HEAD INJURY
- Soccer is unique among sports in the role the head
functions to purposely assist the player in the sport.
One study found that the average soccer player
heads the ball up to 10 times per game (Jordan et al,
1996). - The heading technique is a complex synchronized
motion whereby the head strikes forcefully through
the ball as the trunk goes into flexion. Maintaining a
rigid neck during impact diminishes potential injury
from angular head and neck acceleration. - Speculation exists as to the risk of successive head balls
over an extended career of playing soccer. Such sub-
clinical concussions may predispose soccer athletes to
brain injury analogous to the punch drunksyndrome of
chronic progressive traumatic encephalopathy seen in
career boxers. In 1995, a limited study by Witol and
Webbe captured national attention by implicating the
action of heading balls as causing decreased IQ scores
(Witol and Webbe, 1995). - Though this study was never published in a refer-
enced medical journal it generated further research
interest to question the validity of heading as a cause
for brain injury. In a study by Haglund and Eriksson
1993), they studied typical headerssoccer players
and a control group using neuropyschiatric, radio-
logic, and electroencephalogram (EEG) data and
found no differences in the groups. (Jordan et al
1996) analyzed U.S. National Soccer Team players
with brain MRI and a head injury questionnaire. This
study found no differences in brain anatomy when
comparing soccer player MRIs with age matched
controlled track athletes, but remarkably the ques-
tionnaire identified a new concern for the higher
incidence of unrecognized concussions in soccer
athletes. (Delaney et al 2002) completed a retrospec-
tive study in the Fall 1999 reflecting this same find-
ing that 19.8% of concussed soccer players realized
that they had suffered a concussion during the
season. - Therefore, currently with limited research the data
suggests that heading the ball is safe; however, many
studies are underway and the American Youth Soccer
Organization recommends that children under the age
of 10 not head the soccer ball.
•Regarding concussions in soccer, they occur many
times without acknowledgement from the player.
Concussions in soccer are a result of impact with
another player, the ground or the goal posts. - Assessment and management of a head injured soccer
athlete should be no different from that of any other
athlete. Neuropsychological testing is beneficial if
there exists a preevent baseline study for comparison.
Diagnostic studies and return to play criteria are dis-
cussed in another section.EYE INJURY- The mechanism for eye injuries is usually blunt
trauma caused by a kicked ball or the kicking foot. A
hyphema is the most common injury type and should
be comanaged with an ophthalmologist.
PREVENTION- Ekstrand et al (Ekstrand and Gillquist, 1983) has
demonstrated that in soccer injuries can be reduced by
75% by the implementation of a multilevel approach.
•Training errors need the careful attention of a skilled
coaching staff that recognizes that quality is more
important than quantity. - Attention to equipment utilization, including shin
guards, and optimal field conditions. WBGT guide-
lines should direct periods of play or practice and
hydration standards. - Prophylactic ankle taping or bracing in players with
clinical instability or history of previous strain. - Exclusion of players with serious knee instability.
- Educate soccer players on the importance of disci-
plined play. - No head balls in children under age 10. Ensure the
player learns proper head ball technique. - Early identification and management of concussions.
Preseason standardized neuropsychological testing
for patients at risk by history or by position (goalie or
forward). Pad goal posts. - Supervised and progressive rehabilitative process.
Return to play decisions following injury should come
directly from the team physician and physical thera-
pist. Athletes must demonstrate full range of motion
and 90% strength.
REFERENCES
Albert M: Descriptive three-year data study of outdoor profes-
sional soccer injuries. Athl Train18:218, 1983.
Arendt E, Dick R: Knee injury patterns among men and women
in collegiate basketball and soccer. AM J Sports Med 23:694,
1995.
Boden BP: Soccer injuries: Leg injuries and shin guards. Clin
Sport Med 17:769, 1998.530 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS