Bumps and bruises are a part of growing up and a part of playing sports. The risk of injury should not deter participation in sports because the benefits that sports participation brings generally outweigh the risks. However, some injuries are more serious than others, such as concussions and brain trauma, and should be safeguarded against if possible.
BRAIN INJURY
Metzl (1) reported in the journal Pediatrics that children heal slower from brain injury than do adults. In addition, according to Metzl adolescents appear to be susceptible to second-impact syndrome, “a rapid and often fatal condition associated with a second head injury while the person is still symptomatic from a first.” It is extremely important if a concussion is suspected that a player not return to play in that game and that he be subsequently medically evaluated and withheld from participation until medically cleared (2). It has been reported that once a person has had one concussion, he is four times more likely to suffer another one. In addition, subsequent concussions are easier to get and take longer to heal (3).
Unfortunately, concussions are a regular part of playing soccer. In a three-year study of 10 high school varsity sports, soccer ranked third for boys and first for girls as the sport that produced the most number of injuries that were classified as mild- traumatic brain injury (MTBI). While MTBI accounted for only 4% of the total number of injuries in both boys’ and girls’ soccer over the course of this study (4), the possibility of any injury causing damage to the brain needs to be taken seriously and prevented if possible.
Debate has centered around whether it is possible to sustain long-term cognitive impairment from heading the ball or from suffering concussions during participation in soccer. Research has not shown that normal heading of the ball leads to concussion (5) or cognitive impairment (6), but it is still uncertain as to what effect repetitive heading over the course of a soccer career has on the brain. In research studies it is hard to differentiate between injuries resulting from heading and those caused by concussion. Many of the studies that did show cognitive impairment had design flaws (5, 6). It is appears more likely that concussions and not normal heading of the ball can cause cognitive impairment (6).
HEADGEAR STUDY
Because of the concern over head injuries in soccer and the push to use protective headgear, FIFA, soccer’s international governing body, commissioned a study to evaluate the efficacy of headgear in preventing concussions.
In the study Full90 performance headgear, Head Blast, and Kangaroo Soccer Headgear were examined. Tests were performed to determine the ability to protect against injury when heading the ball normally and also to determine the ability to protect against head to head contact injuries. Results showed that all three significantly reduced the risk of concussion from head to head contact, but none were effective in reducing the risk of injury from normal heading in soccer. This is an extremely important finding since about two thirds of concussions in professional soccer are caused by head to head or head to upper extremity contact (5).
WHAT NOW?
It now follows to see whether or not headgear can gain acceptance in the soccer community. In 2003 FIFA changed its rules to allow headgear in competitions, but has yet to make it a mandatory piece of equipment like shin guards. The United States Soccer Federation (USSF) follows FIFA rules; therefore headgear is also acceptable in USSF sanctioned matches. Because the USSF follows FIFA rules, it will not make headgear mandatory unless FIFA does so. The National Federation of State High Schools (NFHS) has recently followed suit and agreed to allow approved headgear in competition. A list of NFHS approved headgear can be found at HEADGEAR.
Headgear appears to be a valuable piece of equipment capable of protecting not only the careers of our young soccer players but also their most important possession. Since it is not yet mandatory, it is up to the parents and coaches to really encourage its use.
(1) Metzl, J. D. (2006). Concussion in the young athlete. Pediatrics, 117, 1813. Retrieved July 23, 3007 from http://www.pediatrics.org
(2) Dvorak, J., Junge, A., & McCrory, P. (2005). Head injuries. British Journal of Sports Medicine, 39, 1-2. Retrieved July 23, 2007 from http://bjsm.bmj.com
(4) Powell, J. W., & Barber-Foss, K. D. (1999). Traumatic brain injury in high school athletes. The Journal of the American Medical Association, 282, 958-963. Retrieved July 23, 2007 from http://www.jama.com
(5) Withnall, C., Shewchenko, N., Wonnacott, M., Dvorak, J., & Delaney, J. (2005). Effectiveness of headgear in football. British Journal of Sports Medicine, 39, 40-48. Retrieved July 24, 2007 from http://bjsm.bmj.com
(6) Brunk, D. (2000, June 1). No harm seen from soccer ‘heading.’ Family Practice News. Retrieved July 24, 2007 from http://www.highbeam.com
