Dr. Bert Mandelbaum for U.S. News & World Report: Head Injuries in Soccer
Posted on Apr 1, 2019 4:28pm PDT
IT'S A BEAUTIFUL THING when we can bring together the world's most foremost
sports medicine specialists and researchers to talk about and review the research on a particular
topic. Such was the case in 2017 when we gathered for a head injury summit
in New York. And now, The British Journal of Sports Medicine has released
a 10-plus page article of the consensus findings of that important meeting.
It's a fantastic read for us clinicians – our hard work, hours
of research and clinical outcomes all distilled down to digestible stats
and summaries. But I believe this is essential material for public consumption,
as well. Head injuries and sports-related concussions are prevalent in
any collision sport (including soccer), and even in some sports that don't
categorically involve a collision. Contrary to what many believe, American
football isn't the only sport that puts a player in danger of sustaining
a concussion.
At each play level, from youth to high school, collegiate to professional,
head injuries and concussions are an issue. But how these injuries manifest
is worth a look. In youth and high school soccer athletes, a concussion
is the second most common injury sustained during match play. The consensus
data also indicates that the rate of
concussion injury in this player population was on a steady incline year over year from
2006 until roughly around 2011, when it began to plateau. The hypothesis
is that better education and greater awareness, in addition to earlier
symptom recognition and reporting, are at least partially responsible
for this leveling off of injury. One interesting finding from this summit
that is worth noting, particularly in youth and high school soccer players,
is that three-quarters of the concussions in this population occurred
when the player was not aware that contact or collision was coming. When
collision was unexpected, and a concussion resulted, the result was a
longer duration of concussion symptoms than in those players who were
aware that a hit was imminent.
Another particularly disturbing finding that was revealed by research at
this summit was that up to 40 percent of youth soccer players indicated
that they wouldn't report their concussion symptoms to anyone. This
statistic is of particular concern to physicians and should be to parents
of young athletes, as well, for the data tell us that continued play after
concussion in children ages 12 to 18 is associated with significant delays
in symptom recovery.
At the collegiate level, as awareness has increased, so have the rates
of concussion. Though this statistic may seem like a bad thing, anytime
education "works" and signs/symptoms are recognized earlier,
there tends to be an uptick in reporting of injuries, and the expectation
would be that this would level off over time and that the concussion injury
rate would decrease. Another interesting finding from the summit, with
particular regard to collegiate soccer players, is the rate of concussion
injury among male and female athletes. For collegiate men, NCAA data show
that concussion incidence in soccer still trails the pace of wrestling,
American football and ice hockey. For female collegiate players, on the
other hand, concussion rates for this cohort are only eclipsed by ice
hockey. By comparison, women have a higher percentage of head and face
injuries during a soccer match than their male counterparts.
Concussions are the fifth most common injury type among Major League Soccer players,
and though most of the contacts that result in concussion occur with a
player from an opposing team, some are with a teammate. In pro soccer
athletes, defenders who developed concussion injuries more frequently
than players in other positions, and concussions were also more likely
to occur within the first half hour and last half hour of a match. In
tournament play, we again saw a marked increase in the
development of concussion among female athletes than male players. In women, the catalyst for injury
was usually a head-to-head impact, and in men, it was an elbow-to-head impact.