a Safety Program of the Thinkfirst Foundation of Canada in conjunction with the Canadian Soccer Association(“CSA”). Follow the “Thinkfirst” link (on CSA’s Home page, www.canadasoccer.com left hand side), or click on this link, http://www.canadasoccer.com/eng/thinkfirst/ThinkFirst-Soccer-English.pdfto get to the resource guide. The guide covers a wide range of safety considerations, health, nutrition and injuries. Of particular note are the references for concussions (page 9 of the guide).
Thinkfirst is a foundation which defines as its mission, to “prevent brain and spinal cord injury through education aimed at healthy behaviours in children and youth...prevention is the only cure! The resource guide provides further links to the ThinkFirst website, www.thinkfirst.ca which includes concussion protocol guidelines for coaches, and parents (refer Concussion Education). Please, if you have any players experiencing signs or symptoms of concussion, err on the side of caution and ensure they receive medical treatment immediately and follow the recommended protocol for return to play. Players must have a doctor's note before returning to play. It must be given to the Head Coach of the team.
Justin Morneau. Corey Koskie. Ben Hamilton. Taylor Twellman. Brett Favre. Pierre Marc Bouchard. Cindy Parlow. All of them are high level athletes who have had their careers and/or seasons cut short because of concussions. We can also start calling them what they really areâ€¦BRAIN INJURIES.
A concussion is a type of traumatic brain injury that causes dysfunction of the brain and can be caused by a direct blow to the head, a jolt to the body, or a rapid deceleration/acceleration of the brain within the skull. The brain is fairly soft and squishy in consistency but does not do well when it is hit against unforgiving bones that make up the head. Essentially, the brain is being bruised. Bruise = bleeding. Just like there are different types of bruises from mild to severe there are different levels of brain injuries from mild to significant bleeding of the brain. Only this time it isnâ€™t muscles that need to heal; itâ€™s the circuitry of your brain (see concussion leaves 14-year-old basketball player amnesic and left handed). In severe cases with internal bleeding of the brain, the skull causes brain pressure to increase since blood has nowhere to go â€“ this can be fatal.
HOW OFTEN DO THEY OCCUR? The National Institute of Health cites that 4-8% report suffering concussions in soccer, but they also believe that 90% go unreported or unrecognized so the actual incidence could be closer to 40%.
According to the Center for Disease Control, 3.5 million sports-related concussions occur in the U.S. each year. In addition, it is reported that 60% of college soccer players will experience concussion symptoms in a single year. (Clinical Journal of Sports Medicine, 2002) Younger athletes are at a higher risk than adults of experiencing a concussion. Females are more likely to experience concussion than males in similar sports. Athletes who have had a previous concussion are at a higher risk for future concussions and will require less force to reinjure their brains.
HOW DO HEAD INJURIES TYPICALLY OCCUR IN SOCCER?
1. Elbow to head and head-to-head contact when two or more players are contesting for ball in the air. MOST COMMON 2. Goalkeepers getting kicked or getting a knee to the head or hitting head on goalpost. 3. Body-to-body contact without direct contact to the head in which the head accelerates or decelerates violently. 4. Getting hit in head unexpectedly with the ball and hitting head on ground after a fall. 5. Deliberately heading the ball LEAST COMMON
NOTE:Typical boxing punch produces head acceleration of 100g v 20g for typical header. American soccer players head a ball 5-6 times per game and roughly 9 times at practice. In addition, FIFAâ€™s Medical and Research Center concluded that â€œforces generally associated with heading the ball are not sufficient to cause concussions.â€
SYMPTOMS Everyone is different and symptoms can be very subtle. Being knocked UNCONSCIOUS is not a requirement and a â€œdingâ€ can very well result in a concussion, especially for young athletes and athletes who have had previous head injuries.
Confusion, foggy/groggy feeling, sluggish Dizzy, poor balance Sensitivity to noise or light, blurry vision Headache, feeling of pressure Poor memory: canâ€™t remember what they ate earlier that day, the score of the game, what happened, etc. Poor coordination and concentration Nausea/vomiting
Males typically experience more cognitive symptoms such as fogginess and lack of concentration. Females typically experience more somatic symptoms such as drowsiness, sensitivity to light, headaches, and nausea. (Journal of Athletic Training, 2011) If an athlete is experiencing ANY of these symptoms or just doesnâ€™t seem right, DO NOT LET THEM PLAY. Athletes who have a suspected concussion should not be given pain relievers to mask symptoms (headaches). In addition, athletes should be supervised hourly for 24-48 hours following a suspected concussion to monitor for worsening symptoms. Do not leave them alone.
SIGNS OF A MEDICAL EMERGENCY HEADACHES THAT WORSEN REPEATED VOMITING SEVERE NECK PAIN LOSS OF CONSCIOUSNESS OR UNABLE TO BE AWAKENED EASILY SEIZURES INCREASING IRRITABILITY WEAKNESS/NUMBNESS IN ARMS OR LEGS UNABLE TO RECOGNIZE FAMILIAR FACES/THINGS
LIFE-LONG EFFECTS Everyone has different rates of healing, and short-term effects can last from a few hours to several months. Long-term effects are not currently completely understood, but there are a number of studies that are presently being conducted to investigate Chronic Traumatic Encephalopathy (CTE). This is in response to an increasing number of former NFL players with a history of head injury committing suicide and experiencing depression. Boston University is home to the Sports Legacy Institute in which a number of prominent athletes, including Taylor Twellman and Cindy Parlow, have agreed to donate their brain for the sake of research on head injuries.
TIPS FOR COACHING HEADING WITH YOUNG SOCCER PLAYERS
1. Learn proper heading technique â€“ contact with the ball at the hairline/forehead NOT the top of the head. 2. Learn to properly prepare for contact with the ball and a mentality of initiating contact with the ball instead â€œletting the ball hit you.â€ This will prepare the neck and postural muscles to help absorb impact and force to the body and head â€¦and make you a more effective player. 3. Use under-inflated soccer balls or even balloons with younger kids (U12 and younger or inexperienced older players) until they get comfortable with heading and learning proper technique. 4. Strengthen neck muscles 5. Limit the amount of repetitive heading at practice to 10 minutes or less
GOALKEEPING In 2006, Chelsea Goalkeeper Petr Cech injures his head requiring skull decompression surgery.
Watch his hands move down toward his stomach while finishing the save leaving his head exposed. Proper and safe breakaway technique for goalkeepers should include keeping the ball and arms out in front of the head and head hiding behind the hands. It allows the goalkeeper to keep their eye on the ball through the entire save and also protects the head.
POOR TECHNIQUE ON BREAKAWAY
Sliding out feet firstâ€¦and with eyes closed.
Dropping down to knees
HEAD GEAR & NEW DIAGNOSTIC TESTS Does head gear work? The jury is out. One study that tested the head gear on mechanical models concluded that although it does not prevent concussions from ball to head contact it does significantly reduce concussions for head to head contact. I could not find any conclusive studies on the effectiveness of head gear during actual soccer activities with players. The United States Soccer Federation medical staff has voiced concern that head gear may actually promote head injuries via the superman effect or feeling like players are invincible to injury as a result of using the gear.
RETURN TO PLAY GUIDELINES: Physical symptoms almost always resolve before cognitive/neuropsychological symptoms. There is no set schedule for recovery; everyone is different. Time is needed to heal; players must rest cognitively (limit reading, computer, texting, TV). Once players are 100% asymptomatic at rest they can they follow a graded return to play protocol under the supervision and direction of their doctor. (see Justin Morneau, Minnesota Twins)
Second Impact Syndrome â€“ A potentially fatal medical emergency which results from rapid swelling from returning to play before brain is healed and can occur in days, weeks, or minutes after the initial concussion.
TAKE HOME MESSAGE ABOUT HEAD INJURIES: WHEN IN DOUBT, SIT IT OUT.
Want a soccer injury topic addressed? Feel free to send in requests!
About the Author: Julie Eibensteiner PT, DPT, CSCS is a physical therapist and owner of Laurus Athletic Rehab and Performance LLC, an independently owned practice specializing in ACL rehab and prevention in competitive athletes. In addition to being a regular contributor to IMS on topics of sport injury and prevention, Eibensteiner holds an USSF A License, coaches a U18G MRL team for Eden Prairie Soccer Club, and assists with the Menâ€™s and Womenâ€™s soccer programs at Macalester College.
Safety Personnel – Many teams find it very useful to have designated safety personnel, preferably a parent with first aid or medical experience. For any emergency or life threatening injury never hesitate to call 911.
Medical Information and Emergency Contact Information - The club will be sending out to all teams a list of team members, medical numbers, emergency contact information and any specific medical information which was disclosed on the player’s registration – please keep these records in confidence to be used in an emergency and please ensure you have up-to-date emergency contact information for all players.
First aid kits – many of you already have first aid kits for your bench, which is great –the Playing Smart Soccer guide includes a suggested list of components for such kits. Plenty of ice and cold packs are a must. For our girls’ teams, we suggest you also include sanitary supplies in your kits.
Administering Medications - Coaches and managers should NOT, under any circumstance, administer medications to players – over the counter medications such as Tylenol and Advil may be kept in the team kit however ONLY administered to a player by his/her parent. Personal player medications such as inhalers for asthma may be held for the player, but only administered by the player or his/her parent.
Players with Pre-existing medical conditions – for any player with a pre-existing medical condition (eg. asthma, anaphalactic reactions, diabetes, etc.), which should be declared on our Registration Forms, (refer item b above), the parents should be advised team personnel are not authorized to administer medications; please ensure you clarify with the parent(s) the steps the child/parent will be taking in the event of a medical problem arising. For any emergency or life threatening injury never hesitate to call 911.
Walk-in Clinics and Emergency Departments - it is mandatory for all coaches and managers, or safety personnel, to know exactly where the nearest walk-in clinic and/or hospital is located when going to soccer fields both within and outside West Vancouver.
The BC Soccer Association provides coverage to players and members from our insurance provider All Sport Insurance. Full details, including the extent of coverage, process for making a claim and Accident Claim Forms, can be found on BC Soccer’s website, http://www.bcsoccer.net/bcsa/HOME/Insurance/tabid/125/Default.aspx . If that link doesn’t work, go towww.bcsoccer.net, then Insurance (on the left hand side).