Grant Rudow
Burkette
Hon 101
24 November 2016
Concussions in High School Soccer
The National Center for Disease Control (CDC) reports over 170,000 cases of traumatic brain injury or concussions, are seen each year, that are directly related to sports and recreational activities in children under 19 years, which is up 60% during the last decade. Of these ER visits, five sports were most often listed as the cause and soccer is one of those five (“Concussion in Sports and Play”). Further, the Brain Injury Association of Virginia states that, “High School athletes’ recovery times for sports concussion[s] are longer than college athletes’ recovery times” and goes on to note, “High School athletes who sustain concussion are three times more likely to sustain a second concussion” and “lack of proper diagnosis and management of a concussion may result in serious long-term consequences, or risk of coma or death” (“Sports Concussion”). Does this mean soccer is not worth playing? The risk is too great? Soccer, like many other sports, offers high school students the opportunity to stay fit and healthy, participate in a team environment, which in turn promotes friendships with peers, provides learning opportunities on how to be dedicated and instructs on how to put a group’s needs ahead of your individual needs; all of which are excellent life lessons. Balancing the good that the sport brings with the potential danger that participating in it offers is the challenge today for high schools across America.
High school soccer head injuries are on the rise and causing long-term health issues in youth. More concussion and head injuries are diagnosed and reported each year among high school and youth soccer players. Female youth players, in particular, appear to be at an even higher risk than male youth for concussions. An 11-year study published by MedStar Sports Medicine, concluded that, of concussions occurring in boys and girls sports, girls had double the risk of getting one (“Trends In Concussion Incidence”). It was not clear if this statistic was partially due to an increase in participation among girls, their smaller frame and neck muscles, or if girls or their body positioning when playing is less aggressive, and or defensive; but either way it is a statistic that should make any girl think twice before signing up for soccer. But, concussion injuries can be very serious and have resulted in death of high school athletes more than people would like to admit to. In football, in particular, deaths are reported almost every year. For example, recently Charles Youvella in Arizona died in November of 2012 shortly after leaving the field upon receiving more than one blow to the head during a playoff game (Williams) and research indicates that football concussions have now been linked to ALS (Lou Gehrig’s disease) and Alzheimer’s disease, both of which result in untimely death (McClafferty 69). So, even if you don’t die on the field, results of repeated concussions may extinguish your life early down the line. So, it is without dispute that the time has come to reduce repeat concussion risk.
An alteration to the game of soccer’s rules, whether equipment added such as helmets or removing tactics of play, such as headers, may drop the concussion risks, but at the same time change the core elements of the game. The problem of whether or not to change the rules of High School soccer to protect player’s brains has come to the forefront of discussion; the safety concerns are clearly a problem, but is it worth changing the rules of such an influential and cherished sport?
“A concussion typically occurs when the skull is hit from an outside force, causing the brain mass, which is about 3 pounds, to be shaken about inside the skull and the spinal fluid that surrounds it and would normally protect if from a little jar isn’t enough to stop the momentum. When the brain hits the inside of the skull a concussion occurs. Or, when the movement of the brain is too violent within the skull a concussion occurs” (“Concussion Treatment”). In the game of soccer this can happen a few ways. Impact of the ball to the head at speeds that can be up to 70 miles per hour (“Concussion Treatment”), known commonly as a “header” can cause concussion. The header is most often blamed and looked at as the root of the concussion problem in soccer. However, other concussion risks are player-to-player contact, player-to-ground, player-to-goal post contact, and blows to the body of a player, causing whiplash at the head. According to a 2011 study by the American Journal of Sports Medicine of 9 High Schools studied for concussion occurrence, 3 out of 4 concussions reported were from player-to-player contact, and of those, over half were head-to-head collisions. Of the 101 concussions reported in that study for soccer none of them were from headers. This is just one study however, with only 9 schools, so therefore not conclusive. Another interesting finding in the study was that concussion occurrence was not significantly different from one grade to the next, but was for players on varsity teams versus lower teams. Varsity players suffered more than half of the concussions reported (Barton). Concussions typically affect memory, cause headaches, nausea, blurred vision, confusion, disorientation, and take weeks to heal from. Concussions can cause loss of consciousness, but often don’t.
The repeat effect is the place where a simple injury that can be healed from, becomes life threatening. Since a concussion is not usually a visible injury, like a broken bone, it puts the victim in the unique position of having to report their symptoms accurately in order for them to be suspected of having one, especially in cases where consciousness is not lost. “The American Academy of Pediatrics estimates that less than one-tenth of the 3.8 million sports-related concussions each year in the United States are reported” (Edelman). This creates a problem, because if concussion injuries are hidden due to athletes not wanting to risk being sidelined from the game, because to them playing is more important than their health. They in turn cannot be relied on to determine if they’ve been concussed, so we either have to somehow prevent or greatly lower the risk of concussions through rule changes, or rely on other witnesses — such as parents, coaches and fellow players — to identify concussion symptoms and odd behavior in the victim, such as being dazed or confused. When Joe Theismann broke his leg in 1985, the compound fracture was so gruesome players from both his team and the opposing team screamed for help to the sidelines. The break ended his career. Conversely, that same year Jim McMahon who suffered multiple concussions during his career led the Bear’s to the Superbowl. However, McMahon was diagnosed with early-stage dementia at age 53 which has now been linked to those earlier concussion injuries. The difference is McMahon’s injuries were not visible to everyone watching the game like Theissmann’s was, and thus not considered as bad even though both men have suffered lifelong problems from their injuries (McClafferty 35-36). Current measures in place in High School Soccer to protect players are primarily geared around concussion awareness campaigns. Both the CDC, the American Academy of Pediatrics, and many other organizations have produced concussion awareness literature that can be and is being distributed through pediatric offices, schools, and soccer clubs. High Schools that have athletic trainers also sometimes offer special programs specifically around concussion education to get teams, coaches and parents to be more aware of the risks and symptoms of concussions. Also, some High School athletic departments are offering ImPACT testing, a computer based diagnostic, to ascertain baselines on players before they hit the field.
Government directed youth concussion athletic policies are also being put in place across the U.S. The National Federation of State High School Associations put out an official position statement regarding soccer headgear in which while they don’t ban it’s use they don’t require it and feel that awareness and knowledge might be more powerful tools against concussion (“Position Statement”). In September of 2010 the U.S. House of Representatives conducted a hearing before the Committee of Education and Labor, Protecting Student Athletes from Concussions. There was testimony given within the hearing that 50% of second impact concussions resulted in death; which shows the importance of finding a solution to this growing problem and specifically how to address repeat concussions. It was concluded that there is a need to have strict “return to play guidelines” developed and adhered to in High School sports (Committee on Education and Labor). States are following suit with policies of their own. The State of Minnesota’s Senate member, Senator Michelle R. Benson presented S.F. No. 612 – Establishing Youth Athletic Concussion Policies for the state that attempts to control “fee for youth athletic activity” organizations to build concussion awareness among it’s participating athletes, require annual training among leaders, and require athletes and their parents to sign concussion information forms before participating. Further, the athlete must be cleared of any concussion received before returning to play (Senator Michelle R. Benson). As of 2012, “More than 30 states now require concussed student athletes to receive written medical clearance before returning to play” (Scolaro Moser 145).
ImPACT testing is one tool against the concussion crisis. ImPACT stands for Immediate Post-Concussion Assessment and Cognitive Testing. It is a computerized diagnostic and testing system that is most effective when given to an athlete pre-concussion, for example at the beginning of a season, which then establishes a baseline of cognitive ability and then given again post-concussion if one occurs to evaluate damage done. It helps a doctor to determine the extent of the concussion and potential proper healing time, also when administered post healing it allows them to properly assess if the player should be cleared to return to the game. ImPACT is only one tool in the toolbox for medical professionals to make these decisions. Vision and balance are not taken into account with ImPACT, so its results must be combined with physical examinations of the victim in order to be truly effective (Cantu 55). Many High Schools, more than 7,400 across the country, are not only recommending base line ImPACT testing, but offering it to athletes for a nominal fee (ImPACT).
But, is awareness enough? Many sports are battling rising concussion occurrence besides soccer, and there is precedence for changing the rules of a sport in an effort to reduce injury and protect athletes. In baseball, some are trying to ban home-plate collisions while others contend if you don’t let the runner run full bore to the plate they could be injured by the catcher (Abate). In 2011, the NFL took a harder stance on the definition of an illegal tackle but many think it was a step towards ruining the game if you make it less physical (Abate). Meanwhile, youth hockey organizations in Canada are looking at rule changes around body checking and the proper adherence to existing rules in hockey; which, while established, are often overlooked for the play of the game. Michael Cusimano, a Neurologist at St. Michael’s Hospital in Canada, said in a press release in 2012, “Interventions based on rule changes showed the greatest likelihood of making ice hockey safer for youth” (Mick). Similarly, Doctor Robert Cantu, considered America’s leading expert on concussions in youth sports, believes that there should be no heading in youth soccer below the age of 14 to protect younger players from concussion, yet he also states, “in fact, there aren’t any studies that I would rely on linking cleanly heading the ball – the act of head meeting ball with no other trauma to the head – with a higher rate of severe brain injury.” Which appears to be a contradiction of his opinion and the facts. Dr. Cantu like others also makes suggestions in his book, Concussions and Our Kids, that helmets should be mandatory in youth sports like field hockey and girls’ lacrosse, and that there should be no tackling in football, and no body checking in youth hockey before age 14 (Cantu 152-155). However, he also sights education of kids, parents and coaches about concussions and the risk of continuing to play with them as one of the most important things we can all do to stop the crisis of concussions (Cantu). The common denominator of all of these sports (soccer, football, lacrosse, hockey, etc.) is that they are physical games and by that nature people can and will get hurt playing them. So, if rules need to be changed to lessen that risk, which rules and how many can be altered before you’ve irrevocably changed the game into something no one wants to play anymore?
So which rules could change to reduce soccer concussion risks? Soccer is a remarkably simple game in comparison to others. There are only 17 official laws of soccer and “most define game length, field size, ball dimensions, player uniforms, referee duties, and the like, only two laws (#11 – offsides and #12 – fouls and misconduct) describe fouls and infractions” (Kirkendall 3). Soccer is not by nature a “tackle” sport. Most collisions happen by accident in an attempt to get at the ball. So, that leaves the header as the key target for changes in rules; either eliminating it completely or only allowing it after a certain age. However, in a study done by Duke University in the late 90’s of over 20,000 players, 70% of all injuries reported over a 3-year period were from player-to-player contact, versus player’s head-to-ball contact (Kirkendall 179). Many other studies seem to validate this conclusion, which in turn means that eliminating “heading” would not be the cure-all for High School Soccer concussions.
Other theories have surfaced as well as to how to avoid or prevent concussion. Some believe mouth-guards would prevent or lessen the shock inside the skull on impact, but there is no reliable proof of this (Scolaro Moser 107). Others believe soccer players should wear some type of helmet or head guard, but no version of this has been designed or accepted enough, as not disrupting play to make any one want to mandate them. Soccer is a unique sport in that it requires the “purposeful use of the unprotected head to control and advance the ball” (Kirkendall 188). However, in sports like football where the head is not used in play, helmets don’t stop concussions either even though they are required equipment. The NFL requires helmets and they have done extensive research into their effectiveness with regard to concussion and even a STAR rating system was developed to evaluate them, released in the Rowson-Duma helmet study (Barton). However, there still seems to be no conclusive evidence that the helmet could be 100% effective in stopping or reducing concussions. Back to the brain being rattled in the skull, it appears no amount of protective external gear can stop that 3-pound mass from gyrating around if your body or head takes a big enough hit.
Which brings back the question, how do we save the athletes without killing the game? The answer is right in front of us; we push forward with knowledge, research, build awareness, and most critically sideline concussed players until they have been cleared to return to play by a medical professional. Changing the rules of soccer is not the answer. Changing our awareness about injuries, and in concussion’s case, their silent symptoms, and our response to those injuries is the best solution. It’s critical that all participants: coaches, parents, players and the medical community stick together and focus on concussion as a real and deadly foe. We must take it seriously, and team together, to hold it at bay. As a community we need to keep that injured player off the field even if he or she says and feels he or she wants to return, especially if he or she has been concussed. High schools need to continue to educate parents, players, and coaches of the risks and even more importantly, the signs of concussion and the critical importance of properly clearing concussed players before they return to play. In order for it to continue to be a game to enjoy and love, soccer must be a sport we realize is actually just a fun game at the end of the day and our athlete’s long-term health should override it when concussion occurs.
Work Cited
“Concussion in Sports and Play: Get the Facts.” Center for Disease Control and Prevention. CDC. 6 Oct. 2011. Web. 19 Feb. 2014.
“Position Statement Regarding Soccer Headgear.” OSAA.org. National Federation of State High School Association. 2012 Web. 24 Feb. 2014.
“Sports Concussion.” Brain Injury Association of Virginia. Web. 9 Feb. 2014
“Statistics on Youth Sports Safety.” Clearedtoplay.org. Cleared To play Inc., n.d. Web. 9 Feb. 2014.
“Trends in Concussion Incidence in High School Sports.” Medstarhealth.org. MEDSTAR Sports Medicine. Web. 24 Feb. 2014
Abate, Zachary. “The case against changing sports rules to increase safety.” Worldmag.com. WNG.org. 5 March 2013. Web. 19 Feb. 2014
Barton, Lindsay “Concussions in High School Sports.” Momsteam.com. American Journal of Sports Medicine. Web. 9 Feb. 2014
Cantu, Robert, M.D. and Mark Hyman. Concussions and Our Kids. Boston: Houghton Mifflin Harcourt, 2012. Print.
Concussion Treatment. The Sports Concussion Institute. Web. 9 Feb. 2014
Edelman, Byron “Heading taking a lot of blame as concussions increase in soccer.” Thespokesman-review.com. The Spokesman-Review. 16 March 2011. Web. 19 Feb. 2014.
ImPACT. Impacttest.com. ImPACT. Web. 19 Feb. 2014
Kirkendall, Donald. The Complete Guide to Soccer Fitness & Injury Prevention. Chapel Hill: The University of North Carolina Press, 2007. Print.
McClafferty, Carla. Fourth Down and Inches. Minneapolis: Carolrhoda Books, 2013. Print.
Melnick, Meredith. “Frequent Soccer-Ball Headers Linked to Brain Injury.” Time.com. Time Inc., 30 Nov. 2011. Web. 9 Feb. 2014
Mick, Hayley. “Rule changes reduce hockey head injuries: Study.” Theglobeandmail.com. The Globe and Mail. 3 Dec. 2012. Web. 19 Feb. 2014.
Scolaro Moser, Rosemarie, Ph.D. Ahead of the Game. Hanover: Dartmouth College Press, 2012. Print.
United States. Senate State of Minnesota. Senator Michelle R. Benson. “S.F. No. 612 – Establishing Youth Athletic Concussion Policies. Senate.leg.state.mn.us. Senate Counsel, 11 April 2011. Web. 24 Feb. 2014
United States. U.S House of Representatives One Hundred Eleventh Congress. Committee on Education and Labor. “H.R. 6172, Protecting Student Athletes from Concussions.” Gpoaccess.gov. U.S. Government Printing Office, 23 Sep. 2010. Web. 24 Feb. 2014.
Williams, Chris and Richard Obert. “Arizona HS player Charles Youvella dies days after game.” Usatoday.com. USA Today. 12 Nov. 2013 Web. 24 Feb. 2014.