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The Importance of Concussion Awareness in Soccer

Apr 16, 2015


Awareness of concussions in American football has been a growing concern of parents, coaches and trainers over the past several years. The recent ongoing initiative of former NFL players to reach a settlement with the league has identified thousands of players who have suffered repeated concussions and head trauma and are living with cognitive issues, memory loss as well as chronic traumatic encephalopathy (CTE).

While football has been the central focus of the conversation, other team sports including soccer, hockey and lacrosse also carry a risk for concussions. Soccer, in particular, has experienced increasing awareness of risk of concussions in youth, college and professional leagues, as exemplified when millions of spectators watched Christoph Kramer of Germany suffer a concussion during the final of the most recent FIFA World Cup.

What is a Concussion and How Does It Happen? A concussion is a disturbance to brain function, reflected in altered metabolism and blood flow that may occur when the brain is jarred inside the skull due to either direct trauma to the head, or an indirect force transmitted from the body or neck to the brain. For example, a soccer player can suffer a concussion by direct head impact with another player, or by falling abruptly after being tackled (even if the head never suffers direct impact- the fall itself could be sufficient to cause the brain to jar inside the skull, potentially resulting in a concussion).



What are Symptoms of Concussions and How Long Do They Last? Concussions often cause some degree of fogginess or dizziness, leading players to develop abnormal balance. Each patient has an individual timetable with regard to recovery and early cognitive rest and physical rest is recommended. The bulk of symptoms due to a concussion generally disappear within two weeks. However, some effects may linger for several months. After rest, a gradual or graded return to work or school is favored, based upon balance testing and ideally a neuropsychiatric evaluation.

How Often do Concussions Occur in Sports? It is estimated that approximately 3.8 million concussions occur annually in the US in competitive sports across all sports, with the highest incidence in football, hockey, rugby, soccer, and basketball. However up to 50% of concussions often go unreported, meaning that the true number of concussions could easily be twice as high.

In fact, a Norwegian study evaluating current and former players of the Norway national football team noted out that 3% of active and 30% of the former players had ongoing symptoms of concussion, and that 35% of the active and 32% of that former players had abnormal EEG, which evaluate electrical activity and brain waves. [1]

How Often do Concussions Occur in Soccer? Based on data from NCAA studies conducted from the 2004-5 to the 2009-10 soccer seasons, all injuries to the head, face, and neck (including concussions) represent nearly 10% of all reported body injuries, with concussions accounting for over 50% of this subgroup. In other soccer-specific studies, head injuries have been shown to account for up to 22% of overall injuries across all levels of play.

What can be done to reduce the risk of concussions in soccer? First, players who are suspected to have suffered a concussion should have both physical and cognitive (no reading or texting or video games) rest in the immediate post injury period, with a graded return to play based upon serial neurologic exams with should include balance testing and neurocognitive evaluation. Continuing to participate in competition after suffering a concussion increases the chance of being injured again and having longer and more severe symptoms. A second blow can result in second-impact syndrome, which can result in severe injury or death. Second-impact syndrome typically occurs in people under 20.

With this in mind, parents need to be aware of signs and symptoms of concussion and be proactive when dealing with coaches and trainers to report when their children develop headaches or dizziness or other symptoms such as difficulty with academic work after head trauma.



Attention to techniques of dribbling, tackling and defending can make all players more aware of how they can avoid inadvertent head and body contact. Learning to anticipate other players’ moves, and reacting to them in a more careful and attentive manner may have the potential to reduce head-to-head and body collisions which can lead to concussions. Additionally, limiting repetitive heading, especially in youth players, may be key, due to recent evidence of older professional players suffering from long tern cognitive effects. Attention to neck strengthening, adequate stretching, and maintaining proper hydration can all help to reduce the risk for head injuries and potential concussions.

Can protective headgear reduce the risk of concussions in soccer? Just as protective foams worn by many soccer players may disperse and absorb, and thereby reduce impact to bones and soft tissue, it is unclear whether wearing protective foam-based headgear in soccer may lead to reduced blunt head injuries and resulting concussions. In recent years, there have been many innovations in the quality of protective foams used to protect the body and now heads of soccer players. New soccer-specific designs now make headgear in soccer more practical, with a number of professional soccer players in the US and Europe adopting headgear to reduce risk for head injuries. It Is clear that the industry lacks high quality academic and clinical studies focused on the effect of soccer headgear on concussions. Several leading research centers in the US are currently organizing clinical studies to attempt to answer this question.

Conclusion The recent dramatic concussions witnessed by millions in the World Cup this past year have drawn further attention and scrutiny to the policies and management of head trauma and concussion that the governing body of medical policies for FIFA. The implication is that youth soccer as well as high school and college officials need to monitor players who demonstrate any potential signs of concussion including balance difficulties, dizziness, nausea or headaches after a collision--and immediately be removed from play. A licensed independent physician should then conduct a neurologic exam with special attention to assessing cognition, memory as well as balance.

1. "Head and neck injuries in soccer. Impact of minor... [Sports Med. 1992] - PubMed - NCBI". Ncbi.nlm.nih.gov. 2. Cantu, Robert C., and Mark Hyman. "Soccer." Concussions and Our Kids: America's Leading Expert on How to Protect Young Athletes and Keep Sports Safe. Boston: Houghton Mifflin Harcourt, 2012. 3. Cook, Bob. "Study Reveals Many Girls Soccer Players Stay On Field Despite Concussions." Forbes. Forbes Magazine, 21 Jan. 2014. Web. 06 May 2014. 4. Levy, Michael L., Aimen S. Kasasbeh, Lissa C. Baird, Chiazo Amene, Jeff Skeen, and Larry Marshall. "Concussions in Soccer: A Current Understanding." Science Direct. Science Direct, Nov. 2012. Web. 12 Feb. 2014] Dr. Robert Glatter Physician, Lenox Hill Hospital Medical Advisor, Storelli Sports Dr. Robert Glatter is an attending physician in the department of emergency medicine at Lenox Hill Hospital, and is director of sports medicine and traumatic brain injury. He serves on the editorial board of medscape emergency medicine, the physician portal of WebMD. Dr. Glatter is also a medical contributor for Forbes, and serves as a scientific advisor for the American Council on Science and Health. Dr. Glatter serves as medical advisor for Storelli Sports, an innovative sports company and makers of Next-Gen soccer protection gear.
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