Soccer is a sport which is typically played at a fast pace with many instances of contact and collision between players. Additionally, heading of the ball is a common technique which sometimes occurs with a high amount of force distribution upon the impact of the ball with the player’s head. As a result, this can predispose many players to the risk of sustaining head injuries. In this article we will discuss the basics of concussions, how they occur and how they are treated. We will also briefly discuss the short and long term prognosis of concussions as well as potential complications.
Mechanism of Injury
A concussion is a type of traumatic brain injury caused by a blow, bump, or jolt to the head that disrupts the normal functioning of the brain. In soccer, this can occur from various situations such as colliding with another player, heading the ball, or falling and hitting the head on the ground. When a concussion occurs, the brain experiences a complex cascade of biochemical changes. The sudden movement of the brain inside the skull can also cause stretching and damage to brain cells, leading to a temporary disruption in normal brain function. These changes lead to the manifestation of symptoms associated with a concussion.
Risks
Concussions are a significant concern in soccer, with studies showing that up to 22% of all soccer injuries are concussions. Among girls' high school sports, soccer had the highest concussion rate. For boys, soccer ranked fifth highest in concussion rates among high school sports. The risk of concussion in soccer varies depending on several factors, including the level of play, age group, and gender.
Several risk factors have been identified for concussions in soccer. Female athletes have a higher risk in comparison to male athletes potentially due to biomechanical and hormonal differences. Younger athletes may be more susceptible due to ongoing brain development and weaker neck musculature. Players with a history of previous concussion are at a higher risk of sustaining another concussion. Additionally, position and playing styles can certainly impact the risk for concussions. Certain positions such as defenders and midfielders may be at increased risk due to increased exposure to heading and more aggressive player to player contact. A more aggressive or reckless playing style can also increase the risk for concussions.
Symptoms
Key symptoms of concussion include headache, dizziness, nausea, balance problems, cognitive impairments such as memory and concentration issue, emotional disturbances, and sleep disturbances. Loss of consciousness occurs in less than 10% of cases. It is important to note that symptoms can be subtle and may not appear immediately after the injury. Therefore, athletes should be monitored closely for any signs or symptoms of concussion, both on the field and in the following days and weeks.
Diagnosis
The diagnosis of concussions is mainly clinical and based on the symptom assessment of the athlete. This is often done on the sidelines at the time of competition immediately after injury. Certain tools such as the Sports Concussion Assessment Tool (SCAT) can be used to evaluate symptoms, cognition, balance and coordination. Beyond the sidelines, other methods such as neuropsychological testing can be used to aid in diagnosis and monitoring recovery.
Structural imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) of the brain are often done after a concussion. These studies are usually normal in a concussion but are used to rule out other more severe structural injuries. More advanced neuroimaging techniques may provide insights into the underlying pathophysiology and aid in diagnosis and prognosis. Functional MRI (fMRI) and diffusion tensor imaging (DTI) can detect functional and structural changes associated with concussion, such as alterations in brain activation patterns and white matter integrity. However, these techniques are primarily used in research settings and are not routinely employed in clinical practice.
Management
The primary management strategy for concussion is physical and cognitive rest until symptoms resolve. This involves limiting physical and cognitive activities that exacerbate symptoms, such as exercise, schoolwork, and screen time. The initial rest period after a concussion is crucial for allowing the brain to recover and preventing further injury. In general, most athletes recover within 7-10 days, but some may require longer periods of rest and rehabilitation.
Once the athlete is asymptomatic at rest, a gradual return-to-play protocol is implemented under the supervision of a healthcare professional. This protocol typically involves a stepwise progression of increasing physical and cognitive activity, with each step separated by at least 24 hours. The return-to-play protocol may include light aerobic exercise, sport-specific drills, non-contact training, and finally, full-contact practice and game play. Athletes must remain symptom-free at each step before progressing to the next level of activity.
Pharmacological interventions may be considered for specific symptom management, such as analgesics for headache or sleep aids for insomnia. However, medications should be used cautiously, as they may mask symptoms and delay recovery. Certain medications, such as anti-inflammatory drugs, have been associated with potential adverse effects on concussion recovery and should be avoided unless specifically recommended by a healthcare professional.
In some cases, particularly with persistent or prolonged symptoms, rehabilitation and therapy may be recommended to address specific deficits and facilitate recovery. For athletes experiencing balance or dizziness issues, vestibular rehabilitation exercises can help improve balance and reduce symptoms. Cognitive therapy exercises can help address cognitive deficits, such as memory, attention, and processing speed, which are common after a concussion. Some athletes may experience visual disturbances or difficulties with eye movements after a concussion, which can be addressed through vision therapy and exercises. Concussions can also impact mental health, and psychological support or counseling may be beneficial for managing anxiety, depression, or other emotional challenges associated with the injury.
Prognosis
The short-term prognosis for concussion recovery is generally favorable, with most athletes returning to their pre-injury level of functioning within a few weeks. However, factors such as age, sex, concussion history, and injury severity can influence the recovery timeline. It is crucial to allow adequate time for recovery and avoid premature return to play, as this can increase the risk of further injury and potentially prolong symptoms.
The long-term effects of concussion are an area of ongoing research and concern. Repeated concussions, particularly with inadequate recovery time between injuries, may increase the risk of cumulative neurological impairments and neurodegenerative diseases.
Studies have linked repetitive head impacts in contact sports to chronic traumatic encephalopathy (CTE), a progressive neurodegenerative condition characterized by cognitive, behavioral, and motor deficits. CTE is associated with the accumulation of abnormal tau protein in the brain and can only be definitively diagnosed through post-mortem examination. While the exact relationship between concussions and CTE is still being investigated, the potential long-term consequences of repetitive brain trauma highlight the importance of proper management, adequate recovery time, and prevention strategies.
Repeated concussions have also been associated with an increased risk of long-term cognitive and functional impairments, such as memory deficits, attention problems, and decreased processing speed. These impairments can have significant impacts on academic or occupational performance, as well as overall quality of life.
Concussions and repetitive head impacts have been linked to an increased risk of mental health issues, including depression, anxiety, and emotional dysregulation. These conditions can persist long after the initial injury and may require ongoing psychological support and treatment.
Some research has suggested a potential link between concussions and an increased risk of neurodegenerative diseases, such as Alzheimer's disease and Parkinson's disease, although the evidence is still inconclusive. Further research is needed to understand the long-term neurological consequences of concussions and their potential role in the development of these conditions. While most athletes recover fully from a single concussion, the potential long-term consequences of repetitive concussions highlight the importance of proper management, adequate recovery time, and prevention strategies. Ongoing research and increased awareness of concussion risks are crucial for protecting the long-term health and well-being of athletes in high-risk sports like soccer.
References
Chatha K, Pruis T, Peaguda CF, Guo E, Koen S, Malone D, Sabesan V. Concussions in Soccer: An Epidemiological Analysis in the Pediatric Population. Orthop J Sports Med. 2020 Oct 21;8(10):2325967120951077. doi: 10.1177/2325967120951077. PMID: 33173798; PMCID: PMC7588758.
Kaminski TW, Chrisman SPD, Glutting J, Wahlquist V, Eagle S, Putukian M, Tierney R, Broglio SP, McAllister TW, McCrea MA, Pasquina PF, Kontos AP, Investigators CS. Mechanisms of injury for concussions in collegiate soccer: an NCAA/DoD CARE consortium study. Sci Med Footb. 2022 Aug;6(3):325-330. doi:
Maher ME, Hutchison M, Cusimano M, Comper P, Schweizer TA. Concussions and heading in soccer: a review of the evidence of incidence, mechanisms, biomarkers and neurocognitive outcomes. Brain Inj. 2014;28(3):271-85. doi: 10.3109/02699052.2013.865269. Epub 2014 Jan 29. PMID: 24475745.
Hubertus V, Marklund N, Vajkoczy P. Management of concussion in soccer. Acta Neurochir (Wien). 2019 Mar;161(3):425-433. doi: 10.1007/s00701-019-03807-6. Epub 2019 Jan 28. PMID: 30687899.
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