Abstract
OBJECTIVES: To report the incidence and burden of concussion in elite English football; and to compare between sexes (men's vs women's football), activity (matches vs training) and level (international vs domestic). METHODS: Concussion injuries in men's and women's international football (2012-2022) and men's (2013-2022) and women's (2018-2022) English domestic football were diagnosed and recorded by club/team-based medical practitioners, alongside training and match exposure. Severity was also reported based on days lost due to concussion; subsequently, incidence and burden were calculated. Comparisons were made between sexes (men's vs women's football), activity (matches vs training) and level (international vs domestic) using ORs (relative to non-concussion injuries). RESULTS: 327 concussions were reported. Concussion accounted for 7% of all injuries in women's international football, 5% in women's domestic, 3% in men's international, and 2% in men's domestic. Concussions were more likely to occur in matches than training (OR 1.03-2.55), with this difference only significant for men's and women's domestic football. The burden was higher for matches than training (OR 1.38-1.63), except for women's international football, which was lower in matches (OR 0.46). Concussions were more likely to occur in women's international training than domestic (OR 1.81), and the burden was higher in international football (OR 1.10-3.93). The incidence (OR 2.09-4.65) and burden (OR 1.55-5.34) of concussion were higher in women compared with men's football. CONCLUSION: These data provide benchmark statistics for concussions in elite English football, enabling comparisons and assessing the efficacy of future concussion prevention strategies. Contextual factors such as sex (women>men), activity (matches>training), and level (international>domestic) influence the incidence and burden of concussion injuries.