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New Legislation Makes Preventing Concussions a Top Priority

The occurrence of concussion in sports has recently become a hot topic for legislation in both Oregon and Washington. There are now laws in both states that affect how coaches should manage concussions in school-aged athletes.

What is concussion?

Concussion is technically known as a "mild traumatic brain injury" (MTBI). It is caused by a bump, blow, or jolt to either the head or the body that causes the brain to move rapidly inside the skull. This can result in serious long-term consequences, even though the original injury appears to be mild.

The signs and symptoms of concussion include headache, nausea, fatigue, confusion or memory problems, sleep disturbances, or mood changes. Symptoms are usually noticed right away, but some might not be apparent until days or weeks later. Concussion in Sports Factsheet (pdf).

How often do concussions occur?

Based on statistics compiled for the period 2001-05 (pdf), there are between 1.6 and 3.8 million sports- and recreation-related concussions in the United States each year. During the period for which statistics were available, children aged 5-18 had 2.4 million emergency medical visits, of which 135,000, or 6 percent, involved concussions. Of those 135,000, soccer accounted for just under 7,700, or 5.7 percent

These statistics only cover injuries that were treated in emergency departments. There is no statistical information that estimates the number of head injuries that were treated informally or were just ignored.

What causes concussions in soccer?

Most concussions in soccer are the result of contact between a player and a hard object - another player, goal posts or the ground. Intentional heading of a ball is very low-risk. Accidental contact with a ball can cause a concussion, such as when a player is struck in the face or side of the head by a kicked ball that the player is not expecting. FIFA's technical research (pdf) indicates that most concussions occur in the midfield when players competing for a ball approach from opposing directions.

Can equipment prevent concussions?

Headgear can reduce the transfer of impact force from a blow to that part of the head that is directly padded by the headgear. As many of the headgear designs provide cushioning for the part of the head that is used to head the ball and intentional heading does not appear to be a source of concussion, the effectiveness of headgear is unclear. There is also concern that using headgear may lead to more aggressive play by the wearer.

The National Federation of High Schools (NFHS) has specifically authorized the use of soccer headgear that meets ASTM standard F2439-06 for soccer headgear (pdf). FIFA Law 4 does allow the use of headgear so long as the match referee has determined that the particular headgear is not dangerous.

There have been suggestions that the use of a mouthguard can help reduce the incidence of concussions by cushioning the head from jarring caused by impacts to the mouth and jaw. NFHS has recently issued a position paper (pdf) which states that while mouthguards can significantly reduce oral-facial injuries, "Current research does not support the use of mouthguards in reducing the occurrence of Mild Traumatic Brain Injury (Head Trauma/Concussion)."

What can be done about concussions?

It appears that it is not possible to completely prevent concussions from happening while still playing the game of soccer. What can be done, however, is to improve protection for athletes who have suffered a concussion (pdf).

  • Any head injury should be considered as potentially very serious. A player who has suffered or may have suffered a concussion should be seen by a doctor as soon as possible.
  • A player who may have suffered a concussion should not return to play the same day.
  • The injured player should not return to play until an appropriate health care professional has evaluated the player and has cleared the player to return to sports activities.
  • Any recurrence of concussion symptoms after having been cleared can be very serious. The player should be removed from participation in physical activity until once again evaluated and cleared.

The CDC has neatly summarized this perspective in their slogan, "It's better to miss one game than the whole season."

Where can I find out more about concussions?

Here are links to some web-based sources for more information about concussions in sports.


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