Head games: Concussions common and often undiagnosed on soccer field

Posted: Thursday, May 02, 2002

WASHINGTON -- Concussions are common in soccer, with better training needed for coaches and parents to identify and treat children who may get serious head injuries, according to the Institute of Medicine.

''A lot of people -- parents anyway -- found soccer more appealing for their kids because they saw it as less dangerous than football,'' said Janet Joy, who prepared a review for the institute. ''But the fact is, concussions are just as frequent in soccer.''

Players can get concussions from heading the ball, colliding, running into goalposts or hitting their heads on the ground. A player who has a second concussion before recovering from the first may suffer brain swelling that could lead to brain damage and death.

Because young people's brains are still developing, they may be more at risk for serious injury from concussions than adults, the report said.

About 19 million Americans played soccer in 2001, making it one of the fastest growing team sports, according to the Sporting Goods Manufacturers Association.

The report was compiled from doctors' statements at an Institute of Medicine workshop in October on the long-term effects of the game on children's brains. While the report makes no conclusions on the long-term dangers of playing soccer or, specifically, heading balls, it says more studies are needed.

''The most critical studies haven't been done,'' Joy said.

Adults often use unreliable methods to diagnose concussions, the report says. Coaches frequently depend on athletes to speak up when they think they have a concussion, but players are no more aware of how to diagnose the condition than adults, and they may ignore symptoms so they can keep playing.

''A kid is going to lie to go back into the game,'' said Don Kirkendall of the University of North Carolina's department of physical education, exercise and sports sciences. ''They're going to say, 'Yeah, I'm fine. ... No, I'm not dizzy.'''

Coaches should ask their players about recent memories; deep-seated ones, such as what school they attend, are not affected by concussions, Kirkendall said.

''You ask the kid: 'Who passed the ball? What hit you? What was the first thing of you to hit the ground? Can you describe the play?''' Kirkendall said. ''When in doubt, hold them out.''

Coaches often may not think players have a concussion unless they lose consciousness. But players may lose and regain consciousness within seconds -- before anyone realizes they are hurt or the referee has a chance to stop the game.

''Officials at these games should be educated about the signs and symptoms of concussions, because typically it's the referee who stops the game,'' Joy said. ''If the referee has no idea what a concussion might be, they might leave the player in danger.''

Concussions are difficult to diagnose. Symptoms -- including headaches, disorientation, memory problems and loss of consciousness -- are not unique to concussions. Furthermore, not all victims have all the symptoms, and players may not show signs for days after the injury occurs.

Jim Sheldon, executive director of the National Soccer Coaches Association of America, said coaches in all sports need better training to diagnose concussions.

''Pick your sport -- hockey, baseball, football. I don't think there's been enough education for coaches in any youth sport to really diagnose a concussion,'' he said.

The NSCAA, a coaching education group, recommends that its members not stress heading drills among children 10 or younger. The group also advises coaches to get immediate medical attention if there is any question about whether a child has suffered a concussion, Sheldon said.

Doctors involved in the workshop recommended guidelines for determining whether a player has suffered a concussion and when, if at all, he should return to a game. Objective, quantitative tests should be used to assess brain functioning and a qualified physician should examine the athlete, instead of leaving health decisions solely to the coach.

The physician and coach also should consider whether the player has a history of concussions and the likelihood -- based on factors such as field conditions and roughness of play -- that he could be injured again.

The Institute of Medicine is part of the National Academy of Sciences, a private organization chartered by Congress to advise the government on scientific matters.



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