believe the skull is an iron vault that protects that organ inside called the brain,” he said. Another participant suggested calling a concussion a “moderate brain injury.” This term would preserve the acronym already used for mild brain injury, he noted, yet distinguish a concussion from a more severe brain injury.

Athletic Trainers

Dr. Guskiewicz suggested recommending that all high schools with sports programs have certified athletic trainers. These sports medicine professionals are not only well versed in the signs and symptoms of concussions, he said, but because they deal with the team athletes on a daily basis, they are often better at evaluating head injuries than a physician.

“They know the personality and intelligence level of the athlete so they can detect when there is something out of sync or just not normal,” he said. Dr. Guskiewicz thought athletic trainers should be part of the team of neuropsychologists, neurologists, and physicians that are responsible for evaluating players’ head injuries.

According to Dr. Guskiewicz, athletic trainers are currently present at 38 percent of all high schools in this country. He noted that there are several states right now that have legislation in the works that require placing certified athletic trainers in every school district. Even then, it is unlikely that many school districts would have funding to support enough trainers to attend every game of every relevant sport for all schools.


Dr. Brooks noted that heading is a valued part of the soccer game and adds an important dimension to play. Although Dr. Echemendia pointed out that there currently is no evidence that heading, when done properly, causes brain injury in adults and late adolescents, there still was debate on when youths should be taught to do this practice.

Dr. Hergenroeder suggested heading should be taught early, such as before the middle school years, when youth soccer players are usually first taught to head the ball. “If you teach them how to head correctly, that gets them out of trying things that they see the pros doing and they don’t know how to do, such as the backward head,” he said.

Dr. Brooks added that the American Youth Soccer Organization recommends not teaching heading to players below age 10. “But if you talk to trainers, coaches, and a lot of people that are working in the area of educating players,” she said, “many claim it is really important to potentially develop the neck musculature and have athletes prepare to take headers prior to age 12, so that once they become 12 or 13, they are not confronted with situations that they don’t potentially know how to deal with.”

But one participant at the workshop questioned whether children younger than 12 have the musculature and skeletal development to lock their heads in place, which is an important element of safe heading technique.

Dr. Brooks also noted that some people have suggested limiting heading in youths to certain areas of the playing field as a way of eliminating head trauma from some of the longer, more directly returned balls.

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