Coaches and Concussions

What does a soccer coach do when there is not a certified athletic trainer or medical professional present and one of their soccer players appears to have a concussion? Everyday, coaches are faced with this problem and many have no idea what to do.  Here's some good information if you ever encounter this situation:

1. Recognize the problem.
        *Concussions can occur without a loss of consciousness.
        *Know the signs and symptoms to observe and symptoms that could be reported by the athlete.

2. Immediately pull the athlete from practice or competition.
         *Keep athlete out of participation until they are evaluated and cleared by a medical professional.
         *Tell the athletes that it is not smart to play injured and discourage other from pressuring them.

3. Inform the athlete's parents or guardians that they have a suspected concussion and give them a fact sheet on concussions.
        *Make sure they know the athlete needs to see a medical professional.

4. Allow the athlete to participate only after they have been medically evaluated and have proper clearance.
         *If you allow the athlete to return too soon without medical clearance, you are putting them at a great risk for second impact syndrome, which can result in death.

**REMEMBER: there is no such thing as "getting your bell rung" or "getting dinged"!!! These are all indicative of a concussion!

This information comes from the Center for Disease Control and Prevention. They have great information for coaches in their Heads Up: Concussions in High School Sports section. If you follow the link below, you will find a concussion guide for coaches as well as a wallet card, clip board sticker, and symptom list.  No coach should be unprepared when one of their players sustains a concussion!

http://www.cdc.gov/concussion/HeadsUp/high_school.html

Does repetitively heading a soccer ball cause long-term neurocognitive deficits?

It is estimated that throughout a soccer player's career of 300 games, they will sustain around 2,000 blows to the head from voluntarily heading a soccer ball.  Research regarding the long-term problems associate with multiple sport-related concussions is inconsistent and conlicting especially in sports like soccer where athletes sustain recurring blows to the head.  Norweigan researchers evaluated brain scans of retired professional soccer players that sustained roughly 2,000 blows to the head over their career.  Higher rates of electroencephalographic abnormalities and cerebral atrophy were found in these retired soccer players compared to normal adults.  In disagreement with these researchers, others found that other injuries, concussions sustained in falls, or collisions with other players were responsible for lower scores on cognitive tests by retired soccer players. They did not believe that repetitive blows to the head over one's career were the cause for the neurocognitive deficits found in retired soccer players.  This is an area that clearly needs to be studied further to see if repetitive heading is putting soccer players at risk for long-term neurocognitive deficits.

Tsyvaer A, Lochen E. Soccer injuries to the brain: a neuropsychologic study of former soccer players. Am J Sports Med. 1991;19:56-60.


Jordan S, Green G. Acute and chronic brain injury in united states national team soccer players. Am J Sports Med. 1996;24:205-210.

Great action shots of headers by the UCCS Women's Soccer Team

Photos by Ian Talbot

Proper Biomechanics of Heading a Soccer Ball

As stated previously, heading should not technically be introduced until the age of 12. With this said, heading often occurs at a much younger age. Younger athletes are more likely to sustain injuries from heading a soccer ball due to their small stature, poor technique, and weaker musculature. The first step in prevention of injury is to learn the proper techniques of heading a soccer ball. When dealing with athletes of any age, this is the responsibility of the soccer coach.

-Mansell J, Sitler M, Stearne D, Swanik K, Tierney R. Resistance training and head-neck segment dynamic stabilizationin male and female collegiate soccer players. J Athl Train. 2005;40:310-319.

Correct Biomechanics
The correct technique involves using the frontal bone just below the hairline (the hardest part of the skull) while simultaneously isometrically contracting the neck musculature.

The soccer player should then apply a counterforce to the impacting ball by flexing at the trunk.

By performing this action as described, the athlete's body becomes a single, rigid unit that lowers the risk of injury by decreasing the rotational or linear forces to the head as forces generated by the ball are dispersed across the athlete's body.

Keep in Mind: Many concussions are the result of a soccer ball colliding with the head of an unsuspecting soccer player. The neck musculature does not maintain the head in a rigid position at ball inmpact, forcing the cranium into the brain and resulting in a coup injury. If the brain then rebounds into the opposite side of the inner cranium, a contrecoup injury can result.
This is demonstrated in this video by A.D.A.M:
http://www.youtube.com/watch?v=fY7J7bccNoU

-Broglio M, Broglio S, Ju Y, Sell T. The efficacy of soccer headgear. J Athl Train. 2003;38:220-224.

Great Videos Dealing With Concussions!!!

I've had some requests from my fellow certified athletic trainers to post more videos and pictures so here's some YouTube videos dealing with current issues on concussions:

Concussions: When in Doubt, Sit it Out

http://www.youtube.com/watch?v=dOVtbCmY-jE

ESPN segment on concussions, Great information on second impact syndrome and ImPACT testing

http://www.youtube.com/watch?v=jH867uCahEE

Concussions can have delayed consequences-- GREAT for PARENTS: what many parents think: "He didn't lose consciousness, so I didn't think anything was wrong"

http://www.youtube.com/watch?v=LlFSOyRetmA

Full90 Commercial on YouTube-- If you don't know why I created this blog or if you think soccer is not a serious contact sport PLEASE watch this video :)

http://www.youtube.com/watch?v=6J9ixMcYJDY

Kids and Concussions

http://www.youtube.com/watch?v=YUVOpZOAooo

Protecting Athletes Against Concussions

http://www.youtube.com/watch?v=zjOPG_KASY8

ForceField Headband makes the news!

http://www.youtube.com/watch?v=fZFPRMMq-2s

2010 FIFA World Cup South Africa Commerical (this doesn't have anything to do with concussions, but if you'r a soccer fan I know you're excited for June 2010!!)

http://www.youtube.com/watch?v=nXHmTJrPaXQ

Interesting Article and Concussion Prevention

This article does not have to do with soccer, but I thought it was interesting all the same. Dr. Robert Cantu (the neurosurgeon in the article) is a leading researcher on concussions and has been involved in many of the articles I've recently read on the topic. He is moving forward with his debate that football players should not wear helmets during practice. Check it out:

http://www.reporternews.com/news/2010/mar/16/great-helmet-debate/


Prevention of Concussions

While concussions, like any other injury, can not be totally prevented, some steps can be taken to reduce the risk of their occurrence.

-Proper coaching of heading techniques
-Good officiating of the rules (for example, the referee does not let the game get out of control as far as dangerous plays go)
-Properly fitting soccer equipment
-Disqualifying yourself immediately from the activity if you notice any concussion symptoms after receiving a blow to the head
-Follow correct return-to-play guidelines given to you by a medical professional after a concussion, do not return too soon!

Especially for adolescents:
-Appropriate sized soccer balls for youth soccer players (sizes range from 3-5)
-Strengthening neck and core muscles
-Taking in to consideration wearing protective headgear

What's In The News??

Missouri Taking a Step in the Right Direction Regarding Medical Clearance of Concussed Athletes:

http://www.kctv5.com/news/22527031/detail.html


California Enforcing Stricter Laws Regarding Concussions:
http://www.mercurynews.com/high-school-sports/ci_14225622?source=rss&nclick_check=1


Researchers Warn Parents to Take Concussions More Seriously:
http://www.businessweek.com/lifestyle/content/healthday/635031.html


The Importance of Managing Adolescent Concussions:
http://www.oregonlive.com/sports/index.ssf/2009/09/diagnosing_treating_concussion.html

The Zack Lystedt Law passed in 2009 in the state of Washington:
http://www.cdc.gov/media/subtopic/matte/pdf/031210-Zack-story.pdf

Protective Headgear

Protective Headgear in Soccer

***REMEMBER: THIS INFORMATION IS NOT INTENDED TO SWAY SOCCER PLAYERS TO WEAR HEADGEAR OR NOT, IT IS PURELY EDUCATIONAL!! THE USE OF PROTECTIVE HEADGEAR IS COMPLETELY VOLUNTARY.

Recently, the issue of protective headgear for soccer players has become more popular. No major governing body of soccer (ie. FIFA, USSF) mandates the use of this headgear, but voluntary use has been approved.

There is conflicting evidence regarding the effectiveness of protective headgear in soccer. While some researchers claim that it can help reduce the risk of concussions and the 'sting' of the ball, other researchers believe this cannot be proven scientifically due to insufficint biomechanical data. Conditions replicating linear heading of a soccer ball have been attempted in various studies, but rotational forces that are common in soccer may be too difficult to replicate.

-Bruce, S, Cantu R, Ferrara M, Guskiewicz K, Kelly J, McCrea M, McLeod T, Putukian M. National athletic trainers' association position statement: management of sport-related concussion. J Athl Train. 2004;39:280-297.

PROS of protective headgear:

-Headgear can be used to reduce the 'sting' of impacts from the soccer ball

-Manufacturer's claim their headgear reduces the probability of a concussion by 50%

-Often, it is recommended to provide futher protection to those soccer players who have a history of concussions

CONS of protective headgear:

-Might cause athletes to play more aggressively due to a false sense of security therefore causing more head and cervical injuries in the sport (the superman effect)

-The headgear is not intended to be used in return more quickly from a previous concussion

-Concussions can still occur in soccer while wearing protective headgear
-Scientific research has not yet proven the effectiveness of protective headgear.

There are 3 types of headgear that meet the standards (F2439-06) set by the American Society for Testing and Materials:
DjOrthopedics 'Hat Trick' http://www.djortho.com/
Full90 Sports 'Premiere A' http://www.full90.com/
ForceField Protective Headband http://www.forcefieldheadbands.com/

Information for Parents & 2009 REAP Project

Parents of adolescent soccer players that have suffered a concussion play a huge role in the recovery of their child. Parents should be educated on when to recognize a concussion (see signs and symptoms on earlier post) and the proper steps to take to ensure correct care and treatment of the concussion.

1. Seek medical attention right away. A health care professional will be able to decide how serious the concussion is and when it is safe for your teen to return to sports. Some qualified professionals include an MD, DO, NP, PA, and ATC.

2. Keep your teen out of play. Concussions take time to heal. Do not let your teen return to play until a health care professional says it's OK. Athletes who return to play too soon-while the brain is still healing-risk a greater chance of having a second concussion or second impact syndrome.

3. Tell all of your teen's coaches about any recent concussion. Coaches should know if your teen has had a recent concussion in ANY sport. Knowing about the concussion will allow the coach to keep your teen from activities that could result in another concussion.

4. Everyday activities may need to be limited. Physical and Cognitive brain rest are needed for complete recovery. School is where cognitive demands are the highest. Your child may need to stay at home for a few days.

To maximize your child's recovery from concussion, activity needs to be reduced and they needs lots of rest. Insist that your child rest, especially for the first few days after the concussion and throughout the 3 week recovery period (this can be longer!). Do not let your child convince you that he/she will rest "later". Rest must happen immediately! The school that your child attends should help your child reduce cognitive load, either by excusing them from school or reducing the classwork in school. At home, it is your job to help reduce sensory load- i.e. it is advised that teens avoid loud group functions, limit video games, television, and text messaging. Because a concussion will almost universally slow reaction time, driving should be limited/restricted pending medial clearance. Plenty of sleep and quiet, restful activities post-concussion will help maximize recovery.

This information comes from the 2009 REAP project. The REAP project is being adopted by many Colorado school districts. It focuses on a community-based approach to concussion management for high school students, here is the information:


http://cokidswithbraininjury.com/blog/wp-content/uploads/2009/11/REAP-Project-Manual-Final.pdf

What is a Concussion?

A concussion is defined by the National Athletic Trainer's Association as:

An acceleration-deceleration mechanism in which a blow to the head or the head striking an object results in one or more of the following conditions:

-Headache

-Trouble Sleeping

-Nausea

-Drowsiness

-Vomiting

-Fatigue

-Dizziness

-Blurred Vision

-Balance Problems

-Memory Loss

-Feeling 'Slowed Down'

-Difficulty Concentrating

-Sensitivity to light and noise

-Combative

-Bruce S, Cantu R, Ferrara M, Guskiewicz K, Kelly J, McCrea M, McLeod T, Putukian M. National athletic trainers' association statement: management of sport-related concussion. J Athl Train. 2004;39:280-297.

Concussion data was collected from 180 colleges and high schools throughout the United States in a 2007 study. For the 4,431 injuries reported from 9 sports during one school year, about 9% of these were concussions. Soccer was considered a 'partial-contact' sport by these researchers. In the data collected from soccer players, females had a high rate of concussions than males. In this population of females, concussions amounted for a large number of the total sum of injuries. Among both sexes, about 64% of the concussions suffered were from heading a soccer ball. Contact with another soccer athlete was a more widespread mechanism of injury in male soccer players while contact with the playing surface and forces from the actual ball were more common mechanisms in girls. It was also found that concussions accounted for about 21% of injuries to goalkeepers.

-Collins C, Comstock D, Dick R, Fields S, Gessel L. Concussions among united states high school and collegiate athletes. J Athl Train. 2007;42:495-503.

A Few Fun Facts About Concussions

This blog is for soccer players, soccer parents and coaches at all levels. I will post as much information as I can regarding the dangers of concussions in soccer as well as information about protective headgear.


In the United States, there are roughly 300,000 sports-related concussions per year.

Many coaching books do not address heading until the age of 12, with many physicians recommending waiting until the age of 14.
-Covassin T, Elbin R, Stearne D. Concussion history and postconcussion neurocognitive performance and symptoms in collegiate athletes. J Athl Train. 2008;43:119-124.

 In high school sports, football has the highest concussion rate followed by Girls Soccer then Boys Soccer.

-Collins C, Comstock D, Dick R, Fields S, Gessel L. Concussions among united states high school and collegiate athletes. J Athl Train. 2007;42:495-503.


It is estimated that in a career of 300 games, a soccer player will sustain around 2,000 blows to the head from heading a soccer ball.
In the United States alone, there are about seven million high school athletes and roughly 385,000 college athletes.

-Broglio M, Broglio S, Ju T, Sell T. The efficacy of soccer headgear. J Athl Train. 2003;38:220-224.

Information coming soon!!