During a game, a high school football player suffers a blow to his head without being knocked unconscious. Although he has a persistent headache and other symptoms of a concussion, he continues to go to practices and pushes himself to participate in a game just a week later. During that game he is struck in the head again. Two plays later he collapses on the field, and less than a day later he dies.
Although it may sound too incredible to be a true story, it is. Fortunately, such deaths from sports concussions rarely occur, and this is a worst case scenario. But sports concussions are in fact far more serious than most people realize. There are many more examples of former A students struggling to pass high school after experiencing concussions on the soccer or football field. Many student athletes have been forced to abandon both their sports and their career aspirations because they never fully recovered from concussions.
These disturbing examples counter the common belief that a concussion is just a bump on the head with no lasting effects. Indeed, recent research reveals that a concussion unleashes a cascade of reactions in the brain that can last for weeks, and make it particularly vulnerable to damage from an additional concussion.
There is also evidence that youths who experience concussions may be at more risk for brain damage than adults because their brains are still developing and have unique features that heighten their susceptibility to serious consequences from head injuries.
Even though people generally think of soccer as a safer sport than football, soccer players experience concussions about as often as football players. Concussions are usually caused by head collisions with players, goalposts, or the ground. Soccer players also frequently use their unprotected heads to pass or shoot the ball. A soccer ball can hit the head with significant force, and there has been considerable debate over whether such “heading” also fosters brain injury.
Soccer is probably the most rapidly growing team sport in this country, especially for girls and women. Millions of children and adolescents participate in youth soccer leagues and there are hundreds of thousands of adolescents on high school soccer teams. The growing popularity of soccer among youths combined with reports in the medical literature that soccer players may be at increased risk for brain injury has fostered concern that children who play soccer may not be adequately protected from head injury.
To explore whether soccer playing puts youths at risk for lasting brain damage, the Institute of Medicine brought together experts in head injury, sports medicine, pediatrics, and bioengineering. In a workshop entitled “Youth Soccer: Neuropsychological Consequences of Head Impact in Sports,” that was held in Washington D.C. on October 12, 2001, these experts presented the scientific evidence for long-term consequences of head injury from youth sports, especially soccer, possible approaches to reduce the risks, and policy issues raised by the subject. Workshop presenters were asked to:
explore the scope of the scientific evidence regarding repetitive head injury in players,
assess the special considerations for such injuries for youths by reviewing the role of development on vulnerability, and
to identify the policy issues relevant to head injuries in youth sports.
Some of the findings presented by the speakers raised concerns, such as the high concussion rate of high school soccer players, the frequent persistence of impaired brain functions even after other symptoms of a concussion disappear, and the need for a better understanding of when it is safe for players to resume playing after they have had a concussion. But other findings were reassuring, such as studies that suggest that with the type of soccer balls used in the United States, heading is not likely to cause brain injury in youths, nor is playing soccer likely to cause permanent brain damage.
This is a summary of the reports from these experts in the field, and the lively discussions that followed them. Topics covered include: causes of head injuries in soccer; how to detect a concussion; the biology of concussion; studies of soccer and football players; the role of protective headgear; and policy implications, such as how to decide when a concussed player should be allowed to return to the playing field.