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Injury study spurs debate on soccer-related concussions

Panther Creek's Rachael Everhart (5) and Hough's Ashley Johnson (22) go for a header during 2014 the NCHSAA 4A Women's Championship Soccer Game in Raleigh, N.C. Hough won the game, 1-0 (OT).
Panther Creek's Rachael Everhart (5) and Hough's Ashley Johnson (22) go for a header during 2014 the NCHSAA 4A Women's Championship Soccer Game in Raleigh, N.C. Hough won the game, 1-0 (OT). NEWS & OBSERVER FILE PHOTO

A new study on concussion rates in youth soccer has renewed a debate over how to protect young athletes from the dangers of head injuries.

The study of soccer-related head injuries indicated that physical contact rather than heading – or hitting the ball with the head – is the most common cause of concussions in the sport, calling into question whether rules changes, such as a proposed ban on heading, would be effective in cutting injury rates.

The study found that more than half the concussions among girls and almost 70 percent among boys were caused by player-to-player contact rather than contact between the ball and a player’s head.

At issue is whether changing the sport’s rules can cut the incidence of head injuries. The July study’s findings indicate that rules changes on heading might not eliminate the main cause of soccer concussions – the physical nature of the sport – which is much harder to regulate.

Football remains far and away the leading cause of concussions among high school athletes, with approximately 27 concussions for every 10,000 games played. The recent number of football-related deaths and serious head injuries among high school players have led every state to implement laws dictating concussion protocols for all sports. In North Carolina, under the Gfeller-Waller Concussion Awareness Act, athletes exhibiting signs of a concussion cannot return to play the same day, and must be cleared by a medical professional with training in concussion management.

The soccer study, published in Jama Pediatrics and led by Dr. Dawn Comstock of the Colorado School of Public Health, featured data collected from a sampling of 100 U.S. high schools from 2005 until 2014. Researchers found that there were 627 concussions reported for girls and 442 for boys during the time period. In keeping with past findings, the study concluded that soccer was the second-leading cause of concussions for female high-school athletes and the fifth-leading cause for boys.

Researchers saw concussion rates rise during the study period, and for every 10,000 athlete exposures – defined by an athlete stepping on the field for a practice or game for at least a minute – there were 4.5 concussions among girls and 2.8 among boys.

FIFA rules state that only shoulder-to-shoulder contact is allowed when going for the ball, so Fields recommends getting back to stricter enforcement of those rules.

“Enforcement of the rules, de-emphasizing the physicality of soccer and re-emphasizing the technical skills – the passing, the dribbling and those things – will make the game safer, particularly for kids,” said Sarah Fields, associate professor of communication at the University of Colorado-Denver and an author of the study.

Rough play

Dr. Robert Cantu, medical director and director of clinical research of the Dr. Robert C. Cantu Concussion Center and clinical professor of neurology and neurosurgery at the Boston University School of Medicine, agrees that rough play should be eliminated from soccer, but is not sure that would change the prevalence of concussions.

“Where I think the authors in my opinion missed the boat is that because most of the concussions happened because heads were colliding with other body parts, they suggest that if referees would take rough play out of soccer, you would eliminate concussions,” said Cantu, who advises the NFL’s Head, Neck and Spine Committee and several professional franchises. “I am 100 percent supportive of taking all rough play out of soccer, but the majority of soccer players I’ve taken care of (with injuries) that have happened in the act of heading the ball – they weren’t intentionally rough plays.

“Their eyes and intentions were on heading the ball, and somebody else’s head or body part got in the way. It’s not intended rough play, in my experience, that’s leading to this. People are going up for a ball and they’re not seeing somebody else’s head going up for the ball, and heads are colliding and body parts are colliding.”

Despite questions about the impact of heading the ball, Cantu is one of the nation’s strongest proponents of the Sport Legacy Institute’s Campaign to eliminate it for players under the age of 14 by 2017.

“If you eliminate that one activity, you immediately eliminate the most common cause of concussions,” he said. “I’m not recommending, though, that heading be taken out of high school level soccer, because the most dangerous time is at the lower levels. You have to start playing as you will as an adult at some point.”

Regardless of any adjustments in game-play or officiating, with more than 3 million players registered with US Youth Soccer in 2014, some incidence of concussions or other head injuries is inevitable. Among high school sports, girls soccer trails only football and ice hockey in the prevalence of concussions.

“Even if you take heading away, player to player contact at the shoulder level can still result in concussive forces, whether it be with the player initially or taking that player down, then they hit the ground and that’s where the concussive force happens,” Jason Bailey, head athletic trainer of the Capital Area Soccer League, said. CASL has approximately 9,000 players at its various levels, and although not required, Bailey said he has implemented the protocols of the Gfeller-Waller Act when dealing with concussions.

Brent Walston, father of two longtime boys soccer players ages 13 and 16, understands there are risks in any sport.

“My perspective as a parent is that any sport your children are going to play is going to have the opportunity for risks, but you do trust that the people that are teaching your children the game have an understanding for the risks, and also are teaching the skills (so) that they know how to do things properly to try to avoid injury,” Walston, head boys soccer coach and athletic director at Corinth Holders High School, said.

In North Carolina, the institutions governing youth soccer are focused on treating concussions properly rather than officiating changes, in large part because national organizations determine how the game is played in the state.

“We play by National Federation soccer rules, as do all of the other state associations, so we cannot unilaterally change the actual national playing rules,” Rick Strunk, associate commissioner of communications for the North Carolina High School Athletic Association, wrote in an email.

The Gfeller-Waller Act requires that schools distribute concussion information sheets to athletes and parents, implement a post-concussion plan with requirements for athletes to return after sustaining a head injury and maintain an emergency action plan. In a recent audit, 13 out of 115 North Carolina school districts were found out of compliance with the law, but Strunk noted that the state’s Board of Education recently authorized the NCHSAA to enforce penalties and fines if the noncompliance continues.