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Kakavas G, Tsiokanos A, Potoupnis M, Tsaklis PV. Mechanical and Contractile Properties of Knee Joint Muscles after Sports-Related Concussions in Women Footballers. J Funct Morphol Kinesiol 2024; 9:65. [PMID: 38651423 PMCID: PMC11036212 DOI: 10.3390/jfmk9020065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/24/2024] [Accepted: 03/30/2024] [Indexed: 04/25/2024] Open
Abstract
The purpose of this study was to determine if women footballers have an increased lack of neuromuscular control of the knee joint after a concussion compared to a healthy cohort tested with tensiomyography (TMG). Forty-one female collegiate footballers were enrolled in this study from which there were 20 with a history of sports-related concussions (SRCs) and 21 control subjects. Results from the SRC group had significantly higher Tc (ms) (z = -5.478, p = 0.000) and significantly lower Dm (mm) (z = -3.835, p = 0.000) than the control group in the case of the rectus femoris muscle. The SRC group had significantly higher Tc (ms) (z = -2.348, p = 0.016) and significantly lower Dm (mm) (z = -4.776, p = 0.000) than the control group in the case of the vastus medialis muscle. The SRC group had significantly higher Tc (ms) (z = -5.400, p = 0.000) and significantly lower Dm (mm) (z = -4.971, p = 0.000) than the control group in the case of the vastus lateralis muscle. The SRC group had significantly higher Tc (ms) (z = -5.349, p = 0.000) than the control group in the case of the biceps femoris muscle response, whereas no significant difference was found in Dm (mm) (z = -0.198, p = 0.853) between the groups. The results of the current study may have implications for current practice standards regarding the evaluation and management of concussions and can add valuable information for knee prevention programs as well.
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Affiliation(s)
- Georgios Kakavas
- Fysiotek Spine and Sports Lab, 11635 Athens, Greece;
- ErgoMechLab, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece;
| | - Athanasios Tsiokanos
- ErgoMechLab, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece;
| | - Michael Potoupnis
- Medical School, 3rd Academic Orthopedic Clinic, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Panagiotis V. Tsaklis
- ErgoMechLab, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece;
- Department of Molecular Medicine and Surgery, Growth and Metabolism, Karolinska Institute, 17164 Solna, Sweden
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2
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Barnes-Wood M, McCloskey H, Connelly S, Gilchrist MD, Annaidh AN, Theobald PS. Investigation of Head Kinematics and Brain Strain Response During Soccer Heading Using a Custom-Fit Instrumented Mouthguard. Ann Biomed Eng 2024; 52:934-945. [PMID: 38243139 PMCID: PMC10940496 DOI: 10.1007/s10439-023-03430-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
Association football, also known as soccer in some regions, is unique in encouraging its participants to intentionally use their head to gain a competitive advantage, including scoring a goal. Repetitive head impacts are now being increasingly linked to an inflated risk of developing long-term neurodegenerative disease. This study investigated the effect of heading passes from different distances, using head acceleration data and finite element modelling to estimate brain injury risk. Seven university-level participants wore a custom-fitted instrumented mouthguard to capture linear and angular acceleration-time data. They performed 10 headers within a laboratory environment, from a combination of short, medium, and long passes. Kinematic data was then used to calculate peak linear acceleration, peak angular velocity, and peak angular acceleration as well as two brain injury metrics: head injury criterion and rotational injury criterion. Six degrees of freedom acceleration-time data were also inputted into a widely accepted finite element brain model to estimate strain-response using mean peak strain and cumulative strain damage measure values. Five headers were considered to have a 25% concussion risk. Mean peak linear acceleration equalled 26 ± 7.9 g, mean peak angular velocity 7.20 ± 2.18 rad/s, mean peak angular acceleration 1730 ± 611 rad/s2, and 95th percentile mean peak strain 0.0962 ± 0.252. Some of these data were similar to brain injury metrics reported from American football, which supports the need for further investigation into soccer heading.
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Affiliation(s)
- M Barnes-Wood
- Cardiff School of Engineering, Cardiff University, The Parade, Cardiff, CF24 3AA, UK
- Charles Owen & Co, Croesfoel Industrial Park, Wrexham, LL14 4BJ, UK
| | - H McCloskey
- Cardiff School of Engineering, Cardiff University, The Parade, Cardiff, CF24 3AA, UK
- Charles Owen & Co, Croesfoel Industrial Park, Wrexham, LL14 4BJ, UK
| | - S Connelly
- Football Association of Wales (FIFA Medical Centre of Excellence), Hensol, Pontyclun, CF72 8JY, UK
| | - M D Gilchrist
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - A Ni Annaidh
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - P S Theobald
- Cardiff School of Engineering, Cardiff University, The Parade, Cardiff, CF24 3AA, UK.
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3
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Peek K, Duffield R, Cairns R, Jones M, Meyer T, McCall A, Oxenham V. Where are We Headed? Evidence to Inform Future Football Heading Guidelines. Sports Med 2023; 53:1335-1358. [PMID: 37285067 PMCID: PMC10289964 DOI: 10.1007/s40279-023-01852-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 06/08/2023]
Abstract
Given the scientific and public concern regarding the short-, medium- and long-term consequences of heading on brain health, being proactive about developing and implementing guidelines that help reduce the burden (volume, impact magnitude and injury risk) of heading in young and beginner players appears justified. This narrative review explores the evidence underpinning strategies that could be incorporated into future heading guidelines to reduce heading burden in players across all levels of football. A four-step search strategy was utilised to identify all data-based papers related to heading in football. Eligibility criteria for inclusion were: (1) original data, (2) study population included football players, (3) outcome measures included one or more of the following: number of headers, measurement of head acceleration during heading, or head/brain injury incidence, and (4) published in English or English translation available. In total, 58 papers were included that outlined strategies based on (1) game or team development, (2) player skill development and (3) equipment. In particular, greater emphasis existed for small-sided games (particularly in young players) where fewer headers are observed when compared with the conventional 11 versus 11 game, as well as reducing headers from goal kicks and corners. Evidence also existed for developing a heading coaching framework that focusses on technical proficiency as well as neuromuscular neck exercises integrated into general injury reduction exercise programs, enforcement of rules related to deliberate head contact and using lower-pressure match and training balls. To mitigate potential risks of heading on brain health, a number of pragmatic strategies have been examined in scientific studies and may be considered as part of future heading guidelines.
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Rob Duffield
- School of Sport, Exercsie & Rehabilitation, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
- Football Australia, Sydney, NSW Australia
| | - Ross Cairns
- Newcastle Sports Medicine, Warners Bay, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Mark Jones
- Football Australia, Sydney, NSW Australia
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Alan McCall
- School of Sport, Exercsie & Rehabilitation, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
- Football Australia, Sydney, NSW Australia
| | - Vincent Oxenham
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW Australia
- Department of Neuropsychology, Royal North Shore Hospital, Sydney, NSW Australia
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Kepka S, Lersy F, Godet J, Blanc F, Bilger M, Botzung A, Kleitz C, Merignac J, Ohrant E, Garnier F, Pietra F, Noblet V, Deck C, Willinger R, Kremer S. Cerebral and cognitive modifications in retired professional soccer players: TC-FOOT protocol, a transverse analytical study. BMJ Open 2022; 12:e060459. [PMID: 36351716 PMCID: PMC9664284 DOI: 10.1136/bmjopen-2021-060459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Soccer is the most popular sport in the world. This contact sport carries the risk of exposure to repeated head impacts in the form of subconcussions, defined as minimal brain injuries following head impact, with no symptom of concussion. While it has been suggested that exposure to repetitive subconcussive events can result in long-term neurophysiological modifications, and the later development of chronic traumatic encephalopathy, the consequences of these repeated impacts remain controversial and largely unexplored in the context of soccer players. METHODS AND ANALYSIS This is a prospective, single-centre, exposure/non-exposure, transverse study assessing the MRI and neuropsychological abnormalities in professional retired soccer players exposed to subconcussive impacts, compared with high-level athletes not exposed to head impacts. The primary outcome corresponds to the results of MRI by advanced MRI techniques (diffusion tensor, cerebral perfusion, functional MRI, cerebral volumetry and cortical thickness, spectroscopy, susceptibility imaging). Secondary outcomes are the results of the neuropsychological tests: number of errors and time to complete tests. We hypothesise that repeated subconcussive impacts could lead to morphological lesions and impact on soccer players' cognitive skills in the long term. ETHICS AND DISSEMINATION Ethics approval has been obtained and the study was approved by the Comité de Protection des Personnes (CPP) No 2021-A01169-32. Study findings will be disseminated by publication in a high-impact international journal. Results will be presented at national and international imaging meetings. TRIAL REGISTRATION NUMBER NCT04903015.
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Affiliation(s)
- Sabrina Kepka
- Emergency Department, University Hospital Centre Strasbourg, Strasbourg, France
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - François Lersy
- Imaging Department, University Hospital Centre Strasbourg, Strasbourg, France
| | - Julien Godet
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
- Public Health Unit, University Hospital of Strasbourg, Strasbourg, France
| | - Frederic Blanc
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
- Geriatrics and Neurology Departments, Research and Resources Memory Center (CM2R), University Hospital of Strasbourg, Strasbourg, France
| | - Mathias Bilger
- Neuropsychology Department, University Hospital Centre Strasbourg, Strasbourg, France
| | - Anne Botzung
- Geriatrics and Neurology Departments, Research and Resources Memory Center (CM2R), University Hospital of Strasbourg, Strasbourg, France
| | - Catherine Kleitz
- Neuropsychology Department, University Hospital Centre Strasbourg, Strasbourg, France
| | - Jeanne Merignac
- Geriatrics and Neurology Departments, Research and Resources Memory Center (CM2R), University Hospital of Strasbourg, Strasbourg, France
| | | | - Franck Garnier
- School of Osteopathy, College COS Strasbourg, Strasbourg, France
- Medical Sport Center of Strasbourg, CMSM, Strasburg, France
| | | | - Vincent Noblet
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - Caroline Deck
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - Remy Willinger
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - Stéphane Kremer
- ICube, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
- Imaging Department, University Hospital Centre Strasbourg, Strasbourg, France
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5
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Ashton J, Coyles G, Malone JJ, Roberts JW. Immediate effects of an acute bout of repeated soccer heading on cognitive performance. SCI MED FOOTBALL 2022; 5:181-187. [PMID: 35077295 DOI: 10.1080/24733938.2020.1846769] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose: There isgrowing concern surrounding the harmful effects of soccer heading on cognitive function. The present study aims to examine the immediate effects of heading.Methods: 30 recreational male soccer players were divided into three groups that undertook 20 consecutive headers with a soft (8.8 psi), hard (16.2 psi), or no (control) ball. A battery of neuropsychological tests was completed before and after heading: King-Devick, trail-making (TM) (A, B), digit span (DS) and spatial span (SS) (forward, backward).Results: Significant increase in the time (M = 4.44 s) and errors (M = 1.45) for the King-Devick test within the hard and soft groups, although there was no significant difference for TM-A and TM-B. Significant decline for SS forward within the hard and soft groups (M= -16%), although the declines for SS backward (M = -16%), DS forward (M= -23%) and DS backward (M = -25%) were present only for the hard group (ps <.05).Discussion: While outside of regular match-play, this study showed that heading negatively influenced one indicator of a suspected concussion (King-Devick), as well as working memory (DS, SS) that is essential for daily life. These findings contribute to the growing debate surrounding heading safety.
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Affiliation(s)
- Jake Ashton
- School of Health Sciences, Liverpool Hope University, Hope Park, Liverpool, UK, L16 9JD
| | - Ginny Coyles
- School of Health Sciences, Liverpool Hope University, Hope Park, Liverpool, UK, L16 9JD
| | - James J Malone
- School of Health Sciences, Liverpool Hope University, Hope Park, Liverpool, UK, L16 9JD
| | - James W Roberts
- School of Health Sciences, Liverpool Hope University, Hope Park, Liverpool, UK, L16 9JD
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6
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A 2-year longitudinal follow-up of quantitative assessment neck tics in Tourette's syndrome. PLoS One 2021; 16:e0261560. [PMID: 34968403 PMCID: PMC8718009 DOI: 10.1371/journal.pone.0261560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022] Open
Abstract
Background Neck motor tics in Tourette’s syndrome can cause severe neck complications. Although addressed in a few longitudinal studies, the clinical course of Tourette’s syndrome has not been quantitatively assessed. We had previously developed a method for quantifying the angular movements of neck tics using a compact gyroscope. Here, we present a follow-up study aimed at elucidating the clinical course of neck tics at both the group and individual levels. Methods Eleven patients with Tourette’s syndrome from our previous study participated in the present study, and their neck tics were recorded during a 5-min observation period. The severity of neck symptoms was assessed using the Yale Global Tic Severity Scale. The peak angular velocities and accelerations, tic counts, and severity scores in our previous study (baseline) and the present study (2-year follow-up) were compared at the group and individual levels. The individual level consistency between baseline and follow-up were calculated using intra-class correlation coefficients (ICCs, one-way random, single measure). Results At the group level, no significant change was observed between baseline and follow-up. At the individual level, angular velocity (ICC 0.73) and YGTSS scores (ICC 0.75) had substantial consistency over the two time points, and angular acceleration (ICC 0.59) and tic counts (ICC 0.69) had moderate consistency. Conclusions The intensity and frequency of neck tics did not change over time. Therefore, quantification of angular neck motor tics will aid in identifying patients with neck tics at high risk for severe neck complications.
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7
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McCunn R, Beaudouin F, Stewart K, Meyer T, MacLean J. Heading in Football: Incidence, Biomechanical Characteristics and the Association with Acute Cognitive Function-A Three-Part Systematic Review. Sports Med 2021; 51:2147-2163. [PMID: 34129222 DOI: 10.1007/s40279-021-01492-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is growing concern surrounding the role of repetitive sub-concussive head impacts, such as football heading, on brain health. OBJECTIVES Three questions were addressed while only considering studies that observed heading exposure directly: (1) how frequently does heading occur within football training and matches, (2) what are the biomechanical characteristics of heading, and (3) is cognitive function affected by heading? METHODS This review followed the steps described in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Electronic databases including MEDLINE and SPORTDiscus were searched from the earliest entry to July 2020. Studies that reported independently quantified heading exposure, biomechanical characteristics of heading or the relationship between heading and cognitive function were included. Data were extracted and used to populate summary tables with reference to each research question. RESULTS Heading incidence ranged between one to nine headers per player per match. The number of headers observed in small-sided games during training varied depending on the exact format used but generally speaking ranged between zero to one per player per game. The three most commonly reported biomechanical variables were head acceleration, head rotational velocity and overall movement kinematics during the heading action. Average head acceleration ranged from approximately four to 50 g. Nine out of 12 included studies did not observe a negative impact on cognitive test performance following exposure to heading and while three did, these negative effects were limited to specific outcome measures: reaction time and memory function. CONCLUSION The current weight of evidence summarised herein does not support the notion that heading is deleterious to cognitive performance in the short term; however, this conclusion is tentative due to methodological shortcomings in the existing evidence base.
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Affiliation(s)
- Robert McCunn
- Heart of Midlothian Football Club, Tynecastle Park , Edinburgh, EH11 2NL, UK.
| | - Florian Beaudouin
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Katy Stewart
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Hampden Sports Clinic, Glasgow, UK
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - John MacLean
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Hampden Sports Clinic, Glasgow, UK
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8
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Rawlings S, Takechi R, Lavender AP. Effects of sub-concussion on neuropsychological performance and its potential mechanisms: A narrative review. Brain Res Bull 2020; 165:56-62. [PMID: 33011196 DOI: 10.1016/j.brainresbull.2020.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/12/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022]
Abstract
Concussion and mild traumatic brain injury (mTBI) are recognised as serious medical events that are relatively common in contact sports. Recently, the seemingly non-injurious phenomenon of sub-concussion has gained interest among neuroscience researchers and early studies are showing that there may be some acute and chronic effects on brain health and function with repeated sub-concussive events of the type seen in soccer, where players strike the ball with the head, and collision sports like the rugby codes. The aim of this narrative review is to describe sub-concussion and the current understanding of short and long term effects of repeated minor impacts that have been found to occur in human and animal models. Here, potential mechanisms for cognitive dysfunction following sub-concussion and recommend directions for future research are discussed. The Potential mechanisms of injuries resulting from sub-concussion such as changes in blood brain barrier integrity, neuroinflammation, cognitive impairment, and oxidative stress damage, among other changes in central nervous system function vary considerably making understanding of the underlying causative mechanism challenging for researchers. Some evidence suggests a link between impaired cerebrovascular function and cognitive impairment which poses a potential mechanism linking the two. It is hoped that this review helps guide researchers toward a potential direction of investigations.
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Affiliation(s)
- Samuel Rawlings
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Ryusuke Takechi
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia; School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Andrew P Lavender
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia; School of Science, Psychology and Sport, Federation University Australia, Ballarat, Australia.
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9
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Mooney J, Self M, ReFaey K, Elsayed G, Chagoya G, Bernstock JD, Johnston JM. Concussion in soccer: a comprehensive review of the literature. Concussion 2020; 5:CNC76. [PMID: 33005435 PMCID: PMC7506470 DOI: 10.2217/cnc-2020-0004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Sports-related concussion has been examined extensively in collision sports such as football and hockey. However, historically, lower-risk contact sports such as soccer have only more recently garnered increased attention. Here, we review articles examining the epidemiology, injury mechanisms, sex differences, as well as the neurochemical, neurostructural and neurocognitive changes associated with soccer-related concussion. From 436 titles and abstracts, 121 full texts were reviewed with a total of 64 articles identified for inclusion. Concussion rates are higher during competitions and in female athletes with purposeful heading rarely resulting in concussion. Given a lack of high-level studies examining sports-related concussion in soccer, clinicians and scientists must focus research efforts on large-scale data gathering and development of improved technologies to better detect and understand concussion.
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Affiliation(s)
- James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Mitchell Self
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Galal Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - James M Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
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10
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Zuckerman SL, Brett BL, Jeckell A, Yengo-Kahn AM, Solomon GS. Chronic Traumatic Encephalopathy and Neurodegeneration in Contact Sports and American Football. J Alzheimers Dis 2019; 66:37-55. [PMID: 30223396 DOI: 10.3233/jad-180218] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease characterized by the presence of abnormally phosphorylated tau protein in the depths of one or more cortical sulci. Controversy over the risk of CTE and neurologic disorders later in life among contact sport athletes has taken hold in the public spotlight, most notably in American football. Players, parents, coaches, and legislators have taken action based on the commonly held notion that contact sports invariably lead to neurodegenerative disorders. However, to fully understand the science behind this assumed association, a critical appraisal of the evidence is warranted. With regards to CTE in sports, the objectives of the current report are to: 1) describe the history of CTE, 2) review current CTE definitions, 3) critically evaluate the empiric data, divided into all contact sports and exclusively American football, and 4) summarize notable themes for future research.
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Affiliation(s)
- Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin L Brett
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aaron Jeckell
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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11
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Rodrigues AC, Lima MDM, de Souza LC, Furtado C, Marques CE, Gonçalves L, Lima MV, Lasmar RP, Caramelli P. No Evidence of Association Between Soccer Heading and Cognitive Performance in Professional Soccer Players: Cross-Sectional Results. Front Neurol 2019; 10:209. [PMID: 30915024 PMCID: PMC6422927 DOI: 10.3389/fneur.2019.00209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 02/18/2019] [Indexed: 12/29/2022] Open
Abstract
Although the scientific community has focused on the effects of concussions in contact sports, the role of subconcussive impacts, as it can occur during soccer heading, has recently gained attention, considering that it may represent an additional mechanism of cumulative brain injury. The aim of this study is to investigate the effects of soccer heading on cognitive functioning in active professional soccer players. Male soccer players (n = 44), from two soccer teams that play in the Brazilian A Series Championship, and non-athletes (n = 47), comparable in age and education, were submitted to cognitive assessment, consisting of computerized and conventional neuropsychological testing (Neupsilin battery). In the computerized cognitive assessment, soccer players performed better than controls on reaction time measures in general motor coordination, executive functioning and memory tests, and on accuracy measures in executive functioning tests. There were no significant differences between groups on the Neupsilin battery. A comparison between two sub-groups of soccer players, based on the self-reported number of headings, did not show significant differences on tests performance. No significant correlations were found between an estimate of exposure to heading during professional soccer career and cognitive performance. Our data demonstrate no evidence of cognitive impairment in soccer players, compared to non-athletes, and no association between heading exposure and performance on neuropsychological tests. Longitudinal investigations, including neuroimaging assessment, will help to clarify whether soccer heading may be associated with brain injury and cognitive dysfunction.
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Affiliation(s)
- Ana Carolina Rodrigues
- Pró-Reitoria de Graduação, Reitoria da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mariana Drummond Martins Lima
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leonardo Cruz de Souza
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Celso Furtado
- Departamento Médico do América Futebol Clube, Belo Horizonte, Brazil
| | | | - Lucas Gonçalves
- Departamento de Análise de Desempenho do Clube Atlético Mineiro, Belo Horizonte, Brazil
| | | | - Rodrigo Pace Lasmar
- Departamento Médico do Clube Atlético Mineiro, Belo Horizonte, Brazil.,Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Paulo Caramelli
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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12
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Abstract
My objectives are to review: 1) a brief history of sport-related concussion (SRC) and chronic traumatic encephalopathy (CTE), 2) the evolution of CTE in American professional football, 3) the data regarding SRC/CTE as they relate to depression and suicide, 4) the data on the neurocognitive effects of subconcussion/repetitive head trauma (with emphases on heading the ball in soccer and early exposure to football), 5) the evidence related to SRC and neurodegenerative diseases, 6) the published studies of CTE, 7) the NINDS neuropathological criteria for CTE, 8) public beliefs about SRC/CTE, and 9) the scientific questions regarding CTE.
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Affiliation(s)
- Gary Solomon
- a Department of Neurological Surgery, Vanderbilt Sports Concussion Center , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
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13
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Recent and Long-Term Soccer Heading Exposure Is Differentially Associated With Neuropsychological Function in Amateur Players. J Int Neuropsychol Soc 2018; 24:147-155. [PMID: 28829004 PMCID: PMC6554717 DOI: 10.1017/s1355617717000790] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The present study examined the relative contribution of recent or long-term heading to neuropsychological function in amateur adult soccer players. PARTICIPANTS AND METHODS Soccer players completed a baseline questionnaire (HeadCount-12m) to ascertain heading during the prior 12 months (long-term heading, LTH) and an online questionnaire (HeadCount-2w) every 3 months to ascertain heading during the prior 2 weeks (recent heading, RH). Cogstate, a battery of six neuropsychological tests, was administered to assess neuropsychological function. Generalized estimating equations were used to test if LTH or RH was associated with neuropsychological function while accounting for the role of recognized concussion. RESULTS A total of 311 soccer players completed 630 HeadCount-2w. Participants had an average age of 26 years. Participants headed the ball a median of 611 times/year (mean=1,384.03) and 9.50 times/2 weeks (mean=34.17). High levels of RH were significantly associated with reduced performance on a task of psychomotor speed (p=.02), while high levels of LTH were significantly associated with poorer performance on tasks of verbal learning (p=.03) and verbal memory (p=.04). Significantly better attention (p=.02) was detectable at moderately high levels of RH, but not at the highest level of RH. One hundred and seven (34.4%) participants reported a lifetime history of concussion, but this was not related to neuropsychological function and did not modify the association of RH or LTH with neuropsychological function. CONCLUSION High levels of both RH and LTH were associated with poorer neuropsychological function, but on different domains. The clinical manifestations following repetitive exposure to heading could change with chronicity of exposure. (JINS, 2018, 24, 147-155).
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14
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Nel K, Govender S, Rapetsoa M, Nel C. Cumulative mild head injury (CMHI) among college rugby players: A replication and extension study. JOURNAL OF PSYCHOLOGY IN AFRICA 2017. [DOI: 10.1080/14330237.2017.1399571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Kathryn Nel
- Department of Psychology, University of Limpopo, Polokwane, South Africa
| | | | - Mokgadi Rapetsoa
- Department of Psychology, University of Limpopo, Polokwane, South Africa
| | - Christopher Nel
- Department of Human Movement Science, University of Zululand, Kwadlangezwa, South Africa
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15
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Lipton ML, Ifrah C, Stewart WF, Fleysher R, Sliwinski MJ, Kim M, Lipton RB. Validation of HeadCount-2w for estimation of two-week heading: Comparison to daily reporting in adult amateur player. J Sci Med Sport 2017; 21:363-367. [PMID: 28882435 DOI: 10.1016/j.jsams.2017.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/20/2017] [Accepted: 08/13/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To validate the HeadCount-2w questionnaire for estimation of 2-week soccer heading by comparison to daily electronic diary reporting over the same two-week period. DESIGN Prospective observational study. METHODS Adult amateur soccer players completed HeadCount-daily, comprising 14 daily at-home assessments of soccer play and heading via a tablet PC. Following the 14day period, players completed HeadCount-2w, a web-based two-week-recall questionnaire on soccer and heading. intraclass correlation coefficient (ICC) was estimated between HeadCount-daily, the reference standard, and HeadCount-2w estimates of heading during the same 2-week period. RESULTS 53 participants (38 men) reported a mean of 24.36 (median=11.76) headers during 2 weeks via HeadCount-daily and a mean of 38.34 (median=15.0) headers for the same 2 weeks via HeadCount-2w. The ICC comparing 2-week heading from HeadCount-daily and HeadCount-2w was 0.85. Linear regression of the log-transformed Headcount-daily on HeadCount-2w data yielded a slope of 0.71 (p<0.001; 95% CI 0.54-0.82), suggesting that heading tends to be over-estimated by HeadCount-2w relative to HeadCount-daily. Slope estimates for men (0.65) and women (0.71) were similar. CONCLUSIONS HeadCount, a self-administered web-based survey, is valid for self-reporting 2-week heading in adult amateur players, supporting its use in future research and as a simple and low-cost technique for exposure monitoring.
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Affiliation(s)
- Michael L Lipton
- The Gruss Magnetic Resonance Research Center, USA; Departments of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, USA; Departments of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, USA; The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, USA.
| | - Chloe Ifrah
- The Gruss Magnetic Resonance Research Center, USA; Departments of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, USA
| | | | - Roman Fleysher
- The Gruss Magnetic Resonance Research Center, USA; Departments of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, USA
| | - Martin J Sliwinski
- Department of Human Development and Family Studies, Pennsylvania State University, USA
| | - Mimi Kim
- Departments of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, USA
| | - Richard B Lipton
- Departments of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, USA; Departments of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, USA
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16
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Kontos AP, Braithwaite R, Chrisman SPD, McAllister-Deitrick J, Symington L, Reeves VL, Collins MW. Systematic review and meta-analysis of the effects of football heading. Br J Sports Med 2016; 51:1118-1124. [DOI: 10.1136/bjsports-2016-096276] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 01/06/2023]
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17
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Rodrigues AC, Lasmar RP, Caramelli P. Effects of Soccer Heading on Brain Structure and Function. Front Neurol 2016; 7:38. [PMID: 27047444 PMCID: PMC4800441 DOI: 10.3389/fneur.2016.00038] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/07/2016] [Indexed: 12/14/2022] Open
Abstract
Soccer is the most popular sport in the world, with more than 265 million players worldwide, including professional and amateur ones. Soccer is unique in comparison to other sports, as it is the only sport in which participants purposely use their head to hit the ball. Heading is considered as an offensive or defensive move whereby the player's unprotected head is used to deliberately impact the ball and direct it during play. A soccer player can be subjected to an average of 6-12 incidents of heading the ball per competitive game, where the ball reaches high velocities. Moreover, in practice sessions, heading training, which involves heading the ball repeatedly at low velocities, is common. Although the scientific community, as well as the media, has focused on the effects of concussions in contact sports, the role of subconcussive impacts, as it can occur during heading, has recently gained attention, considering that it may represent an additional mechanism of cumulative brain injury. The purpose of this study is to review the existing literature regarding the effects of soccer heading on brain structure and function. Only in the last years, some investigations have addressed the impact of heading on brain structure, by using neuroimaging techniques. Similarly, there have been some recent studies investigating biochemical markers of brain injury in soccer players. There is evidence of association between heading and abnormal brain structure, but the data are still preliminary. Also, some studies have suggested that subconcussive head impacts, as heading, could cause cognitive impairment, whereas others have not corroborated this finding. Questions persist as to whether or not heading is deleterious to cognitive functioning. Further studies, especially with longitudinal designs, are needed to clarify the clinical significance of heading as a cause of brain injury and to identify risk factors. Such investigations might contribute to the establishment of safety guidelines that could help to minimize the risk of possible adverse effects of soccer on brain structure and function.
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Affiliation(s)
- Ana Carolina Rodrigues
- Pró-Reitoria de Graduação, Reitoria da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rodrigo Pace Lasmar
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paulo Caramelli
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Andre JB. Arterial Spin Labeling Magnetic Resonance Perfusion for Traumatic Brain Injury: Technical Challenges and Potentials. Top Magn Reson Imaging 2015; 24:275-287. [PMID: 26502309 DOI: 10.1097/rmr.0000000000000065] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Traumatic brain injury (TBI), including concussion, is a public health concern, as it affects over 1.7 million persons in the United States per year. Yet, the diagnosis of TBI, particularly mild TBI (mTBI), can be controversial, as neuroimaging findings can be sparse on conventional magnetic resonance and computed tomography examinations, and when present, often poorly correlate with clinical signs and symptoms. Furthermore, the discussion of TBI, concussion, and head impact exposure is immediately complicated by the many differing opinions of what constitutes each, their respective severities, and how the underlying biomechanics of the inciting head impact might alter the distribution, severity, and prognosis of the underlying brain injury. Advanced imaging methodologies hold promise in improving the sensitivity and detectability of associated imaging biomarkers that might better correlate with patient outcome and prognostication, allowing for improved triage and therapeutic guidance in the setting of TBI, particularly in mTBI. This work will examine the defining symptom complex associated with mTBI and explore changes in cerebral blood flow measured by arterial spin labeling, as a potential imaging biomarker for TBI, and briefly correlate these observations with findings identified by single photon emission computed tomography and positron emission tomography imaging.
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Affiliation(s)
- Jalal B Andre
- Harborview Medical Center, University of Washington, Seattle, WA
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19
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Alexander DG, Shuttleworth-Edwards AB, Kidd M, Malcolm CM. Mild traumatic brain injuries in early adolescent rugby players: Long-term neurocognitive and academic outcomes. Brain Inj 2015; 29:1113-25. [DOI: 10.3109/02699052.2015.1031699] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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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; 28:271-85. [PMID: 24475745 DOI: 10.3109/02699052.2013.865269] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Soccer is currently the most popular and fastest-growing sport worldwide. Similar to many sports, soccer carries an inherent risk of injury, including concussion. Soccer is also unique in the use of 'heading'. The present paper provides a comprehensive review of the research examining the incidence, mechanisms, biomarkers of injury and neurocognitive outcomes of concussions and heading in soccer. METHODS Seven databases were searched for articles from 1806 to 24 May 2013. Articles obtained by the electronic search were reviewed for relevance, with 229 selected for review. Ultimately, 49 articles met criteria for inclusion in the present review. RESULTS Female soccer players have a higher incidence of concussions than males. The most frequent injury mechanism is player-to-player contact for both genders. Few studies examined the effects of concussion in soccer players; however, neurocognitive outcomes were similar to those reported in the larger sport concussion literature, while the effect of heading is less clear. CONCLUSION Despite variation in research designs and study characteristics, the outcomes of concussions in soccer align with the greater concussion literature. This review makes recommendations for future research to increase standardization of research for improved understanding of concussions in soccer as well as the effects of heading.
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Affiliation(s)
- Monica E Maher
- Institute of Medical Sciences, University of Toronto , Toronto, Ontario , Canada
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21
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Lipton ML, Kim N, Zimmerman ME, Kim M, Stewart WF, Branch CA, Lipton RB. Soccer heading is associated with white matter microstructural and cognitive abnormalities. Radiology 2013; 268:850-7. [PMID: 23757503 DOI: 10.1148/radiol.13130545] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the association of soccer heading with subclinical evidence of traumatic brain injury. MATERIALS AND METHODS With institutional review board approval and compliance with HIPAA guidelines, 37 amateur soccer players (mean age, 30.9 years; 78% [29] men, 22% [eight] women) gave written informed consent and completed a questionnaire to quantify heading in the prior 12 months and lifetime concussions. Diffusion-tensor magnetic resonance (MR) imaging at 3.0 T was performed (32 directions; b value, 800 sec/mm(2); 2 × 2 × 2-mm voxels). Cognitive function was measured by using a computerized battery of tests. Voxelwise linear regression (heading vs fractional anisotropy [FA]) was applied to identify significant regional associations. FA at each location and cognition were tested for a nonlinear relationship to heading by using an inverse logit model that incorporated demographic covariates and history of concussion. RESULTS Participants had headed 32-5400 times (median, 432 times) over the previous year. Heading was associated with lower FA at three locations in temporo-occipital white matter with a threshold that varied according to location (885-1550 headings per year) (P < .00001). Lower levels of FA were also associated with poorer memory scores (P < .00001), with a threshold of 1800 headings per year. Lifetime concussion history and demographic features were not significantly associated with either FA or cognitive performance. CONCLUSION Heading is associated with abnormal white matter microstructure and with poorer neurocognitive performance. This relationship is not explained by a history of concussion.
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Affiliation(s)
- Michael L Lipton
- Gruss Magnetic Resonance Research Center, Department of Radiology, Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Ave, Bronx, NY 10461, USA.
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23
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Abstract
A 16-year-old adolescent boy presented with headache, dizziness, loss of consciousness, and a tonic-clonic seizure after heading a soccer ball in a competitive match. A computed tomographic scan of the head revealed an acute subdural hematoma with a mass effect. The patient was emergently referred to a tertiary care facility where he eventually recovered completely with conservative care. No predisposing medical conditions were found. To the best of our knowledge, this is the first report of an intracranial hemorrhage secondary to the heading of a soccer ball alone in an otherwise healthy child without any underlying predisposing central nervous system abnormalities.
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Rutherford A, Stephens R, Fernie G, Potter D. Do UK university football club players suffer neuropsychological impairment as a consequence of their football (soccer) play? J Clin Exp Neuropsychol 2008; 31:664-81. [PMID: 19048428 DOI: 10.1080/13803390802484755] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Male players from football and rugby clubs and sportsmen from a variety of noncontact sports clubs at a UK university were compared on biographical and neuropsychological test measures. A data analysis paradigm was developed and employed to control the inflation of Type 1 error rate due to multiple hypotheses testing. Rugby players sustained most head injuries in their chosen sport, but neuropsychological tests of attention, memory, and executive function provided no evidence of performance impairment attributable to the number of head injuries sustained or the football, rugby, or noncontact sport groups. Footballers' heading frequency was related to the number of football head injuries sustained, but no relationship was detected between footballers' heading frequency and their neuropsychological test performance. Following discussion of pertinent methodological limitations it is concluded that there was no evidence in this dataset of neuropsychological impairment consistent with either mild head injury incidence or football heading frequency. However, a need for further research examining the long-term neuropsychological consequences of such head injuries was identified.
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Affiliation(s)
- Andrew Rutherford
- School of Psychology, Keele University, Keele, Staffordshire, ST5 5BG, UK.
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25
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Shuttleworth-Edwards AB, Smith I, Radloff SE. Neurocognitive vulnerability amongst university rugby players versus noncontact sport controls. J Clin Exp Neuropsychol 2008; 30:870-84. [PMID: 18608657 DOI: 10.1080/13803390701846914] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
University rugby players were compared with IQ-equivalent noncontact sports controls on memory and attentional tasks at the pre- and postseason intervals. Results revealed significant lowering for rugby players relative to controls at the postseason interval for attentional tasks with a speeded visuomotor component (ImPACT Visual Motor Speed; Trail Making Test, TMT, A and B). There was a practice effect for controls only between the pre- and postseason intervals for attentional tasks that commonly reveal improvements after a long retest interval (TMT A and B; Digits Backwards). Medium to large effect sizes implicate clinically relevant cognitive vulnerability for university-level rugby players in association with years of exposure to repetitive concussive injury.
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Wicks P, Ganesalingham J, Collin C, Prevett M, Leigh NP, Al-Chalabi A. Three soccer playing friends with simultaneous amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2007; 8:177-9. [PMID: 17538780 DOI: 10.1080/17482960701195220] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Amyotrophic lateral sclerosis is a neurodegenerative disease of largely unknown cause, predominantly affecting upper and lower motor neurons. A recent study in Italy suggested an increased incidence of ALS among professional Italian soccer players. We report a cluster of three amateur league soccer players who were friends from the same part of southern England, and developed ALS simultaneously. This might suggest that keen amateur soccer players are also at risk.
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Affiliation(s)
- Paul Wicks
- MRC Centre for Neurodegeneration Research, King's College London, Institute of Psychiatry, Department of Psychology, London, UK
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