Monday, September 19, 2016
My son’s soccer coach argued regularly that soccer was “getting too soft.” He would proudly display his war wounds earned through years of battles on the pitch. “We never wore shin guards,” he’d proclaim whenever a kid would go down after a swift kick to the legs. “You need to be a man,” and he’d roll up his pants to reveal gouges, bumps, and scars riddling his massive shins. “That’s real soccer,” he’d declare. When discussions began about the effects of concussions, he dismissed the talk as too “touchy feely” and announced that no goalkeeper on his teams would ever wear a head guard. Bryce was a keeper. Part of the coach’s bravado was certainly a knee-jerk reaction to the prevalence of dual soccer and football players on his squads shuttling back and forth between practices and games for both sports. He wanted to sell soccer to those parents as a real man’s sport where players run non-stop for 45 minutes and have no protection, no oxygen, and no sideline cooling stations. Why should football players have any concerns over concussions when they wore helmets, neck supports, and padding? Soccer players hit heads all the time without benefit of any protection, avoiding any concern for concussion. For this coach, a concussion was less than a non-issue; it was a ridiculous distraction.
This week the NFL announced a $100 million campaign to address the issue of concussions among youth players. This initiative called the “Play Smart Play Safe” program will primarily be devoted to medical research to discover how concussions occur in players and in developing technology to create a safer environment for players. Included in the program will be a push to help youth coaches learn the latest techniques for protecting players from concussions through safer on-field tactics and proper equipment use. The hope is any results will translate into policies and materials for adults as well as for other youth sports. Likewise there will be a strong move towards evaluating players with strict concussion protocols for any hard contact involving the head. Part of this push is to help assure parents that football is safe for their children to play. Participation has dropped in the last few years with even ex-pro players saying they wouldn’t allow their own children to compete. But a more important aspect isn’t so self-serving; they want to make the sport as safe as possible for everyone who plays because that’s the right thing to do.
I can just imagine how my son’s coach would react to this news. $100 million would go a long way to improving soccer exposure and facilities in America. I’m sure he’d rather see people contributing to promote the sport that he grew up playing in Serbia and that most children around the world play on a regular basis. The NFL is a billion dollar industry who has every reason to want to keep their sport front and center in America’s attention. The seven most watched programs in U.S. television history are the last seven Super Bowls. The income generated from each event ($620 million) is higher than the GNP of nine countries. Therefore, donating $100 million towards a project to improve concussion rates in youth players is truly a very small percentage of the NFL’s budget. Nevertheless, there are plenty of researchers on the topic who are grateful for the monetary support of their studies. The emphasis seems to be on finding a technological answer to preventing concussions – better helmets, more neck support, impact sensors, and scientific tools to assess possible concussion. My son’s coach would definitely not favor that approach, and he is not alone. There are many critics who argue that depending on science to relieve concussions gives players and coaches a false sense of protection. They believe the emphasis should be on education that addresses three areas: improved coaching techniques, alerting parents, coaches, and officials to the symptoms of concussion, and providing trained concussion evaluators at every practice, game, and tournament.
How common are concussions in youth players? A fairly significant number of players suffer concussions, although most recover sufficiently to return to playing after a few days of rest. The five sports recording the most concussions from highest number to lower are bicycling, football, baseball, playground activities, and soccer. There are 1.6 to 3.8 million sports- and recreation-related concussions reported in the United States, although most don’t require a hospital or doctor visit. However 6% of the annual emergency room visits annually for children 5-8 years of age during 2001-2005 were due to concussions (135,000 annually). In soccer the rate of concussions among female youth players was 68% higher than among males and in basketball their rate was 268% higher. Among high school athletes during the 2008-09 school year there were 400,000 concussions. The greatest percentage of injuries in youth sports occur during practices (62%). Emergency room visits for concussions sustained during organized team sports doubled for 8 to 13 year olds from 1997-2007 and nearly tripled for older youth players. High school athletic trainers testified that nearly 15% of all sports-related injuries reported to them were concussions. History of injury is a risk factor for future re-injury, which speaks directly to the critical need for education, prevention techniques and equipment.
Since sports-related concussions don’t play favorites and seem to affect youth players at a significant rate, occasionally even higher than that among adults, it might be useful going forward to form partnerships among youth sports organizations and their adult governing agencies to address this issue. Certainly what the NFL is doing will benefit more than just young football players because these results will be applicable across several sports platforms. However, imagine how much more research could be done that specifically targets the dangers concussions hold for youth players if there was a joint effort with MLS, US Soccer, NBA, World Rugby, FIFA, and other national and international sports organizations. Donating what funds they could add to NFL’s contribution could give a concerted push to identifying causes of and creating preventive solutions for concussions that would benefit more than just youth players. While equipment innovations aren’t in the picture for sports like soccer and basketball, they certainly would be important for bicycling, football, and the playground. Additionally research might reveal how better playing surfaces could help prevent concussion, which would benefit every sport.
Concussions gained national attention through NFL players suffering severe mental deterioration, so the spotlight was focused on football. Now that medical researchers have access to the brains of deceased players so they can study how concussions change the brain, their findings won’t just impact football. Likewise, serious explorations of how to prevent youth concussions through better coaching techniques and playing guidelines in youth football will help all youth players. US Soccer has already mandated that players who are 10-years-old and under shouldn’t be heading the ball. When he heard this, my son thought the policy was ridiculous. “How will they build up their neck muscles to handle headers if they don’t train for them regularly?” His point of view was probably the result of some lingering influence from his tough coach. However, when I explained the science behind the decision (Kids’ brains are smaller in their brain cavities, so they rattle around more.), he understood the requirement. That scientific insight came from research. More is needed. Finding funding should be a top priority which would greatly benefit from a joint effort.
Deciding the thrust of the research will be more difficult. The NFL wants to focus on equipment; soccer would probably want to focus on preventive training techniques. Therefore, a partnership may be unworkable, even if it would be far more impactful by creating deep financial pockets for research. Nevertheless, I would expect that any discoveries however funded and by whom will benefit all youth sports.
What can we, as parents, do to reduce the possibility of a concussion for our child? At a minimum, we should never take a head injury lightly. If a child gets hit in the head even if he or she doesn’t black out or even wobble, that player should be removed from the game to be assessed. I sadly watched a football game in which a player received a blow to the head. He ran off the field on his own power and exhibited little effect from the hit. He sat on the bench for about a minute and then suddenly collapsed to the ground. He was rushed to the hospital and got treatment, but ended up being debilitated by the bleed in his brain for the rest of his life. On some occasions a bleed can be slow and symptoms only show up as much as an hour later. Therefore, no child should return to play that game, even though the “tough guy” standard says he or she should suck it up and get back in there. Every adult should be trained in concussion protocol. It’s available online on dozens of sites. Here’s the form physicians use to do a pre-evaluation to set a baseline for a player and then a check list that should be gone through after any head injury (www.brainline.org/downloads/PDFs/AcuteConcussionEvaluation_ACETest.pdf). The NFL offers an even more extensive form which includes questions to ask the player to help assess his or her mental status (www.uwmedicine.org/services/sports-medicine/Documents/NFL-SIDELINE-TOOL-Post-Injury.pdf). I’d suggest that these forms be accessible to coaches at every practice and game. As a parent, you can stuff some copies in your bag and in your child’s soccer bag. When in doubt make a doctor’s visit. Know the symptoms of a concussion since these may not appear immediately. Obviously dizziness would be a strong signal, but vomiting, drowsiness, slurred speech, and confusion are serious indicators that the brain has been injured. Having a baseline study on file with your family physician will help your doctor assess the level of change and seriousness when considering a concussion. No one should rush back to playing. Guidelines say that any loss of consciousness, even for a few seconds, dictates three to five days away from any activity. If the blackout lasted longer, a longer period of rest may be necessary. Don’t minimize symptoms when a child presents concerns. Consider the level of change in a child’s alertness, acuity, and pain (headaches and neck pain in particular).
I applaud the NFL for its initiative and can look past any self-serving aspects of their investment because any study in reducing concussions among youth players is a step in the right direction. There are head gears for soccer players, but these are not widely accepted as they don’t fit into the image of a standard soccer player. There are also head rings that look a bit like ear muffs but again are regarded as “geeky” looking. Should more professional players start wearing the gear, they would be more acceptable to youth players. Until then the best line of protection is the coach who can promote a safe playing environment and will teach proper techniques for headers, tackles, and player to player contact. Since most concussions occur during practice, it’s important that coaches regulate the tempo and intensity to insure safety. A game actually has a more controlled environment because the teams are moving in expected directions and have singular jobs, whereas in a practice, there are lots of kids on the pitch often doing different drills in different areas which the coach can’t completely oversee. Finally, keep your cell phone charged to call 911 if necessary and know the actual address of the field since sometimes fields are difficult for emergency workers to locate. Most concussions will be transient and not impede a player from returning to the pitch after a proper period of rest, but repeated concussions can put the player’s brain at risk, so whatever we can do to understand how to assess, treat, and, importantly, prevent concussion will make youth sports all the more enjoyable.