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Changes needed to prevent soccer concussions for kids: researchers

Soccer is the world’s most popular and fastest-growing sport, with more
than 265 million players around the globe, including 27 million in North
America.

In a review of previous studies that looked at the
incidence of concussion in both amateur and professional soccer players,
researchers at Toronto’s St. Michael’s Hospital found that concussions
accounted for 5.8 per cent to 8.6 per cent of total injuries sustained
during games.

"Just the incidence of concussions in soccer, I
found quite striking," said principal investigator Tom Schweizer,
director of neuroscience research at the hospital. "We don’t really
associate concussions, head injury, with this game as much obviously as
we do with hockey and football."

In all, 49 studies were analyzed as part of the review article, which was published Monday in the journal Brain Injury.

One
study found that almost 63 per cent of varsity soccer players had
suffered symptoms of a concussion during their playing careers, yet only
about 19 per cent realized it at the time.

Another determined
that roughly 82 per cent of athletes had experienced two or more
concussions, and that players with a history of the brain injury had
triple the risk of sustaining another one compared to those who had
never been concussed.

Still another showed that head impacts while playing soccer accounted for 15 per cent of all sports-related concussions.

More
than 40 per cent of those brain injuries resulted from a blow to the
head from another player’s elbow, arm or hand, research showed.

One paper found that 58 per cent of soccer concussions occurred during a heading duel, often when two players collided mid-air.

Female
soccer players have a higher incidence of concussion than their male
counterparts, the review found, although the exact reason isn’t known.

"Some
have speculated that it could be smaller neck muscles in female players
that don’t allow them to brace fully for the impact," said Schweizer.

Defencemen
and goalkeepers are at greatest risk for concussion, the research
revealed. Most are caused by unintentional or unexpected contact, such
as when one player collides with a teammate, opponent or the playing
surface, including a goalpost.

Goalkeepers get twice as many
concussions as other players, said co-author Monica Maher, a master’s
degree student in neuroscience and a former netminder on the University
of Toronto’s Varsity Blues women’s soccer team.

"As a goalkeeper
myself, it’s a situation where you’re quite literally throwing yourself
at other players’ feet," she said. "So you’re kind of at risk for being
kicked in the head or (getting) a ball to the head, even in some cases
the goalpost."

There is significant concern about the potential
long-term cognitive and behavioural consequences for athletes who suffer
an acute or repeated concussion, a brain injury that causes such
symptoms as dizziness, confusion, memory loss, headache, nausea or
vomiting.

Depending on the severity, symptoms can last for days,
weeks or months. Concentration and the ability to remember may be
impaired; the person can be irritable, depressed and have marked
personality changes; sensitivity to noise and light, along with
disturbed sleep, are also common.

However, soccer players may
experience multiple sub-concussive impacts, often from heading, which
may have cumulative effects over time.

"The practice of heading,
which might occur thousands of times over a player’s career, carries
unknown risks, but may uniquely contribute to cognitive decline or
impairment in the short or long term," said Schweizer.

Studies on
the long-term effects of heading found greater memory, planning and
perceptual deficits in forwards and defenders, the players who execute
the technique most often.

One study found professional players
with the highest prevalence of heading during their careers scored the
lowest on tests of attention as well as verbal and visual memory.
Another found older or retired soccer players had significantly impaired
conceptual thinking, reaction time and concentration.

Schweizer
said the goal of the research review is to come up with effective ways
to prevent concussions and repeated sub-concussive hits to the head,
particularly in children whose brains are still developing.

"Our main focus is obviously the little kids, which is where you can effect the most change, I think," he said.

Those
changes could include prohibiting the use of heading until children
have reached a certain age — and only after they have been taught the
technique properly. Goalposts should also be padded for games involving
kids, the researchers suggest.

"With older players, adult
players, that’s not desirable because it changes the rebounding of the
ball off the goalposts," Schweizer said. "But with the very young —
we’re talking six-, seven-, eight-year-olds — I don’t think that’s an
issue.

"A lot of times the players are just learning to dribble
the ball, their heads are down, they could make contact with a very hard
goalpost. The goaltenders, they don’t have a lot of spatial awareness
in the early years."

Soccer players of all ages might also
consider wearing special headbands meant to absorb the shock of impact,
although it’s not clear yet from research how effective they are in
preventing concussions.

Schweizer and Mayer said their paper is
not meant to be alarmist or to suggest that parents pull their kids
permanently off the soccer pitch because of the risk of concussion.

"The physical benefits, the cardiovascular benefits of the sport far outweigh any of the risks," he said.

"However,
like any other sport, with the sheer number of kids that are playing
it, if we can make it safer by looking at some of these changes, then
why wouldn’t we try that?"