Fans' View

Fans’ view: Youth soccer and concussions

Photo: Courtesy of nays.org

The discussion about concussions has been around for a few years and, helped in no small part through the efforts of people like Taylor Twellman, it’s an issue club and school soccer have finally started to treat more seriously.

Every coach in my club has to take the concussion test offered by EPYSA. My eldest son, as a incoming 9th grader, was required to take the baseline concussion test in order to play at the high school. My husband, who is a licensed referee, is also required to take a concussion test. In doing research for this article, I found to my surprise, that the Pennsylvania state legislature passed a bill in 2011 establishing standards for managing concussions known as the Safety in Youth Sports Act.

This rise in awareness is evident outside of the playing field. I’ve noticed it in my high school classroom. The first time I had heard of a student being out of school for an extended period of time due to a concussion was 2010. Now, it is not uncommon to have multiple students out for weeks with concussion symptoms. I’ve also had kids play the system and say they can’t take a test or turn in an assignment because they think they may have a concussion.

What gives me angst is that even with all of this testing, we’re still struggling with developing reliable protocols to determine, during a game, if a concussion has occurred. We’ve seen this time and time again in the professional leagues. The incidents with Oscar in the Arsenal-Chelsea match, and Germany’s Christoph Kramer in the 2014 World Cup final, are two examples that come to mind.

Professional rugby has implemented a policy that allows players with suspected concussions to be temporarily subbed out while medical professionals assess the player. If the player passes the test, they are allowed back onto the pitch. This sensible rule will help to prevent players continuing to play even after a head injury because the coach or the player wants to continue.

In soccer, the discussion on whether to allow a “short-term” sub so that a player can be evaluated, or allow teams an additional sub for the sole purpose of a concussion related injury, has gone nowhere. But if experts believe the three-minute period that is allowed in the World Cup for medical staff to evaluate a player for concussion is inadequate for a true diagnosis, what can be done at the youth level where, more often than not, a doctor won’t be on the sideline?

I know that for the most part, youth soccer errs on the side of caution. In games that my sons have played in, any hint of a head knock typically results in the player being pulled. Last year, my son came down hard and hit his head on the ground during a school practice. The coach called that evening to let us know what had happened. Being a teenager, our son didn’t say anything to us.

Still, in another game, the goalie took a kick to the back of the head, play continued, and the referee never stopped the game to evaluate the player. It took the coach yelling at the ref repeatedly for the whistle to be blown. Who is responsible for making these decisions? The referee? The coach? Someone else?

To my knowledge I’ve never had a concussion — well maybe once when I got mowed over by a runner when I was catching at home plate, but never to the extent that I was unable to function for an extended period of time. But, as we now know, suffering even a “slight” concussion increases the chances of the next concussion. In other words, there really is no such thing as a “minor” concussion.

Concerns about concussions coming from contact in the run of play have resulted in some school districts requiring players to wear protective head gear — much like USWNT defender Ali Krieger has been wearing at the World Cup — and there have long been calls to ban heading the ball in certain age levels, whether to minimize the chance for head-to-head contact, or over awareness of the cumulative effect heading the ball can have.

Despite the seriousness of concussions, whether coming from a kind of “When I was kid, I was told to just ‘suck it up,’ and I turned out fine” mentality, or in recognition of how overprotective we’ve become as a society, it can be hard sometimes when talking about concussions not to wonder if responses like requiring head gear or banning heading the ball are an overreaction.

The prescription for concussions is rest, no TV screens, no reading, and no strenuous mental work. As parents, coaches, referees, and administrators involved in youth soccer, we’ve come a long way in recognizing the dangers of concussion. But we can’t rest now, we still have a lot of work to do.

5 Comments

  1. One wonders about concussions and the prevalence and how it is they ‘seem’ so much worse than in years past. We are a hyper vigilant society now…. MAking kids wear protective headgear as required protocol is insanity to me. I sometimes wonder if the screens and the amount of neural stimulus has caused brains to be more stressed particularly in recovering from head injuries. My 5 year old had a concussion at 36 months playing Wipeout with his big brothers….
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    And keep a close eye on him- very wary of his melon and guarding it but not hypervigant.
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    I shudder when I see coaches allowing goalies to punt balls still…… Absolutely should be banned from the game.
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    Good article.

  2. Great topic Staci. As a pediatrician and dad, this is something I constantly think about. You hit the nail on the head. The research is constantly evolving and there is very little consensus in the medical community on best practices. Because of this uncertainty and the rare, but serious poor outcomes, most of the medical community errs on the side of caution.
    .
    Two recent research studies of note. One compared one group of children prescribed 100% brain rest for a set length of time compared to another who were encouraged to gradually resume normal activities at an earlier time. Surprisingly, the group given the longer period of brain rest actually kept their symptoms (headaches, etc) longer.
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    The second area of research has seemed to show that young children in particular seem to take longer to recover from concussion than older children. This information, I believe, will further the argument for taking heading out of the game at the youth level – perhaps even pre-high school. We have already seen one high school in this area ban heading for their players, and I suspect many will start to follow suit.
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    As for protective headgear – there is no research to show a reduction in head injury. In fact, there is some concern that it may in fact increase injuries as children become less fearful of head collisions and therefore don’t naturally protect themselves (much in the way the number of head injuries increased when football players began wearing helmets).
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    More research, more research, more research.

  3. Staci, you pointed out several issues that are of prime importance in handling concussions. During a game, FIFA specifies that a referee is supposed to handle a suspected concussion situation, by sending a player to the sideline. Problem here is that the vast majority of referees are not educated in concussions. All of the attention is on the coaches. You combine this with the fact that the majority of referees are youth referees, you then have a situation that has fundamental difficulties. The situation then falls to the coach, to ensure that a player is removed, if they feel that a concussion is suspected. If a player can stand, and move, the coach is most likely not going to be too eager to take the player off the field. This is where the ‘invisible injury’ aspect of concussions comes into play. This also can be exhibited on the sideline, if a coach has to evaluate a player for a concussion. During a game, a coach is heavily involved in watching play, typically directing players. When they have to evaluate a player, they have to balance this against ignoring the game for player evaluation. They also have to remember, instantly, all of the concussion signs/symptoms, to evaluate a player. This also includes any questions to ask the player, to determine their cognitive functionality. This can be daunting for some. Part of a field ‘procedure’ may lay in providing a tool that helps the coach in the evaluation process, so that things flow smoothly. I might recommend the PAR, Concussion Recognition & Response Tool (CRR), which is an application that runs on smart phones (Android & Apple). It provides an instant field concussion evaluation capability, with data storage, and the capability of emailing the summarized information to whomever might need it. It takes a load off the coach, and provides for documentation/recording of the concussion incident, for medical/coach/soccer organization usage. The application also has an area for parents, to monitor & record the status of their player, for helpting them to determine if action is needed immediately on their part, at home, or for conveying to their medical doctor. This application is free.

    Headgear is an area where a parent/player can be mislead. The concussion occurs from the brain rebounding against the skull, on the inside of the head. The headgear will lessen abrasions from an impact, and may slightly lessen the force of the impact, but it cannot stop the brain from striking the skull. Some players may take more risks while wearing headgear, feeling that they are protected from concussions.

  4. IMO there should be training at the youth level (U10 and up)on how to minimize the effect of head contact with ground after a collision of players. The emphasis should be on either learning how to fall and roll while protecting your head or like in Tae Kwon Do you learn to slap out before your body completely makes contact to the ground when knocked on your backside. I’m aware that a players head contacting the ground is only one of many ways of jarring your brain but some thought along the lines of teaching the kids how to protect themselves going into the contact and how to minimize going to the ground would be a big help in reducing these terrible injuries. Contact and aggression are a big part of the sport and if that is to continue the kids deserve some input from coaches/trainers on what should be allowed so that they can protect themselves. Concussions suck.

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