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We should all care about concussions in women’s soccer. Here’s why.

Hope Solo, Morgan BrianHope Solo, Morgan Brian
U.S. goalkeeper Hope Solo, right, tends to teammate Morgan Brian, who collided with Germany's Alexandra Popp during the first half of a semifinal in the Women's World Cup soccer tournament, Tuesday, June 30, 2015, in Montreal, Canada. (Ryan Remiorz/The Canadian Press via AP)Photograph by Ryan Remiorz — AP

For roughly four minutes last Tuesday, I watched doctors huddle around two women lying on the ground, one bleeding and motionless and the other kicking in pain.

It wasn’t a crime scene. It was the Women’s World Cup semi-final game at the Olympic Stadium in Montreal. U.S. midfielder Morgan Brian and German forward Alexandra Popp smashed noggins while trying to head the ball after a free kick. Then, they both dropped.

Watching from the seats next to me were my 13-year-old daughter and several of her soccer teammates. Most of the girls and their friends have played in travel soccer clubs and worked with professional trainers since they were eight or nine years old. Soccer is part of their identities. So, it wasn’t a surprise that their expressions seemed a mix of concern and empathy. After all, I’ve seen several of these kids take hits that would make a grown man or woman cry.

Not Exactly Child’s Play

Youth soccer is big business in the U.S. with more than 14 million children playing the game, according to Gary Hopkins, president and CEO of New York City-based sports marketing firm CSM Soccer, Inc. (The Safer Soccer campaign reports the number as closer to 8 million.) Hopkins, author of Star-Spangled Soccer: The Selling, Marketing and Management of Soccer in the USA, estimates that the participation fees for organized soccer alone total $3 billion annually. Add up the dough shelled out for uniforms, gear, private trainers, tournaments and travel and you “could easily add at least another billion to that amount,” he says.

Those aren’t audited numbers, but no one denies that there’s money in youth soccer. As a business journalist, I’m fascinated by this thriving industry, built at the intersection of childhood passion and parental pride.

But as the mother of a daughter who loves the game, I believe that very intersection can put the sport on shaky ethical ground, sometimes prompting participants to ignore safety in favor of competition. I’ve seen plenty of players refuse to “take a knee” to stop the game after an injury. And what does it tell our kids when we send players back into the game after they’ve sustained a traumatic blows to the head—especially one that’s still bleeding, as Popp’s appeared to be?

Hitting Where It Hurts

Soccer is the number one cause of concussions for female athletes, says Chris Nowinski, executive director of the Sports Legacy Institute in Waltham, Massachusetts, which advances the study and treatment of brain injuries in sports and co-sponsors the Safer Soccer campaign. A 2011 study published in the American Journal of Sports Medicine found that, in similar boys’ and girls’ sports, girls were twice as likely to sustain concussions as boys. More than 30% of concussions in soccer are caused by heading the ball or attempting to do so and colliding with another player, object or the ground, like Brian and Popp did.

Dr. Jason Ahuero, assistant professor of orthopedic surgery at Baylor College of Medicine in Houston, Texas says adolescent girls are also among those at the highest risk for anterior cruciate ligament (ACL) injuries, especially if they’re not properly conditioned or if they over-train, as many do for never-ending soccer seasons and tournament lineups. Ahuero says that knee and ankle injuries are also common.

Youth soccer is supposed to be about health, fitness and the positive lessons organized sports can teach. So, what are we doing to our girls?

Heading for Change

Fortunately, some leaders are calling for change. Former U.S. Women’s National Team player Brandi Chastain is working with the Sports Legacy Institute and the Santa Clara University Institute of Sports Law and Ethics on the Safer Soccer campaign, which promotes delaying the introduction of heading the ball in youth soccer until age 14 instead of the current U.S. Soccer guidelines of age 10. The campaign says doing so would prevent more than 100,000 concussions just among middle school aged players registered with US Youth Soccer every three years. Nowinski says there has been no official response from US Soccer, but he has heard that some support the change and others are against it.

A 2007 study by researchers at McGill University in Montreal found that wearing concussion head gear could cut a player’s risk of concussion in half—and defender Ali Krieger gave parents an example to point to when she wore protective head gear by Unequal for the 2015 World Cup games. And while a group of players, including Wambach, ended up dropped a lawsuit against FIFA over artificial turf, their objections did bring attention to concerns about turf injuries and alleged gender inequities in soccer.

“Concussion education for coaches, athletes, parents and referees, improved and safer training methods, neck strengthening are among the best options we have [to prevent injury],” Nowinski says.

While any contact sport is going to have injury risk, Ahuero says that additional solutions lie with parents. Work with girls so that they’re in shape, but also have time to recover from rigorous seasons and tournaments. Choose coaches and trainers who prioritize injury prevention and give players time off to rest. Make sure that cleats, shin guards and other gear fit properly. And teach children the warning signs of concussion and to pay attention to how their bodies feel, reporting injuries or discomfort. Parents need to stand up for their children if they feel they’re at risk.

At the same time, some of the money pouring into youth soccer needs to be directed to research. We need to understand why girls and boys sustain certain injuries and how to best prevent them. The answers may lie in rule changes, better gear or facilities or other areas, but we won’t know until we better examine the issues, Ahuero says. An industry that profits from the effort and commitment of children owes it to them to invest in protecting them from preventable injuries.

Cheering on the U.S. Women’s National Team with my family and friends was one of the most exciting experiences of my life. But I was worried about Brian and Popp being sent back onto the field and the message that sent to our daughters. As a new generation looks to these remarkable women athletes as role models, we owe it to both the young players and the professionals themselves to make player safety and well-being top priorities.