Changes needed to prevent soccer concussions for kids: researchers

Sheryl Ubelacker, The Canadian Press
February 11, 2014
By Sheryl Ubelacker, The Canadian Press
Feb. 11, 2014 — When most people think of sports-related concussions, hockey and football tend to first pop to mind because of their rough-and-tumble nature. But researchers say not enough attention has been paid to soccer, which carries its own unique risks of brain injury, especially from collisions related to heading and the long-term consequences of repetitively using the noggin to control the ball.
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?"

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