the reality of head injuries, so that you can be properly horrified).
Note that unlike bruised shins, twisted ankles, or even broken bones, the effects of a TBI are almost invariably irreversible (and multiple TBIs have a compounding effect).
Also unlike bruised shins or broken bones, brain damage doesn’t just cause some pain, inconvenience, or even loss of physical function—it irreversibly damages (or, in more severe cases, destroys) who you are.
I’ve seen the effects of severe TBI up close and personal. If avoiding a large increase in my risk for such a fate means that I’m “not living”, then maybe “living” isn’t all it’s cracked up to be.
How large an increase? Well, here are some citations:
An estimated 300,000 sport-related traumatic brain injuries, predominantly concussions, occur annually in the United States. Sports are second only to motor vehicle crashes as the leading cause of traumatic brain injury among people aged 15 to 24 years.
According to CPSC data, there were an estimated 446,788 sports-related head injuries treated at U.S. hospital emergency rooms in 2009. This number represents an increase of nearly 95,000 sports-related injuries from the prior year. … The actual incidence of head injuries may potentially be much higher for two primary reasons. In the 2009 report, the CPSC excluded estimates for product categories that yielded 1,200 injuries or less, those that had very small sample counts and those that were limited to a small geographic area of the country. Additionally, many less severe head injuries are treated at physicians’ offices, immediate care centers or are self-treated.
The following 20 sports/recreational activities represent the categories contributing to the highest number of estimated head injuries treated in U.S. hospital emergency rooms in 2009.
[full list omitted; soccer is 7th, being responsible for 24,184 cases —SA]
The top 10 sports-related head injury categories among children ages 14 and younger:
[full list omitted; soccer is 7th again, being responsible for 8,392 cases —SA]
Protection against head injuries in soccer is complicated by the fact that heading is an established part of the game, and any attempt to protect against head injuries must allow the game to be played without modification. Several head guards have been developed to reduce the risk of head injuries in soccer. One independent research study found that none of the products on the market provided substantial benefits against minor impacts, such as heading with a soccer ball.
A McGill University study found that more than 60 percent of college-level soccer players reported symptoms of concussion during a single season. Although the percentage at other levels of play may be different, these data indicate that head injuries in soccer are more frequent than most presume.
In summary: for anyone who values their personal survival, and the retention of their mental faculties (which, I think, describes most people on Less Wrong), participating in sports—especially sports like soccer—is an exceptionally bad idea.
I wanted to get a better sense of the risk, so here is some arithmetic.
Putting together one of the quotes above:
An estimated 300,000 sport-related traumatic brain injuries, predominantly concussions, occur annually in the United States.
And this bit from the recommended Prognosis section:
Most TBIs are mild and do not cause permanent or long-term disability; however, all severity levels of TBI have the potential to cause significant, long-lasting disability. Permanent disability is thought to occur in 10% of mild injuries, 66% of moderate injuries, and 100% of severe injuries.
And this bit from the Epidemiology section:
a US study found that moderate and severe injuries each account for 10% of TBIs, with the rest mild.
We get that there are 300k sport-related TBI’s per year in the US, and of those, 240k are mild, 30k are moderate, and 30k are severe. Those severity levels together result in 24k + 20k + 30k ~= 75k cases of permanent disability per year.
To put that in perspective, we can compare to another common activity that has potential to cause harm:
In 2010, there were an estimated 5,419,000 crashes, 30,296 of with fatalities, killing 32,999, and injuring 2,239,000.
If we say that a fatality and a permanent disability due to brain injury are the same order of magnitude of badness, this suggests that sports and traveling by car expose the average (as in mean, not median) American to roughly the same level of risk.
Would be interesting to dig deeper to see how much time Americans spend in cars vs playing sports on average (and then you’d also want to look at the benefits you get from each), but I’ll stop here for now.
While I agree with this, the consequences of a largely sedentary lifestyle on cognitive performance are also pretty significant, and human motivation is fickle. I am not sure how the calculus turns out, but if you find that the only thing that makes you exercise is playing soccer, then I would probably recommend that you keep playing soccer (while also trying to minimize your use of heading in your soccer strategy).
The scenario you describe is not, of course, literally impossible. However, it seems to me that the number of people for whom the only feasible choices are either “play soccer” or “be a couch potato” must be so small that even considering this point as a meaningful concern is epistemically unwise. (There are, after all, so many ways in which to avoid a “largely sedentary lifestyle”, starting with “get up, go outside, and walk around the block a few times” and going all the way to “play other team sports, selected specially for their unusually low incidence of head injuries”, with many stops along the way at places like “go swimming”, “go hiking”, “go to a gym”, “purchase and use basic exercise equipment”, etc., etc., etc.)
I think the situation where you are currently playing soccer, because it’s a common sport, and if you would stop doing that you would revert to a sedentary lifestyle, isn’t that rare. I’ve multiple times had the experience that most of my exercise was coming from some kind of hobby, or a constraint of my work-environment (such as being able to walk to work), and that I’ve reverted to being almost fully sedentary when that hobby or constraint went away, despite attempts at doing plain-exercise or picking up different hobbies.
I do agree, that on the macro-scale, over the course of multiple years, one should be able to find a stable source of exercise that doesn’t come with potential head injuries. My comment was more directed at avoiding negative short-term changes in people’s lifestyles.
It is lazy and irresponsible for them not to provide those injuries on a per-capita basis. From the American Association of Neurological Surgeons paper:
Football: 21,878 <----- played almost exclusively by boys, extensive protection
Soccer: 8,392 <----- played by both genders, no head protection
Weirdly, combatives like wrestling and full-contact martial arts come off very good in this analysis; there are comparatively few damaging headstrikes, largely because they are so debilitating. Despite its lack of emphasis—because the raw numbers are so low—avoid boxing.
By “per capita” do you mean “what percentage of people who engage in each activity sustain head injuries”? If so, yes, I agree that this would be useful to know.
I’m somewhat confused by your notes about the gender distribution of sports. Could you elaborate on that?
I was not specific there, but the point is that the population of soccer players and potential soccer players is much higher because nearly all kids play. By contrast, football is usually only available to boys, and overwhelmingly lopsided even if girls teams are available. Soccer is also much cheaper, owing to the lack of equipment costs, so we should expect it to be available virtually everywhere.
Fundamentally my expectation is that soccer only appears as a risk because so many people do it. It would be the same category of bad idea as living someplace with stairs.
I see. This seems like a fairly poor approach to estimation, though. It doesn’t actually matter how many potential soccer (or football) players there are, when it comes to calculating risk, except insofar as it helps us estimate how many actual soccer (or football) players there are. But we can just get those numbers directly:
24,472,778
Number of people who play soccer at some level in the U.S. — second only to China. (Source: FIFA World Football Big Count)
3,055,148
Youth players officially registered with U.S. Soccer programs in 2014 — up by 89 percent since 1990, the first year the U.S. qualified for the World Cup final round since 1950.
The largest category of soccer in the United States in terms of participation is boys’ and girls’ youth soccer. Soccer is one of the most played sports by children in the United States. In 2012, soccer was the #4 most played team sport by high school boys, and soccer overtook softball to become the #3 most played team sport by high school girls.[117] As of 2006, the U.S. was the #1 country in the world for participation in youth soccer, with 3.9 million American youths (2.3 million boys and 1.6 million girls) registered with U.S. Soccer.[118] Among girls, the U.S. has more registered players than all other countries combined.[119] The number of high school soccer players more than doubled from 1990 to 2010, giving soccer the fastest growth rate among all major U.S. sports.[120]
Even leaving aside the 1,531 girls who played high school football in the 2012-2013 school year, the 1,086,627 high school boys who played football exceeded the number of boys and girls combined who participated in any other sport.
Here are the Top Ten high school sports by the number of students who participated in them in the 2012-2013 school year:
Football, 1,088,158 (1,086,627 boys; 1,531 girls)
…
Soccer, 782,514 (410,982 boys; 371,532 girls)
…
In 2012-2013, a record 7,713,577 students participated in a high school sports, up from 7,692,520 in 2011-2012.
A total of 1.23 million youth ages 6-12 played tackle football in 2015, up from 1.216 million the year before, according to data from the Sports & Fitness Industry Association, which commissions an annual survey of participation rates in United States households across a range of sports.
A record 4.3 million children were born in the U.S. in 2007 -- they are now around age 8, when communities begin to offer tackle football. As a share of the age 6-12 population, the total participation rate remained the same as the past year, 4.2 percent.
Across the board, in the 6-12 and 13-17 age groups, participation in football on a regular and casual basis is down since 2009, before the risks of youth playing the game began to grow, partly due to research findings and a number of former NFL players saying they would keep their kids from football or delay their entry into tackle until adolescence.
In 2009, 3.96 million youth ages 6-17 played tackle football. Last year, that number fell to 3.21 million, down from 3.25 million in 2014.
Putting the numbers into a more common format for comparing risks via back of the envelope, this means football players get head injuries of about 20 per 1000, and soccer players about 10 per 1000, making a season of football only twice as dangerous. That is surprising to me.
Moving that one to the bottom of the list for my daughter, I suppose.
According to Statista, 10-11% of Americans below the age of 50 have played soccer in the last 12 months. Wikipedia puts that number at 24 million and rising in 2006. There are 4 million players registered with official US Soccer Association, but I play every week and have no idea what that is.
So there are somewhere between 5 million and 30 million people who play soccer *regularly* in the US, and 25,000 were admitted to a hospital for head injuries for a rate of 1/200-1/1200.
I play every week but I don’t go flying into the sort of aerial tackles that end up with two players banging heads, as well as being cautious about my cranium in general. If my chance of head injury given this is 1/1000 each year, playing soccer is still worth it.
A McGill University study found that more than 60 percent of college-level soccer players reported symptoms of concussion during a single season. Although the percentage at other levels of play may be different, these data indicate that head injuries in soccer are more frequent than most presume.
A 60% chance of concussion is more than enough for me to stay far away.
TBI is common enough that the effects are large on a population-wide basis:
We found that the crude population contributions of TBI explained approximately...2%–6% of the population differences in the outcomes. The strongest population attributable risks were found for the severe outcomes, including psychiatric inpatient hospitalisation (PAF = 5.5%; 4.9%–6.1%), premature mortality (PAF = 4.7%; 2.9%–6.5%), and disability pension (PAF = 4.6%; 3.8%–5.3%).
The comment goes on to list statistics on various long-term effects of TBIs—worth reading, IMO.
Re: “4. You will get hurt. That’s OK”:
Yes, this is true…
… unless the way you get hurt is by sustaining a traumatic brain injury.
Then you can look forward to such exciting consequences as are listed in the “Prognosis” and “Complications” sections of the Wikipedia page I linked (do read them in their entirety—don’t take my word for it; it’s worth being fully aware of the reality of head injuries, so that you can be properly horrified).
Note that unlike bruised shins, twisted ankles, or even broken bones, the effects of a TBI are almost invariably irreversible (and multiple TBIs have a compounding effect).
Also unlike bruised shins or broken bones, brain damage doesn’t just cause some pain, inconvenience, or even loss of physical function—it irreversibly damages (or, in more severe cases, destroys) who you are.
I’ve seen the effects of severe TBI up close and personal. If avoiding a large increase in my risk for such a fate means that I’m “not living”, then maybe “living” isn’t all it’s cracked up to be.
How large an increase? Well, here are some citations:
(From the Journal of Athletic Training)
(From the Johns Hopkins Medicine Health Library)
(From the American Association of Neurological Surgeons; emphasis mine)
In summary: for anyone who values their personal survival, and the retention of their mental faculties (which, I think, describes most people on Less Wrong), participating in sports—especially sports like soccer—is an exceptionally bad idea.
I wanted to get a better sense of the risk, so here is some arithmetic.
Putting together one of the quotes above:
And this bit from the recommended Prognosis section:
And this bit from the Epidemiology section:
We get that there are 300k sport-related TBI’s per year in the US, and of those, 240k are mild, 30k are moderate, and 30k are severe. Those severity levels together result in 24k + 20k + 30k ~= 75k cases of permanent disability per year.
To put that in perspective, we can compare to another common activity that has potential to cause harm:
If we say that a fatality and a permanent disability due to brain injury are the same order of magnitude of badness, this suggests that sports and traveling by car expose the average (as in mean, not median) American to roughly the same level of risk.
Would be interesting to dig deeper to see how much time Americans spend in cars vs playing sports on average (and then you’d also want to look at the benefits you get from each), but I’ll stop here for now.
While I agree with this, the consequences of a largely sedentary lifestyle on cognitive performance are also pretty significant, and human motivation is fickle. I am not sure how the calculus turns out, but if you find that the only thing that makes you exercise is playing soccer, then I would probably recommend that you keep playing soccer (while also trying to minimize your use of heading in your soccer strategy).
The scenario you describe is not, of course, literally impossible. However, it seems to me that the number of people for whom the only feasible choices are either “play soccer” or “be a couch potato” must be so small that even considering this point as a meaningful concern is epistemically unwise. (There are, after all, so many ways in which to avoid a “largely sedentary lifestyle”, starting with “get up, go outside, and walk around the block a few times” and going all the way to “play other team sports, selected specially for their unusually low incidence of head injuries”, with many stops along the way at places like “go swimming”, “go hiking”, “go to a gym”, “purchase and use basic exercise equipment”, etc., etc., etc.)
I think the situation where you are currently playing soccer, because it’s a common sport, and if you would stop doing that you would revert to a sedentary lifestyle, isn’t that rare. I’ve multiple times had the experience that most of my exercise was coming from some kind of hobby, or a constraint of my work-environment (such as being able to walk to work), and that I’ve reverted to being almost fully sedentary when that hobby or constraint went away, despite attempts at doing plain-exercise or picking up different hobbies.
I do agree, that on the macro-scale, over the course of multiple years, one should be able to find a stable source of exercise that doesn’t come with potential head injuries. My comment was more directed at avoiding negative short-term changes in people’s lifestyles.
Agreed, this is good advice.
It is lazy and irresponsible for them not to provide those injuries on a per-capita basis. From the American Association of Neurological Surgeons paper:
Football: 21,878 <----- played almost exclusively by boys, extensive protection
Soccer: 8,392 <----- played by both genders, no head protection
Weirdly, combatives like wrestling and full-contact martial arts come off very good in this analysis; there are comparatively few damaging headstrikes, largely because they are so debilitating. Despite its lack of emphasis—because the raw numbers are so low—avoid boxing.
Do the responsible thing: train in MMA.
By “per capita” do you mean “what percentage of people who engage in each activity sustain head injuries”? If so, yes, I agree that this would be useful to know.
I’m somewhat confused by your notes about the gender distribution of sports. Could you elaborate on that?
I was not specific there, but the point is that the population of soccer players and potential soccer players is much higher because nearly all kids play. By contrast, football is usually only available to boys, and overwhelmingly lopsided even if girls teams are available. Soccer is also much cheaper, owing to the lack of equipment costs, so we should expect it to be available virtually everywhere.
Fundamentally my expectation is that soccer only appears as a risk because so many people do it. It would be the same category of bad idea as living someplace with stairs.
I see. This seems like a fairly poor approach to estimation, though. It doesn’t actually matter how many potential soccer (or football) players there are, when it comes to calculating risk, except insofar as it helps us estimate how many actual soccer (or football) players there are. But we can just get those numbers directly:
(From NBCNews.com)
(From Wikipedia)
(From cnsnews.com)
(From ESPN.com)
The numbers aren’t clear-cut, but from what I can see, your prediction does not seem to be borne out.
Oops! It appears you are right.
Putting the numbers into a more common format for comparing risks via back of the envelope, this means football players get head injuries of about 20 per 1000, and soccer players about 10 per 1000, making a season of football only twice as dangerous. That is surprising to me.
Moving that one to the bottom of the list for my daughter, I suppose.
According to Statista, 10-11% of Americans below the age of 50 have played soccer in the last 12 months. Wikipedia puts that number at 24 million and rising in 2006. There are 4 million players registered with official US Soccer Association, but I play every week and have no idea what that is.
So there are somewhere between 5 million and 30 million people who play soccer *regularly* in the US, and 25,000 were admitted to a hospital for head injuries for a rate of 1/200-1/1200.
I play every week but I don’t go flying into the sort of aerial tackles that end up with two players banging heads, as well as being cautious about my cranium in general. If my chance of head injury given this is 1/1000 each year, playing soccer is still worth it.
You don’t need to estimate this.
A 60% chance of concussion is more than enough for me to stay far away.
Here is a series of comments by gwern with many citations of research into head trauma and brain injury.
This comment in particular cites a paper called…
The comment goes on to list statistics on various long-term effects of TBIs—worth reading, IMO.
More data: these figures on injury rates in various sports, among children, from the National Institutes of Health.