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3. Head Protection
“There are over 50 concussion management guidelines produced. The one common theme agreed upon by all is that no player who demonstrates any signs of concussion should be allowed to return to the field of play”
Head injuries occur in soccer and are reported to comprise anywhere from 4% to 22% of soccer injuries. Most of them occur from head to player contact, followed by head to ground contact, head to ball contact, and head to goal post contact. Most head injuries are not noted to occur due to purposeful heading of the soccer ball although players can certainly receive head injuries if accidentally struck by the ball.
Some studies suggest that of adult players who frequently head the ball, up to 81% of them may suffer from some type of neurologic complaint such as decreased memory, attention, and concentration. Forwards and defenders tend to head the ball more often than midfielders and goalkeepers. Researchers cannot agree, however, that correct heading of the soccer ball causes any damage to players heads or brains. Many of the previous findings may have been caused by concussion rather than repeated heading of the ball.
A study in the Journal of the American Medical Association (JAMA) has raised new concerns about the practice of "heading" a soccer ball. A group of 33 young adult amateur soccer players in the Netherlands submitted to more than a dozen tests designed to measure various brain functions. The results were compared to those of a control group of runners and swimmers. The findings:
- 39% of the soccer players had an impaired performance on tests measuring planning abilities, compared with 13% of the control athletes.
- 27% of the soccer players, compared with 7% of the control athletes, had an impaired performance on memory tests.
- Concussions were frequent; 27% had one concussion due to soccer play; 23% had two to five concussions over the course of their years playing the sport.
The Conclusions:
"Participation in amateur soccer is associated with decreased performance on tests of memory and planning. Although cognitive impairment appears to be mild, it presents a medical and public health concern... Methods for surveillance and prevention should be developed and adopted to maximize safety."
This was a small study with only a few soccer players but the findings should raise some eyebrows and instigate further studies in the area. I hope that at the very least all coaches will take training progressions for young players very seriously when it comes to learning to head the ball.
Heading a soccer ball is a difficult task for which most coaching books have players at least 12 years old before beginning the training progression. The importance of preparing the head for contact cannot be overstated. This preparation requires in part neck and torso strength and in part precision timing which depends on skillful coaching. The discussion of heading progression drills is beyond the scope of this book but the following neck exercises can help strengthen a player’s neck muscles to protect the head and neck from concussions or other injury.
Exercise |
Instructions |
Picture |
| Lateral neck resistance |
Hold one hand against the side of your head. Use your hand to resist the movement as you try to touch your shoulder with your ear. Hold this posture for a count of 5. |
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| Front of neck resistance |
Hold one or both hands against your forehead. Try to move head forward, but resist the movement with your hands. Keep the chin tucked throughout. Hold this posture for a count of 5. |
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| Back of neck resistance |
Place both hands behind your head.
Try to move head backwards, but resist the movement with your hands. Don't tip the chin upwards. Hold this posture for a count of 5. |
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| Lateral neck resistance |
Hold one hand against the side of your head. Use your hand to resist the movement as you try to rotate your head to one side until your chin is lined on top of your shoulder. Hold this posture for a count of 5. |
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Soccer Balls
Soccer balls should be kept in good condition and allowed to dry if they get wet. We suggest teams use soccer balls made of waterproof or water resistant materials rather than leather due to the increased weight and safety risk of a heavy, water logged soccer ball. Water logged soccer balls can be 20% heavier than a dry ball.
The panels of the ball should be firmly stitched. If one of the panels comes loose and the ball is kicked with a spin on it, the loose flap can catch someone in the face or eye.
FIFA has set safety standards for size 4 and size 5 soccer balls. These standards include pressure (0.8 bar, or 11-12 pounds per sq inch). This said, when learning heading, either pressure should be released from the balls or a softer, lighter ball should be used to teach the skill.
In my experience, the moment when the ball strikes the player rather than the player striking the ball, accounts for most soccer ball related injuries. I was present at one particular match when a player seemingly lost track of the ball in the tussle with his opponent. The ball struck this player’s head causing him to stop momentarily. He was substituted from the game but after a few minutes he lapsed into unconsciousness. Their trainer initiated the emergency action plan but by the time the specialists controlled the bleeding inside this young man’s head, he suffered serious and permanent brain injury.
Goal Post Safety
Collision with a soccer goal post can cause serious injury. In fact, fatalities in soccer are almost exclusively associated with traumatic contact with the goal posts. Some companies now make padding for the posts. Current designs have a fairly thin, high density padding to improve player safety while allowing the flight of the ball to continue uninterrupted. Although only a few teams use the goal post pads, there seems to be a definite trend towards improving player safety.
Anyone observing a corner kick will agree that the goal area can be a busy space. As players jockey for position and converge on a crossed ball, the risk of contact with one of the posts goes up dramatically.
Falling soccer goals have caused 31 deaths since 1979 and account for approximately 90 emergency room head injury visits per year. All movable goals should be anchored. No player should be allowed to climb on soccer goals. A full chapter is devoted to the area of soccer goal safety in Chapter 10.
Concussions
Concussions represent one of the scariest injuries for player, parent and coach alike. Any potential head injury must be treated seriously as complications can be catastrophic. Concussions also represent the greatest number of head injuries. Return to play guidelines are numerous but their common thread of agreement is that all the signs and symptoms of a concussion should be cleared before the athlete is allowed to return to play.
Concussions are now more loosely defined as “a temporary disturbance of brain function due to a head injury.” Symptoms are quite diverse and the onset is not always immediate. Symptoms can last for hours, days, weeks, or even months.
How to recognize signs:
Confusion and memory loss are the two most common signs. Memory loss might be seen as a loss of memory of the events leading up to the injury or it may present as a loss of memory from the injury onwards. This list from the Mayo Clinic illustrates some of the additional signs to watch for:
- Headache
- Dizziness
- Ringing in the ears
- Nausea or vomiting; and
- Slurred speech.
Some symptoms of concussions don't appear until hours or days later. They include:
- Mood and cognitive disturbances
- Sensitivity to light and noise; and
- Sleep disturbances.
Head trauma is very common in young children. But concussions can be difficult to recognize in infants and toddlers because they can't readily communicate how they feel. Nonverbal clues of a concussion may include:
- Listlessness, tiring easily
- Irritability, crankiness;
- Change in eating or sleeping patterns
- Lack of interest in favorite toys; and
- Loss of balance, unsteady walking.
When to refer to the doctor:
This advice is also directly from the Mayo Clinic:
While most concussions get better on their own, some blows to the head can cause more serious injuries. You should seek medical advice if you have any of the following symptoms:
- • Loss of consciousness requires medical advice while prolonged loss of consciousness requires immediate transport to the hospital
- Prolonged headache or dizziness
- Vision disturbances
- Nausea or vomiting
- Impaired balance
- Prolonged memory loss
- Ringing in the ears; and
- Loss of smell or taste
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Any child who has lost consciousness after a blow to the head should be seen by a doctor. Other warning signs of a potentially serious injury include persistent vomiting, seizures, or a large bruise on the scalp. In general, a bruise on the front of the head is less dangerous than one on the side or back of the head.
When to return to play:
There are over 50 concussion management guidelines produced. It is difficult enough for the clinician to decide, let alone the parent or player. The one common theme agreed upon by all is that no player who demonstrates any signs of concussion should be allowed to return to the field of play.
Healing and recovery take time! Players who suffer repeated concussions may also suffer cumulative brain damage.
Prevention:
Though rarely seen in the modern game of soccer, more players are wearing head protection. The company called Full90, www.full90.com are the leaders in protective headgear – their site also features a monthly newsletter devoted to soccer head injuries. FIFA has approved the use of headgear while playing. I can imagine a day when all players wear head gear as a normal part of the game. |
