It was, in Maisie Rayback’s mind, a “freak incident.”

The Cape Elizabeth junior back was jumping to try to head a corner kick into the net during last year’s regional girls soccer semifinal against Freeport when her teammate, Noelle Mallory, had the same idea, and the two collided while going for the ball.

Mallory was fine. Rayback was not. She fell to the ground, got up and felt dizzy.

Rayback left the game early, then missed the regional final against Greely four days later. In the weeks that followed she had headaches, found it harder to pay attention in school and had trouble sleeping.

“You don’t feel like yourself,” she said. “That’s the scariest part.”

Rayback’s experience is nothing unusual in high school soccer, a contact sport in which collisions often occur and the head either frequently plays the ball or is in the line of fire of a shot, and data show the risk is even higher on the girls’ side.

Concussions are serious injuries, with recoveries that can stretch for weeks or even months and have long-term effects on daily life. But in soccer, the people who play it and coach it don’t see an easy way to limit them.

A national study of high school sports injuries from 2023 to 2024 shows girls soccer was second only to football in concussion rate at 6.08 per 10,000 athlete exposures, a number that has risen each year since the 2020-21 season.

It’s also more than three times higher than the rate for boys soccer — 1.94.

The Maine high school soccer season is deep in the playoffs, with regional final games set for Tuesday and Wednesday. State championship games will be played Saturday.

Thirteen of 17 girls soccer teams that responded to a Press Herald survey said they’ve had concussions either this year or last, compared to eight of 16 boys’ teams. Alex Fusco, an athletic trainer at Kennebunk, said that girls have suffered 11 of the school’s 14 soccer concussions over the last three years.

The link between the sport and head injuries is not new; a 2017 study by Northwestern University professor Dr. Wellington Hsu showed that concussions occurred more often in girls soccer than in any other high school sport — football included.

Yet players and coaches still don’t see an easy way to limit them.

“It’s a contact sport. At times, people can get knocked over,” Deering coach Paul Cameron said. “I don’t know how you take that out of the game, to be honest with you, without changing the game completely.”

COMMON CAUSES

Dr. Elizabeth Rothe, a sports medicine specialist at Maine General and the head team physician at Colby College, said soccer’s physical nature makes it more prone to concussions than other popular girls sports, including basketball, volleyball and lacrosse.

“Soccer, in and of itself, is a contact sport, and there can be a lot of chaos on the field,” she said. “Rates of concussion in girls are actually more pronounced with head to ground, or head to equipment like a goal post. Heading the ball isn’t as associated with an increase.”

In that chaos are plenty of chances for the head to be in the wrong place at the wrong time. Rayback hit hers against a teammate’s. Greely back Amelia Savoy had two concussions 10 months apart, both from being hit by kicked balls at close range. Former Yarmouth keeper Regan Sullivan suffered one in 2022 when she tried to cover up a save and was kicked in the head by an opponent going for the ball. She missed school for a month, and still is sensitive to light and noise.

Even when the ball is on the ground, there are chances for collisions, whether it’s in jostling for position, racing down the field with their head down, or while attempting a slide tackle.

“I’ve had a lot of people that have come to watch our games, or soccer games in general, and been like ‘Wow, I had no idea that it was this physical,'” Skowhegan girls coach Mike Herrick said.

Rothe said she first became aware of the higher concussion rates in girls soccer in a 2015 Journal of the American Medical Association study that showed collisions, rather than headers, are the primary source for these injuries.

“I think it did give people pause to say ‘Oh, boy, there is difference there, what’s the reason for that?'” she said.

Rothe now points to athletes’ typical muscle mass. Boys generally have more strength in their necks, she said, so when their head comes into contact with something else (the ball, another player, etc.), that strength can affect how much force can be absorbed and limit how much the head moves.

A SERIOUS MATTER

Amelia Savoy was playing with her club team in a tournament in Florida in January of 2022 when an opponent’s mid-air kick smacked her in the head. Her coach began calling out to her, but to Savoy, the words were gibberish.

“I couldn’t understand English for a little bit,” the Greely senior back said. “I knew something wasn’t right. I gained full consciousness and could put sentences together after, like, 15 minutes, and then I was really nauseous and sick.”

The real struggle for Savoy, however, came later. She was concussed for about five months, then dealt with post-concussion syndrome for two. She struggled with reading and got headaches in noisy environments. She remembers getting angry and irritable when overwhelmed by the stimuli around her.

“Some days, I just didn’t want to get out of bed,” she said. “Even the sounds of my siblings upstairs in my house was too much.”

Savoy’s experience highlights the dangerous aspect of concussions. For some, it’s a headache that lasts a few days. For others, the recovery can be lengthy and debilitating.

And even for people trained to spot them, they can be difficult to recognize.

“Concussions are tricky. It’s not like a sprained ankle, where you see a swollen (part),” said Tony Giordano, the athletic trainer at Thornton Academy since 2011. “With concussions, you can’t really see it. It’s more how they feel, it’s a lot of subjective data, a lot of subjective conversations.”

And sometimes those conversations have to be started by the players themselves. After Cape Elizabeth’s Rayback had her concussion in last year’s regional final, she told coaches how she was feeling, and that she was sidelining herself for the regional final against Greely.

It wasn’t easy, she said. But it far outweighed the gamble of playing through.

“My head is not something I mess around with,” she said.

Zack Chase, Biddeford’s trainer who’s worked in high school sports for 12 years, said girls are often more forthcoming when they feel they’ve been hurt than boys are.

“I think we have more girls that are reporting symptoms,” he said. “They seem to be more in tune with their bodies. I think they’re (more likely) to speak up when something doesn’t feel right, which I think is great.”

FEW SOLUTIONS

The U.S. Soccer Federation in 2015 banned headers for players aged 10 and under. Some older players, including Savoy and Sullivan, the former Yarmouth keeper, have worn Q collars, which go around the back half of the neck and aim to reduce concussions by slightly increasing the flow of blood to the head and keeping it around the brain to provide extra cushioning.

According to a 2022 New York Times article, football players at more than two dozen college and NFL teams were wearing the collar. A 2023 Business Insider article said Costa Rica’s Rocky Rodriguez and Canada’s Quinn wore one at the Women’s World Cup that year.

“My dad actually made me wear it around the house to get used to it before actually going out and playing with it,” said Sullivan, now a sophomore playing at Lasell University. “I really don’t care if it looks embarrassing. If it’s going to save my brain, I’m going to wear it.”

Cameron, the Deering coach, said better instruction can help as well. He supports not allowing headers before the age of 10 in competition, but said players should be taught proper header form beforehand.

“That way you can practice it in a controlled environment, in a training session, and make sure that they’re not doing too many repetitions and that you’re reinforcing good technique,” he said.

That still leaves the source of most concussions, however: the head-to-head and body-to-body collisions, the kicked balls to the head, and the falls to the ground. And for the players, those come with the territory of playing the game they love.

“It’s hard. You can come up with all these ways as far as (limiting) heading, but every other injury, I don’t know how avoidable they are,” said Herrick, the Skowhegan coach. “There’s a soccer ball, two people are running after it, you’re going to have to battle a little bit for it and stuff might happen.”