A look at what we can do to protect soccer players of all ages and levels
from head injuries
In my
first installment of this article series, I shared the recently published consensus statement
from a head injury summit and discussed the incidence and cause of sport-related
concussion as it relates to soccer players – from youth to professional.
A bevy of research has told us that concussion and head injuries are an
issue for soccer players. The question now is – what can we do with
this information to help reduce a player’s injury risk, or better
yet – prevent these injuries from occurring altogether? This next
installment covers what the research has also illuminated as potential
considerations for helping to reduce player risk.
Our first sport concussion prevention touchpoint is education. Now don’t
roll your eyes. Although it may not sound like an innovative solution
on the surface, research has shown that educating involved stakeholders
can have a significant positive impact on the incidence of injury in sport.
The stakeholders are more than just the coaches and in the case of youth,
the parents. Referees, the athletes themselves and club or league administrators
all play a vital role in creating a culture of ‘safe sport.’
For the education to work, the message must be consistent, strategic and
easy to understand for all of the groups involved. Whether or not they
know what to look for (which is also essential), feeling comfortable to
say something when they see something is imperative. Believe it or not,
a good education is a driver not only of awareness, but also of progress
and of change in policy should the need arise.
Though the use of soft-shelled headgear has been discussed as a preventative
measure against concussion in soccer, the current research literature
(which there isn’t much of at present) on its potential effectiveness
is mixed. While some of the evidence supports headgear use in protecting
against hard impacts, like head-to-head or elbow-to-head, for example,
there is little evidence to support its use in ‘heading’ of
the ball. There also exists a concern that the use of headgear may create
a false protective sense and encourage a player to potentially play more
aggressively than he or she otherwise would if no helmet was worn.
If the evidence on headgear’s potential to reduce soccer-related
concussion is mixed, then we must ask – what else can we do to minimize
concussion risk? One area of significant progress includes restrictions
on ‘heading’ of the ball. Now, it is important to consider
that the act of ‘heading’ the ball in-and-of-itself is not
associated with significant sport concussion risk. However, the research
does tell us that the most significant soccer-related concussion risks
come from head-to-head, elbow-to-head or knee-to-head blows, immediately
following an aerial challenge of the ball. So, it stands to reason that
– if we can minimize aerial challenges of the ball, in age and level-appropriate
ways without significantly altering the course of the sport, then that
is something we must attempt to do. To address the concern of heading
the ball on sports-related concussion, the governing bodies of U.S. Soccer
have taken what can be seen as a graduated approach. For example, players
10 and under are expressly prohibited from heading the ball. Players in
the 11-12-year-old range may engage in training for heading of the ball
for no more than 30 minutes each week, with a weekly cap on the number
of headers per player at no more than 15-20. There are no restrictions
for players 14 years-of-age and older. Other rules that have been put
in place to help reduce the likelihood of aerial challenges of the ball
include modifications of the playing field size and rule enhancements
that do not penalize player substitutions when an injury in a player is
suspected and must be evaluated.
Some of the more novel concepts in the prevention of soccer-related concussion
that may prove promising but still require more research are neck strength
training and situational awareness training. In some studies of high school
athletes, the data indicated that those players with a smaller circumference
(ratio of head to neck size) and lower neck strength had a higher incidence
of sustaining a concussion. In soccer specifically, the observation is
that neck strength improvement could have a positive effect on the reduction
of head acceleration during impact. So, strength training of the neck
muscles follows the logic that a strong neck can help guard against head
injuries. Another area of significant research interest in sport-related
concussion prevention is something called ‘situational awareness.’
As the name implies, training players to prepare or protectively brace
their bodies for impact if they see physical contact coming.
We’ve brought together many of the best and brightest minds in the
world to curb the incidence of concussion in soccer, and there is much
progress toward education and preventive measures that are helpful and
simple-enough to implement across a wide range of ages, levels, and organization-types.
But there is more work we must do, and we have identified so many areas
that have great potential to keep our players in the game they love and
safe from injuries that could sideline them forever.
Sources:
https://bjsm.bmj.com/content/early/2019/02/13/bjsports-2018-100232