When it comes to youth sports, concussions aren't confined
to the football field.
Soccer players – especially girls – also experience the
dizziness, nausea, blurry vision and headaches that can accompany head trauma.
The American Journal of Sports Medicine studied the rate of
concussions in high school athletics from 2008 through 2010.
Of the 1,936 reported concussions during the study, 47
percent were suffered playing or practicing football. No. 2 on the list: girls’
soccer, at 8.2 percent.
A 2013 report from the American Academy of Neurology found
that football has the highest rate of concussions in high school sports (1.55
per 1,000 games), with girls soccer placing second (0.97 per 1,000 games). [1]
Doctors and coaches cite multiple factors for the high
number of brain injuries in girls’ soccer. Among them:
• Girls’ necks and heads are smaller than their
male counterparts, giving their brains less protection. Men tend to have
stronger necks, and a stronger neck can help reduce the risk of a concussion by
slowing down the moving of your head.
• Inspired by iconic heroes like Mia Hamm, Brandi
Chastain and Abby Wambach — plus lured by potential college scholarships —
girls are playing more aggressively, sometimes recklessly so.
• When in midair, boys appear to have better
spatial awareness, recognizing potential collisions and avoiding them.
• Girls may be more inclined to report
concussions than boys.
“None of (these factors) are conclusive,” said Dr. William
Perry, the associate director of neuropsychiatry and behavioral medicine at UC
San Diego Health System. “While it’s a hypothesis, we just don’t know for
sure.”
Interestingly, the physical act of heading a soccer ball is
not believed to be one of the major reasons for head trauma.
Said Perry: “Essentially, there is no data supporting
heading the ball causing concussions.”
But new research has shown that players who hit the ball
with their heads often have brain abnormalities similar to people who are known
to have had concussions.
Dr. Michael Lipton, a neuroradiologist at the Albert
Einstein College of Medicine in New York City and lead author of the study
suggests that while a definitive cause and effect relationship between heading
the ball and brain injury cannot be inferred, soccer should start keeping a
“head count” to monitor the number of headers players use in a given game. The
head count would be analogous to the “pitch count” in baseball that ensures
pitchers don’t throw too many pitches in a single outing. [2]
The study authors pointed out that soccer players head the
ball six to 12 times each game, and the ball can travel more than 50 mph each
time. During practice, players can expect to hit the ball with their head 30 or
more times. While one header probably won't result in any traumatic brain
damage, researchers worried that repeatedly hitting the ball would have lasting
effects.
"Repetitive heading could set off a cascade of
responses that leads to degeneration of brain cells over time," Lipton
explained.
I will refer to
one of my all time favorite quotes from Winston Churchill, “scientists should
always be on tap but never on top.” While this research is definitely valuable
in that it raises awareness to a potential safety hazard in youth sports the
advice falls short practically. Most headers will occur in practice drills and
though at much slower speeds than what is experienced in games there is no
reasonable way for all of those headers to be accounted for.
More practically the best strategy to avoid any potential
cumulative effect of heading the ball would be to make sure soccer athletes do
not play on more than one team in any given season and limiting the exposure to
the sport to a maximum of 6-9 non-consecutive months a year. Ideally young athletes would play
sports seasonally and that practice alone would significantly reduce the number
of cumulative stress related injuries in any sport. However, in reality kids
play some sports (soccer being on of the primary ones) nearly year round
without a break in the action. In that case a header count may be valid but
would require a designated official (headcounter if you will) to track the
numbers but again would likely only be possible in a game setting. Executing
headers with proper technique would also be wise in addition to a good strength
and conditioning program in this case with an emphasis on muscles of the core
and neck.
Another notion that was referenced previously is also worth
expanding on; “When in midair, boys
appear to have better spatial awareness, recognizing potential collisions and
avoiding them.”
“Honestly, I don’t know a good way to word this. But if you
watch, girls will focus on the ball and don’t see anything else around them
when they go up for the ball. If it happens that a girl’s in the way, they end
up colliding. Guys maybe have a
little bit more peripheral vision. And I think guys manipulate their bodies
better and are better at avoiding contact than girls.”
Peter Stogsdill, Head
Girls Soccer Coach Westview High in San Diego, California.
I posed this hypothesis to a local high school soccer coach
whom coaches both the boys and girls at the varsity level.
I am not sure I agree
or disagree. My theory is that
boys play other sports growing up, like baseball, football and basketball. Those sports require hand eye
coordination. I think girls are not as used to balls in the air as boys are. I don't know if that makes a difference
in awareness or not but just an opinion.
I loved this coach’s answer because it comes from someone
with years of experience in the trenches and it also conveniently jibes with my
strong belief on just how crucial the developmental years can be for the
long-term performance and health of young athletes.
Girls often are not exposed to a diversity of sports during
childhood and adolescence so they never develop certain fundamental abilities
like how to sense, prepare and absorb impact, or the ability to track objects
in flight. As an example a term I am sure you have heard many times before
attached to a boy or even man that doesn’t throw a ball well is that he “throws
like a girl.” This is of course a very misinformed concept. Boys and girls that
don’t throw well is largely the result of a lack of exposure during a sensitive
period when the skill of throwing is most optimally “learned.” If a skill isn’t experienced and
experimented with during the developmental years the skill(s) will never fully
mature.
So the idea that girls may lack the spatial awareness or
hand-eye-coordination necessary to jump up in a crowd and efficiently head a
soccer ball is very legitimate in my view. And while boys' gross motor skills (running, jumping,
throwing) develop slightly faster, these underdeveloped abilities in females
are more attributable to lack of experience. Girls can develop these abilities
if they gain the appropriate experience and receive proper coaching. Again
think about the throwing concept from above. I know plenty of female athletes
that throw well with a mature throwing pattern and many boys that display an
immature pattern. However, boys do
tend to be more physically aggressive and impulsive, as revealed by studies of
their brains. The pleasure center of the brain actually lights up more for boys
when they take risks. That's not to say that girls aren't active and
risk-taking, only that on average boys are more so. Heading a soccer ball is a fairly aggressive action
especially in a game setting when going up in a crowd of competitors.
The Elephant in The
Room
Children don't understand the word "concussion"
very well. So what you'll find (is that) athletes will report symptoms but they
don't attach the word concussion to it. If you ask if they've suffered a
concussion, they'll say "no." But if you ask if they were hit in the
head and saw stars or got dizzy, they may say "yes."
So coaches and parents should talk to their children in
terms of symptoms and not necessarily using the word "concussion."
And it’s very important that the coach creates an
environment where the young athlete is not fearful off being chastised for
being a “baby” or “not tough.” If a child is fearful of losing playing time or
being the subject of ridicule from coaches or teammates they are likely to
withhold/hide vital information that could prevent a serious injury.
There are likely a host of factors and not a sole culprit
for the prevalence of concussions in youth sports in general and girls soccer
specifically. The things that are
within our control to prevent head traumas are well thought out long-term
athletic development programs, safe and properly fitted equipment, coaching of
fundamental sport techniques such as heading the ball, and keenly aware coaches
who create an environment that encourages athletes to speak up if they
experience any symptoms.
Reference:
Related Information
and Resources
This is an excellent resource to post in the locker room or
on the refrigerator.
Youth Concussions Signs and Symptoms Poster
Sample return to play protocol:
Athletes must be symptom free after each stage and pass no
more than one stage per day.
1.Ride a stationary for 15 minutes.
2.Run for 10 to 15 minutes.
3.Introduce lower-body exercise. For example, run for five
minutes, and then add pushups and sit-ups. Repeat the circuit once more. Adding
pushups and sit-ups forces head movement.
4.Practice without contact. For example, participate in
sport-specific drills.
5.Return to full practice.
6.Play games.
CONCUSSIONS BY THE
NUMBERS
*Girls playing high school soccer suffer concussions 68
percent more often than boys playing the same sport (Winter 2007-2008 edition
of Journal of Athletic Training)
*Girls appear more susceptible to concussions in sports like
soccer and basketball than boys (Winter 2007-2008 edition of Journal of
Athletic Training)
*One study of collegiate soccer players found that females
had 26 percent less total mass in their head and neck than males
*Roughly 40 percent of soccer concussions are the result of
collisions between players. (U.S. Consumer Product Safety Commission)
*Approximately 13 percent are due to headers. (U.S. Consumer
Product Safety Commission)
*Female soccer players are twice as likely to get concussed
as males. (British Journal of Sports Medicine)
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