Head Injuries in Soccer Part 2 - An Ounce of Prevention

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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

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