Banning headers in soccer won't prevent concussions

A study shows that banning headers in soccer won't solve the concussion problem.

While many experts have called for a ban on "heading" the ball in youth soccer because they believe it is a leading cause of concussions, a new study suggests the body contact that often occurs during such play is to blame for most brain injuries.

So banning headers among high school players would not reduce concussion rates as much as enforcing existing rules on rough play would, the researchers added.

Heading the ball "is very much at the heart of soccer culture," explained study author R. Dawn Comstock, a faculty member in the department of epidemiology with the Colorado School of Public Health at the University of Colorado in Aurora. "And, yes, we found that heading is the activity in soccer during which most concussions occur among both boys and girls," she added.

"But if you look closely, it's not generally the impact of the ball to the head that leads to concussion. The vast majority of the time it's the athlete-to-athlete contact that happens during [heading] that causes the concussion. One player's head hitting another player's head, or a shoulder-to-head [collision]. That's the problem. Not the ball," Comstock explained.

"So, yes, if you eliminate heading in soccer you would definitely reduce concussions," Comstock acknowledged. "But soccer is not actually a full-contact sport. And there are rules of the game that already exist that penalize the kind of dangerous out-of-position contested heading that results in athlete-to-athlete contact."

So, she suggested, "if you just enforce these rules you would dramatically reduce aggressive body contact, and dramatically lower the concussion rate, without having to change the culture of the sport by eliminating heading itself."

The findings are published in the July 13 online edition of the journal JAMA Pediatrics.

Soccer's popularity among U.S. high school students has grown enormously in recent years. Today, almost 800,000 teens play the sport in the United States, compared with the mere 50,000 (exclusively male) students who played back in 1970, according to the report.

An analysis of data collected between 2005 and 2014 showed that today, girls actually face a higher risk for soccer concussions than boys: 4.5 concussions for every 10,000 practice or game exposures, compared with just 2.8 concussions per 10,000 exposures among boys.

Heading is the most concussion-prone activity, accounting for more than 30 percent of all concussions among boys, and more than 25 percent among girls, the investigators reported.

However, 78 percent and 62 percent of heading-related concussions among boys and girls, respectively, were attributed to body-on-body contact between players, rather than head contact with the ball, the study said.

"Based on this evidence, I would say that if soccer officials are going to allow the sport to become increasingly aggressive then, yes, please ban heading," said Comstock. "But be clear that what's causing concussions is not the ball. It's athlete contact."

But Robert Stern, a professor of neurology, and neurosurgery and anatomy and neurobiology at Boston University School of Medicine, argued that the current study "really misses the point."

"I'm a soccer fan and a major supporter of youth athletics of all different types," he said. "And we must keep in mind the incredible benefits of youth sports, including sports that result in a lot of injuries. But I do completely support those who want to eliminate heading in soccer at a young age, because the intense focus we've been having on the so-called 'concussion crisis' in recent years misses the much bigger issue: What happens to brains when they are exposed to repetitive hits to the head?" Stern said.

"I don't expect there to be a lot of concussions caused directly by heading a ball," stressed Stern, who also serves as the clinical core director of the university's Alzheimer's disease and CTE Center.

"But I'm talking about all the long-term consequences that come from 'sub-concussive' hits, absent any concussive symptoms. The repetitive brain trauma that comes with hitting the ball frequently with the head, causing changes to the white matter integrity of the brain, cognitive [mental] changes, and other alterations to brain functioning," he explained.

"And I would say that parents who struggle with trying to understand this issue need to ask one very important question: Does it make sense for us to allow for our young kids to participate in an activity that results in repetitive brain trauma?" he said. "Personally, I think children deserve to have adults protect their developing brains."

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Study claims concussions are common in middle school-aged girls playing soccer

A recent study claims that girls who are middle school-aged and play soccer commonly have concussions.

Girls who play soccer in middle school are vulnerable to concussions, new research shows.

And despite medical advice to the contrary, many play through their injury, increasing the risk of a second concussion, the study found.

Although awareness has increased about sports concussions, little research has been done on middle school athletes, especially girls, noted study co-author Dr. Melissa Schiff, a professor of epidemiology at the University of Washington School of Public Health in Seattle.

In the study, which evaluated 351 soccer players between the ages of 11 and 14, Schiff and her colleagues found 59 concussions. A concussion is defined as a traumatic injury to the brain after a blow, shaking or spinning. In the study, the girls' symptoms included headache, dizziness, drowsiness and concentration problems.

That rate of injuries, Schiff said, is higher than what has been reported at either high school or college level of women's soccer.

Heading the ball was to blame for about 30 percent of the injuries. This involves hitting the ball with your forehead to redirect the ball in play. More than half of the concussions were from contact with another player.

Experts recommend those who have a concussion be evaluated by a doctor or other health care professional trained in the injury, but Schiff found that ''56 percent were never evaluated." Experts also advise that players not return to practice or games until symptoms disappear, but 58 percent of the players in the study continued to play even with symptoms persisting, she said.

The study was published online Jan. 20 in the journal JAMA Pediatrics.

Awareness about the dangers of concussions has increased, Schiff said, beginning with the National Football League's attention to the problem. Research about the problem has slowly increased to encompass college-level, high school, and now middle school players, she said.

In this study, the researchers randomly selected 33 of 72 elite teams from four youth soccer clubs in the Puget Sound region of Washington state. The study continued from 2008 to 2012. Players reported injuries and symptoms.

With so many injuries blamed on heading the ball, should it be banned?

Schiff thinks that is unrealistic. "It's part of the soccer sport," she said. However, it was found to result in concussion 23 times more often in a game than in practice. One suggestion, she said, is to teach middle school athletes heading in practice but tell them not to do it in games until they are older. The researchers speculate that younger players' less mature brains and weaker neck muscles, along with poorer heading technique, may contribute to the number of concussions.

The new study ''calls attention to the high incidence of concussion in this age group," said Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children's Hospital.

The number of injuries blamed on heading the ball, 30 percent, is not surprising, he said. "I see it all the time," Kuluz explained. Often, he noted, a heading injury occurs along with colliding with another player.

Kuluz advises young athletes who have had a concussion to avoid heading the ball.

Parents need to pay attention to their child during and after soccer, he suggested. "In the event of an injury, pay attention to symptoms," Kuluz said. He added that if a concussion is suspected, a young athlete must be evaluated by a doctor or trainer who has experience with concussions.

"Soccer can be done safely," he said, but parents and coaches need to be aware of concussion symptoms and obtain good medical evaluation and care.

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Heading Soccer Balls and Brain Injury

A study shows that heading a soccer ball can result in brain injury resembling a concussion.

Researchers at Albert Einstein College of Medicine of Yeshiva University have shown that soccer players who frequently head the ball have brain abnormalities resembling those found in patients with concussion (mild traumatic brain injury). The study, which used advanced imaging techniques and cognitive tests that assessed memory, published online today in the journalRadiology.

"We studied soccer players because soccer is the world's most popular sport," said Michael L. Lipton, M.D., Ph.D., associate director of Einstein's Gruss Magnetic Resonance Research Center and medical director of MRI services at Montefiore, the University Hospital and academic medical center for Einstein. "Soccer is widely played by people of all ages and there is concern that heading the ball -- a key component of the sport -- might damage the brain." Dr. Lipton is also associate professor of radiology, of psychiatry and behavioral sciences and in the Dominick P. Purpura Department of Neuroscience at Einstein.

On average, soccer players head the ball six to 12 times during games, where balls can travel at speeds of more than 50 miles per hour. During practice drills, players commonly head the ball 30 or more times. The impact from a single heading is unlikely to cause traumatic brain damage such as laceration of nerve fibers. But scientists have worried that cumulative damage from heading's repeated subconcussive impacts might be clinically significant. "Repetitive heading could set off a cascade of responses that leads to degeneration of brain cells over time," noted Dr. Lipton.

To study possible brain injury from heading, the researchers used diffusion tensor imaging (DTI), an advanced MRI-based imaging technique, on 37 amateur adult soccer players (median age 31 years) who had all played the sport since childhood. Participants reported playing soccer for an average of 22 years and had played an average of 10 months over the previous year. Researchers ranked the players based on heading frequency and then compared the DTI brain images of the most frequent headers with those of the remaining players. All participants also underwent cognitive testing.

DTI "sees" the movement of water molecules within and along axons, the nerve fibers that constitute the brain's white matter. This imaging technique allows researchers to measure the uniformity of water movement (called fractional anisotropy, or FA) throughout the brain. Abnormally low FA within white matter indicates axon damage and has previously been associated with cognitive impairment in patients with traumatic brain injury.

"The DTI findings pertaining to the most frequent headers in our study showed white-matter abnormalities similar to what we've seen in patients with concussion," said Dr. Lipton. "Soccer players who headed the ball above a threshold between 885 to 1,550 times a year had significantly lower FA in three areas of the temporal-occipital white matter." Dr. Lipton noted that players with more than 1,800 headings per year were also more likely to demonstrate poorer memory scores compared to participants with fewer yearly headings.

"Our study provides compelling preliminary evidence that brain changes resembling mild traumatic brain injury are associated with frequently heading a soccer ball over many years," said Dr. Lipton. "While further research is clearly needed, our findings suggest that controlling the amount of heading that people do may help prevent brain injury that frequent heading appears to cause."

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How Cognitive Performance is Affected by Heading a Soccer Ball

This article discusses the results of a study on the changed in cognitive tasks after high school female soccer players headed a soccer ball.

Sports-related head injuries are a growing concern, and new research suggests that even less forceful actions like 'heading' a soccer ball may cause changes in performance on certain cognitive tasks, according to a paper published February 27 in the open access journal PLOS ONEby Anne Sereno and colleagues from the University of Texas Health Science Center at Houston.

The researchers tested the effects of non-injurious head-to-ball impacts on cognitive function using a tablet-based app. They found that high school female soccer players were significantly slower than non-players on a task that required pointing away from a target on the screen, but showed no difference in performance when pointing to the on-screen visual target.

According to the study, tasks that involve pointing away from a target require specific voluntary responses, whereas moving toward a target is a more reflexive response. Based on their observations, the authors conclude that sub-concussive blows to the head may cause changes specifically linked to certain cognitive functions.

The authors say that the app used in their research may be a quick and effective way to screen for and track cognitive changes in athletes. They add that a tablet-based application for such quick screens may also have broader applications in the clinic or the field.

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How To Prevent Sports Concussions Among Children

A great article from the New York Times discusses ways to prevents concussions in children by sport.

This fall, about three million children younger than 14 are playing organized tackle football in the United States. Is that a good thing?

For many parents and coaches, that means three million children are getting some pretty serious exercise, hanging out with old friends and making new ones, and unplugging from technology, for a few hours at least.

I see those positives. Yet if it were my call, those millions would be playing touch football instead. Many would be learning the fundamentals of tackling and other football skills. But they would not be playing tackle football until they turned 14.

The reason is simple. Tackle football is too dangerous for youngsters. Exposure to head trauma is too risky. What we know about football and the vulnerabilities of children’s brains leads me to this conclusion. More worrisome is what we don’t know. How will the hits absorbed by a 9-year-old today be felt at 30, or 50?

I’ve been treating young athletes for concussions and other head trauma for four decades. In an average year, I’ll meet with patients to discuss their concussion symptoms 1,500 times or more. I’ve treated children for concussions in any sport you can name, and a few you wouldn’t think of. I’ve seen pole-vaulters, BMX riders and tennis players. Not that long ago, I treated a young man injured playing Ultimate Frisbee.

I’m not in favor of abolishing any sport for children, football included. Sports have too much to offer young people. There is nothing like being part of a Little League team or competing as a swimmer, tennis player or golfer to promote perseverance, sportsmanship, fair play, to keep fighting until the last point in the match or the last out. These are traits that carry us through life’s challenges.

In light of what we now know about concussions and the brains of children, though, many sports should be fine-tuned. But many parents and coaches are satisfied with the rules as they are. They like seeing youngsters in helmets and pads, and watching them slide headfirst into second base. The closer the peewee games resemble those of the professionals, the happier we are. It’s natural for a parent or a coach. Even a neurosurgeon.

But children are not adults. Their bodies are still maturing. Their vulnerabilities to head trauma are far greater.

A child’s brain and head are disproportionately large for the rest of the body, especially through the first five to eight years of life. And a child’s weak neck cannot brace for a hit the way an adult’s can. (Think of a bobblehead doll.) A child’s cranium at 4 is about 90 percent the size an adult’s. That’s important to a discussion of concussions and concussion risk.

We cannot eliminate head trauma from youth sports. What we can change is our mind-set so protecting the head and the brain is always a top consideration.

The guiding principle should be that no head trauma is good head trauma. Let’s re-examine youth sports and take steps to keep young athletes safe. I would like to see these changes written into the rules across the country.

SOCCER Many parents and coaches are surprised to learn that soccer is not among the safer sports for head trauma. It is actually one of the riskiest. In 2010, more high school soccer players sustained concussions than did athletes in basketball, baseball, wrestling and softball combined, according to the Center for Injury Research and Policy in Columbus, Ohio.

Most of that risk comes from one play: heading the ball. When two or more leap to direct the ball with their heads, a number of collisions can occur with heads, shoulders and elbows. From a neurological standpoint, nearly all are bad. About 90 percent of the patients I see with soccer head trauma and concussion are related to heading accidents.

It’s an easy call for me: take heading out of soccer until the players are 14.

ICE HOCKEY The progressive leadership of USA Hockey and Hockey Canada have done most of the heavy lifting in this sport. Hockey Canada outlawed checking to the head throughout amateur hockey. In 2011, USA Hockey approved a ban on body checking before the age of 13. I would extend the ban on body checking to 14. (The previous rule permitted body checking for players as young as 11.)

BASEBALL AND SOFTBALL Batting helmets are mandatory at every level of baseball, yet it’s surprising how little we do to ensure that they stay on. Some youth leagues around the country have mandated chin straps for years. All youth and high school leagues should require them.

In addition, headfirst slides should be eliminated. When a child’s head plows into an ankle or a shin, the leg always wins. Worse are home-plate collisions in which the head of the base runner can crash into the catcher’s hard shinguards.

FIELD HOCKEY AND GIRLS’ LACROSSE

I have heard that girls would be emboldened to play more aggressively if helmets were required in these sports, and that the net effect would be more injuries, not fewer. I say hold officials accountable for enforcing the rules, and that will not happen.

In lacrosse, some officials now favor something like a bike helmet to protect the top of the head. That is not good enough. When helmets that cover the entire head are required, fewer young women will sustain concussions.

Field hockey rules state that players should not raise their sticks above the knee. But that rule is broken in every game, often resulting in concussions, eye injuries, cuts, broken noses and more. Helmets are needed, although they do not have to be as robust as football helmets.

]I would expect resistance to these recommendations from parents of the 16,000 players in Pop Warner football’s tackle division for 5- to 7-year-olds, for example. But let’s begin the debate.

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Study Claims that Kids' Concussion Symptoms Can Last a Year

Some children who suffer a concussion will display continued difficulties, such as attention and memory problems, for many months, a new study finds.

Concussions, also known as mild traumatic brain injury, are common in childhood, with more than 500,000 children and teens a year needing hospital treatment for these injuries, the researchers note.

"The results of the study suggest that the majority of kids who sustain mild traumatic brain injuries actually do quite well and don't have to have persistent symptoms after their injury," said lead researcher Keith Owen Yeates, director of Behavioral Health Services at Nationwide Children's Hospital in Columbus, Ohio.

"But, there is a small, but significant proportion of kids that do go on to have persistent symptoms after their injury, lasting as long as three to 12 months," he added.

The extent and duration of the symptoms appear to be related to the severity of the injury, and can affect quality of life and school performance, he said.

Kids shouldn't go back to play until their symptoms are gone, and the medical profession must fine-tune guidelines regarding permissible post-concussion activity, Yeates said.

The report was published in the March 5 online edition of Archives of Pediatrics & Adolescent Medicine.

For the study, Yeates' team compared almost 200 children and teens ages 8 to 15 who suffered a mild brain injury to about 100 similarly aged children who had a bone injury.

The researchers looked for symptoms of headache, fatigue, inattention and memory problems during the year after the injury.

They found children who suffered a mild brain injury were more likely to show these symptoms compared to other children. Also, the physical symptoms abated sooner in the concussed kids than the problems involving mental, or cognitive, functioning.

Moreover, these symptoms appeared worse in children who had lost consciousness or had abnormalities seen on brain scans, the investigators added.

It's not just football and hockey that pose a risk for student athletes. Soccer is the leading cause of sports-related concussions among high-school-age girls, the study pointed out.

Dr. Frederick Rivara, a professor and division chief of general pediatrics at the University of Washington in Seattle and author of an accompanying journal editorial, said concussions are taken more seriously by physicians, parents and coaches nowadays.

Sports are important for health, but care must be taken to protect youngsters from head injuries, Rivara said.

"If kids have symptoms of concussion they should be taken out of the game and shouldn't return to play without seeing a physician," he said.

Rivara said children should see a doctor after a concussion whether or not they lose consciousness.

"We have ignored these injuries, and we don't know enough about these injuries," he said. More research is needed about the consequences of concussions, he added.

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Frequent 'Heading' in Soccer Can Lead to Brain Injury and Cognitive Impairment

Using advanced imaging techniques and cognitive tests, researchers at Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, the University Hospital and academic medical center for Einstein, have shown that repeatedly heading a soccer ball increases the risk for brain injury and cognitive impairment. The imaging portion of the findings was recently presented at the annual meeting of the Radiological Society of North America (RSNA) in Chicago.

The researchers used diffusion tensor imaging (DTI), an advanced MRI-based imaging technique, on 38 amateur soccer players (average age: 30.8 years) who had all played the sport since childhood. They were asked to recall the number of times they headed the ball during the past year. (Heading is when players deliberately hit or field the soccer ball with their head.) Researchers ranked the players based on heading frequency and then compared the brain images of the most frequent headers with those of the remaining players. They found that frequent headers showed brain injury similar to that seen in patients with concussion, also known as mild traumatic brain injury (TBI).

The findings are especially concerning given that soccer is the world's most popular sport with popularity growing in the U.S., especially among children. Of the 18 million Americans who play soccer, 78 percent are under the age of eighteen. Soccer balls are known to travel at speeds as high as 34 miles per hour during recreational play, and more than twice that during professional play.

After confirming the potentially damaging impact of frequent heading, "Our goal was to determine if there is a threshold level for heading frequency that, when surpassed, resulted in detectable brain injury," said lead author Michael Lipton, M.D., Ph.D., associate director of Einstein's Gruss Magnetic Resonance Research Center and medical director of MRI services at Montefiore. Further analysis revealed a threshold level of approximately 1,000 to 1,500 heads per year. Once players in the study exceeded that number, researchers observed significant injury.

"These two studies present compelling evidence that brain injury and cognitive impairment can result from heading a soccer ball with high frequency."

- Michael L. Lipton, M.D., Ph.D."While heading a ball 1,000 or 1,500 times a year may seem high to those who don't participate in the sport, it only amounts to a few times a day for a regular player," observed Dr. Lipton, who is also associate professor of radiology, of psychiatry and behavioral sciences, and of the Dominick P. Purpura Department of Neuroscience at Einstein.

"Heading a soccer ball is not an impact of a magnitude that will lacerate nerve fibers in the brain," said Dr. Lipton. "But repetitive heading may set off a cascade of responses that can lead to degeneration of brain cells."

Researchers identified five areas, in the frontal lobe (behind the forehead) and in the temporo-occipital region (the bottom-rear areas) of the brain that were affected by frequent heading -- areas that are responsible for attention, memory, executive functioning and higher-order visual functions. In a related study, Dr. Lipton and colleague Molly Zimmerman, Ph.D., assistant professor in the Saul R. Korey Department of Neurology at Einstein, gave the same 38 amateur soccer players tests designed to assess their neuropsychological function. Players with the highest annual heading frequency performed worse on tests of verbal memory and psychomotor speed (activities that require mind-body coordination, like throwing a ball) relative to their peers.

"These two studies present compelling evidence that brain injury and cognitive impairment can result from heading a soccer ball with high frequency," Dr. Lipton said. "These are findings that should be taken into consideration in planning future research to develop approaches to protect soccer players."

Read more: http://www.sciencedaily.com/releases/2011/11/111129092420

Youth sports community supports concussion laws

In two decades of coaching hockey, camp director Stu Gould has seen plenty of concussions. He said the helmet is one part of the sports budget parents shouldn’t skimp on — and not just because he sells $1,400 custom masks of his own.

“It’s your head, for God’s sake,” Gould said.

According to the U.S. Department of Health and Human Services, children account for 90 percent of hospital emergency room visits for sports-related concussions. Analysts with HHS’ Agency for Healthcare Research and Quality, found this in the agency’s 2008 emergency department database.

Jennifer Crowley of Lombard has twin 8-year-old sons, Aaron and Patrick, who both play hockey. She said she got them to wear mouth guards by giving them a lecture about concussions.

“I said, ‘They don’t care about your teeth. They care about your head, because if your teeth get knocked together, you can get a concussion,’” she said.

Concussions — brain injuries from a bump, blow or jolt to the head — can occur in any recreational activity, even sports considered non-contact, according to the Centers for Disease Control and Prevention. And complications can occur in both the short-term and long-term, including headaches, dizziness, mood changes and death.

The CDC’s national concussion awareness campaign encourages athletes to report any head injury because all concussions are serious — and not to let themselves, coaches or parents pressure them into returning to the game before they’re ready.

Concussions by sport

The NCAA Injury Surveillance Program reported the rate of concussions for the most injury-prone sports over a five-year period. From 2004 to 2009, for every 1,000 college athletes who took the field during games, the following number suffered a concussion:

Football: 3.1

Men’s lacrosse: 2.6

Men’s ice hockey: 2.4

Women’s ice hockey: 2.2

Women’s soccer: 2.2

Wrestling: 1.4

Men’s soccer: 1.4

Women’s lacrosse:1.2

Field hockey: 1.2

Women’s basketball: 1.2

Men’s basketball: 0.6

Source: 2010-2011 NCAA Sports Medicine Handbook

Read more at: http://specialsections.suntimes.com/home/6990934-554/youth-sports-community-supports-concussion-laws.html

Can mouthguards and football helmets really prevent concussion?

The growing concern over concussions has ushered in new products designed to prevent or treat the mild traumatic brain injuries. But do any of them really work? Here's a look at some of the most common claims:

http://www.chicagotribune.com/health/ct-met-concussion-sidebar-20110625,0,3241267.story

New Texas State Bill on Pediatric Concussion

Local Father Supports Concussion Bill

HOUSTON - Texas is one step closer to major changes when it comes to the way schools treat athletes who suffer a concussion. Lawmakers in the Texas House have passed legislation and now it's on to the Senate.
The proposal breaks down, step by step, how a student with a concussion should be treated. It emphasizes education and prevention.

"I dove back to second base and my helmet hit the person cover second base's knee," described 14-year-old Gabrielle Nieto. "I felt pain but I also don't remember anything about getting hit."
The softball player had just suffered her second concussion in less than a month. Like many devoted athletes, Nieto was eager to return to play so she wasn't exactly truthful with her doctor.
"I told him I didn't have any headaches, symptoms for one whole week so I could go back and play."


Read more: http://www.myfoxhouston.com/dpp/news/local/110505-local-father-supports-concussion-bill#ixzz1Lp35Nqcr