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Pensato U, Cortelli P. Soccer (football) and brain health. J Neurol 2024; 271:3019-3029. [PMID: 38558150 PMCID: PMC11136867 DOI: 10.1007/s00415-024-12320-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024]
Abstract
Soccer is one of the most popular sports worldwide, played by over 270 million people and followed by many more. Several brain health benefits are promoted by practising soccer and physical exercise at large, which helps contrast the cognitive decline associated with ageing by enhancing neurogenesis processes. However, sport-related concussions have been increasingly recognised as a pressing public health concern, not only due to their acute impact but also, more importantly, due to mounting evidence indicating an elevated risk for the development of neurological sequelae following recurrent head traumas, especially chronic traumatic encephalopathy (CTE). While soccer players experience less frequent concussions compared with other contact or combat sports, such as American football or boxing, it stands alone in its purposeful use of the head to hit the ball (headings), setting its players apart as the only athletes exposed to intentional, sub-concussive head impacts. Additionally, an association between soccer and amyotrophic lateral sclerosis has been consistently observed, suggesting a potential "soccer-specific" risk factor. In this review, we discuss the neurological sequelae related to soccer playing, the emerging evidence of a detrimental effect related to recurrent headings, and the need for implementation of comprehensive strategies aimed at preventing and managing the burden of head impact in soccer.
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Affiliation(s)
- Umberto Pensato
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
- IRCCS Humanitas Research Hospital, via Manzoni 56 Rozzano, 20089, Milan, Italy.
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Jo J, Boltz AJ, Williams KL, Pasquina PF, McAllister TW, McCrea MA, Broglio SP, Zuckerman SL, Terry DP, Arbogast K, Benjamin HJ, Brooks A, Cameron KL, Chrisman SPD, Clugston JR, Collins M, DiFiori J, Eckner JT, Estevez C, Feigenbaum LA, Goldman JT, Hoy A, Kaminski TW, Kelly LA, Kontos AP, Langford D, Lintner LJ, Master CL, McDevitt J, McGinty G, Miles C, Ortega J, Port N, Rowson S, Schmidt J, Susmarski A, Svoboda S. Mechanisms of Injury Leading to Concussions in Collegiate Soccer Players: A CARE Consortium Study. Am J Sports Med 2024; 52:1585-1595. [PMID: 38656160 DOI: 10.1177/03635465241240789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Few previous studies have investigated how different injury mechanisms leading to sport-related concussion (SRC) in soccer may affect outcomes. PURPOSE To describe injury mechanisms and evaluate injury mechanisms as predictors of symptom severity, return to play (RTP) initiation, and unrestricted RTP (URTP) in a cohort of collegiate soccer players. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The Concussion Assessment, Research and Education (CARE) Consortium database was used. The mechanism of injury was categorized into head-to-ball, head-to-head, head-to-body, and head-to-ground/equipment. Baseline/acute injury characteristics-including Sports Concussion Assessment Tool-3 total symptom severity (TSS), loss of consciousness (LOC), and altered mental status (AMS); descriptive data; and recovery (RTP and URTP)-were compared. Multivariable regression and Weibull models were used to assess the predictive value of the mechanism of injury on TSS and RTP/URTP, respectively. RESULTS Among 391 soccer SRCs, 32.7% were attributed to a head-to-ball mechanism, 27.9% to a head-to-body mechanism, 21.7% to a head-to-head mechanism, and 17.6% to a head-to-ground/equipment mechanism. Event type was significantly associated with injury mechanism [χ2(3) = 63; P < .001), such that more head-to-ball concussions occurred in practice sessions (n = 92 [51.1%] vs n = 36 [17.1%]) and more head-to-head (n = 65 [30.8%] vs n = 20 [11.1]) and head-to-body (n = 76 [36%] vs n = 33 [18.3%]) concussions occurred in competition. The primary position was significantly associated with injury mechanism [χ2(3) = 24; P < .004], with goalkeepers having no SRCs from the head-to-head mechanism (n = 0 [0%]) and forward players having the least head-to-body mechanism (n = 15 [19.2%]). LOC was also associated with injury mechanism (P = .034), with LOC being most prevalent in head-to-ground/equipment. Finally, AMS was most prevalent in head-to-ball (n = 54 [34.2%]) and head-to-body (n = 48 [30.4%]) mechanisms [χ2(3) = 9; P = .029]. In our multivariable models, the mechanism was not a predictor of TSS or RTP; however, it was associated with URTP (P = .044), with head-to-equipment/ground injuries resulting in the shortest mean number of days (14 ± 9.1 days) to URTP and the head-to-ball mechanism the longest (18.6 ± 21.6 days). CONCLUSION The mechanism of injury differed by event type and primary position, and LOC and AMS were different across mechanisms. Even though the mechanism of injury was not a significant predictor of acute symptom burden or time until RTP initiation, those with head-to-equipment/ground injuries spent the shortest time until URTP, and those with head-to-ball injuries had the longest time until URTP.
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Affiliation(s)
- Jacob Jo
- Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrian J Boltz
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristen L Williams
- Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul F Pasquina
- Department of Physical Medicine and Rehabilitation at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA; Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Douglas P Terry
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristy Arbogast
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Holly J Benjamin
- University of Chicago, Chicago, Illinois, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alison Brooks
- University of Wisconsin-Madison, Madison, Wisconsin, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kenneth L Cameron
- United States Military Academy, West Point, New York, USA)
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sara P D Chrisman
- University of Washington, Seattle, Washington, USA)
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James R Clugston
- University of Florida, Gainesville, Florida, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Micky Collins
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John DiFiori
- Hospital for Special Surgery, New York, New York, USA)
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James T Eckner
- University of Michigan, Michigan, USA)
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos Estevez
- United States Coast Guard Academy, New London, Connecticut, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Luis A Feigenbaum
- University of Miami, Coral Gables, Florida, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joshua T Goldman
- University of California, Los Angeles, Los Angeles, California, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - April Hoy
- Azusa Pacific University, Azusa, California, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas W Kaminski
- University of Delaware, Newark, Delaware, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Louise A Kelly
- California Lutheran University, Thousand Oaks, California, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony P Kontos
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dianne Langford
- Temple University, Philadelphia, Pennsylvania, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura J Lintner
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christina L Master
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jane McDevitt
- Temple University, Philadelphia, Pennsylvania, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gerald McGinty
- United States Air Force Academy, El Paso, Colorado, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chris Miles
- Wake Forest University, Winston-Salem, North Carolina, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justus Ortega
- California State Polytechnic University, Pomona, California, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicholas Port
- Indiana University, Bloomington, Indiana, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steve Rowson
- Virginia Tech, Blacksburg, Virginia, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Julianne Schmidt
- University of Georgia, Athens, Georgia, USA)
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adam Susmarski
- United States Naval Academy, Annapolis, Maryland, USA)
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven Svoboda
- MedStar Health, Columbia, Maryland, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Shibukawa K, Hoshikawa Y. Decrease in aerial challenges after revision of goal kick rules in Japan Professional Soccer League: explorative study of the possibility of a risk reduction for head injury, concussion, and brain damage by a rule revision. SCI MED FOOTBALL 2024; 8:15-20. [PMID: 36315233 DOI: 10.1080/24733938.2022.2142274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/05/2022]
Abstract
In 2019, FIFA revised the goal kick (GLK) rule such that a GLK could be performed even if the kicker had teammates in the penalty area. This study aimed to examine whether the rule revision reduced the frequency of aerial challenge (AC) and long GLKs (LGLKs), which are risk factors for head injury and concussion in soccer. We analyzed all official league matches (306 matches/season) of the Japan Professional Soccer League 1st Division before (2018 season) and after the rule revision (2020 season). The analysis categorized GLKs into short GLKs (SGLKs) and LGLKs, depending on the GLK distance, and included the frequency and causes of AC, in each match following a GLK, which were compared between the 2018 and 2020 seasons. The average number of LGLKs per match in the 2020 season (8.85) decreased compared to that in the 2018 season (14.20). Additionally, for ACs following a GLK, the frequency of ACs decreased from 6.08 to 3.92 per match. Meanwhile, the frequency of LGLKs tended to increase toward the end of the first and second halves in matches. The results of this study revealed that the 2019 GLK rule revision reduced the number of LGLKs and ACs.
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Affiliation(s)
- Kenichi Shibukawa
- Sports & Health Sciences Lab, Faculty of Sciences, Toho University, Chiba, Japan
| | - Yoshihiro Hoshikawa
- Department of Sports Science, Japan Women's College of Physical Education, Tokyo, Japan
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Kader M, Pasternak B, Lim CE, Neovius M, Forssblad M, Svanström H, Ludvigsson JF, Ueda P. Depression and anxiety-related disorders and suicide among Swedish male elite football players: a nationwide cohort study. Br J Sports Med 2024; 58:66-72. [PMID: 37857446 PMCID: PMC10804025 DOI: 10.1136/bjsports-2023-107286] [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] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To assess whether male elite football players, during and after their active career, were at increased risk of depression and anxiety-related disorders and suicide, as compared with the general male population. METHODS We included male football players active in the Swedish top division 1924-2019 and general male population (matched to football players based on age and region of residence) aged <65 years in 1997. Using nationwide registers, we followed the football players from their first season in the top division (or the date of their first registered residency in Sweden) or 1 January 1997, and compared the risk of depression and anxiety-related disorders (captured through diagnoses from hospital admissions and outpatient visits, and use of prescription drugs) among football players versus controls. In a secondary analysis using data from death certificates, we compared the risk of suicide between football players and general population males who were alive in 1969 (when cause of death became available) . RESULTS During follow-up through 31 December 2020, 504 (13.6%) of 3719 football players and 7455 (22.3%) of 33 425 general population males had a depression or anxiety-related disorder. In analyses accounting for age, region of residence and calendar time, the risk of anxiety and depression-related disorders was lower among football players versus general population males (HR 0.61, 95% CI 0.55 to 0.66). The protective association was attenuated with increasing age, and from around age 70 years the risk was similar in the two groups. The risk of suicide was lower among football players versus general population males (HR 0.48, 95% CI 0.32 to 0.72). CONCLUSIONS In this nationwide cohort study in Sweden, elite male football players had a lower risk of depression and anxiety-related disorders and suicide as compared with the general population.
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Affiliation(s)
- Manzur Kader
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Björn Pasternak
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Kobenhavn, Denmark
| | - Carl-Emil Lim
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Forssblad
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Svanström
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Kobenhavn, Denmark
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Örebro University Hospital, Orebro, Sweden
| | - Peter Ueda
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Hageman G, Hageman I, Nihom J. Chronic Traumatic Encephalopathy in Soccer Players: Review of 14 Cases. Clin J Sport Med 2024; 34:69-80. [PMID: 37403989 DOI: 10.1097/jsm.0000000000001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/22/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Exposure to repetitive sports-related concussions or (sub)concussive head trauma may lead to chronic traumatic encephalopathy (CTE). Which impact (heading or concussion) poses the greatest risk of CTE development in soccer players? DESIGN Narrative review. SETTING Teaching hospital and University of Applied sciences. PATIENTS A literature search (PubMed) was conducted for neuropathologic studies in the period 2005-December 2022, investigating soccer players with dementia and a CTE diagnosis, limited to English language publications. 210 papers were selected for final inclusion, of which 7 papers described 14 soccer players. ASSESSMENT Magnetic resonance imaging studies in soccer players show that lifetime estimates of heading numbers are inversely correlated with cortical thickness, grey matter volume, and density of the anterior temporal cortex. Using diffusion tensor imaging-magnetic resonance imaging, higher frequency of headings-particularly with rotational accelerations-are associated with impaired white matter integrity. Serum neurofilament light protein is elevated after heading. MAIN OUTCOME MEASURES Chronic traumatic encephalopathy pathology, history of concussion, heading frequency. RESULTS In 10 of 14 soccer players, CTE was the primary diagnosis. In 4 cases, other dementia types formed the primary diagnosis and CTE pathology was a concomitant finding. Remarkably, 6 of the 14 cases had no history of concussion, suggesting that frequent heading may be a risk for CTE in patients without symptomatic concussion. Rule changes in heading duels, management of concussion during the game, and limiting the number of high force headers during training are discussed. CONCLUSIONS Data suggest that heading frequency and concussions are associated with higher risk of developing CTE in (retired) soccer players. However based on this review of only 14 players, questions persist as to whether or not heading is a risk factor for CTE or long-term cognitive decline.
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Affiliation(s)
- Gerard Hageman
- Department of Neurology, Medisch Spectrum Twente, Hospital Enschede, Enschede, the Netherlands; and
| | - Ivar Hageman
- Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Jik Nihom
- Department of Neurology, Medisch Spectrum Twente, Hospital Enschede, Enschede, the Netherlands; and
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Smoliga JM, Deshpande SK, Binney ZO. Interaction of Surface Type, Temperature, and Week of Season on Concussion Risk in the National Football League: A Bayesian Analysis. Epidemiology 2023; 34:807-816. [PMID: 37732833 DOI: 10.1097/ede.0000000000001657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND Artificial turf fields and environmental conditions may influence sports concussion risk, but existing research is limited by uncontrolled confounding factors, limited sample size, and the assumption that risk factors are independent of one another. The purpose of this study was to examine how playing surface, time of season, and game temperature relate to diagnosed concussion risk in the National Football League (NFL). METHODS This retrospective cohort study examined data from the 2012 to the 2019 NFL regular season. We fit Bayesian negative binomial regression models to relate how playing surface, game temperature, and week of the season independently related to diagnosed concussion risk and any interactions among these factors. RESULTS We identified 1096 diagnosed concussions in 1830 games. There was a >99% probability that concussion risk was reduced on grass surface (median incidence rate ratio [IRR] = 0.78 [95% credible interval: 0.68, 0.89]), >99% probability that concussion risk was lower at higher temperatures (IRR = 0.85 [0.76,0.95] for each 7.9 °C), and >91% probability that concussion risk increased with each week of the season (IRR = 1.02 [1.00,1.04]). There was an >84% probability for a surface × temperature interaction (IRR = 1.01 [0.96, 1.28]) and >75% probability for a surface × week interaction (IRR = 1.02 [0.99, 1.05]). CONCLUSIONS Diagnosed concussion risk is increased on artificial turf compared with natural grass, and this is exacerbated in cold weather and, independently, later in the season. The complex interplay between these factors necessitates accounting for multiple factors and their interactions when investigating sports injury risk factors and devising mitigation methods.
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Affiliation(s)
- James M Smoliga
- From the Department of Physical Therapy, One University Parkway, High Point University, High Point, NC
- Doctor of Physical Therapy Program (Seattle), Tufts University School of Medicine, Boston, MA
| | - Sameer K Deshpande
- Department of Statistics, University of Wisconsin, 7225B Medical Sciences Center, Madison, WI
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Reeschke R, Haase FK, Dautzenberg L, Krutsch W, Reinsberger C. Training matters: Heading incidence and characteristics in children's and youth football (soccer) players. Scand J Med Sci Sports 2023; 33:1821-1830. [PMID: 37259619 DOI: 10.1111/sms.14408] [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: 01/18/2023] [Revised: 04/03/2023] [Accepted: 05/15/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Concerns about short- and long-term consequences of repetitive heading contributed to heading restrictions in youth football in some countries. This prospective longitudinal cohort study aims to describe heading exposure in children's and youth football over two seasons using standardized video analysis. METHODS All matches and training sessions of a male Under-11 (n = 29), Under-15 (n = 28), Under-19 (n = 38), and female Under-17 (n = 39) team were videotaped during the seasons 2019-2020 and 2020-2021. Heading frequencies and characteristics were analyzed. Individual heading exposure is presented as average incidence rates (IR) per 1000 match/training hours. RESULTS In 275 matches and 673 training sessions, 22 921 headers were observed. Heading IR per player in matches was 1256 (Under-11 m), 1608 (Under-15 m), 1050 (Under-17 f), and 1966 (Under-19 m). In training sessions, IR per player was 739 (Under-11 m), 2206 (Under-15 m), 1661 (Under-17 f), and 1419 (Under-19 m). Five Under-15 males headed the ball five to eight times per training on average. Most headers were performed without heading duels. Flight distance was predominantly 5-20 m (54%) in matches and <5 m (65%) in training. While head impact location most frequently was at frontal areas, one-third of all headers in Under-11 in matches hit temporal, parietal, and occipital parts of the head. CONCLUSION Heading incidence was low in the youngest age group, whereas (predominantly five) Under-15 males showed very high heading exposures in training. In assessment and regulation of heading burden, training sessions and individual heading behavior should specifically be addressed. Recommendations for heading the ball in practice should account for individual and age-related differences.
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Affiliation(s)
- Rebecca Reeschke
- Institute of Sports Medicine, Paderborn University, Paderborn, Germany
| | | | - Lena Dautzenberg
- Institute of Sports Medicine, Paderborn University, Paderborn, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Claus Reinsberger
- Institute of Sports Medicine, Paderborn University, Paderborn, Germany
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Espahbodi S, Hogervorst E, Macnab TMP, Thanoon A, Fernandes GS, Millar B, Duncan A, Goodwin M, Batt M, Fuller CW, Fuller G, Ferguson E, Bast T, Doherty M, Zhang W. Heading Frequency and Risk of Cognitive Impairment in Retired Male Professional Soccer Players. JAMA Netw Open 2023; 6:e2323822. [PMID: 37459095 PMCID: PMC10352859 DOI: 10.1001/jamanetworkopen.2023.23822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/01/2023] [Indexed: 07/20/2023] Open
Abstract
Importance Although professional soccer players appear to be at higher risk of neurodegenerative disease, the reason remains unknown. Objective To examine whether heading frequency is associated with risk of cognitive impairment in retired professional soccer players. Design, Setting, and Participants A UK nationwide cross-sectional study was conducted between August 15, 2020, and December 31, 2021, in 459 retired male professional soccer players older than 45 years and registered with the Professional Footballers' Association or a League Club Players' Association. Exposure Data on heading frequency in 3 bands-0 to 5, 6 to 15, and more than 15 times per match or training session and other soccer-specific risk factors, such as player position and concussion-were collected through a self-reported questionnaire. Main Outcomes and Measures Cognitive impairment was defined using the Telephone Interview for Cognitive Status-modified as scores of less than or equal to 21. Hopkins Verbal Learning Test, verbal fluency, and independent activities of daily living were also assessed. Test Your Memory and physician-diagnosed dementia/Alzheimer disease were self-reported via the questionnaire. Adjusted odds ratios (AORs) with 95% CIs were calculated. Results Of 468 retired male professional soccer players who completed questionnaires (mean [SD] age, 63.68 [10.48]; body mass index, 27.22 [2.89]), 459 reported heading frequency: 114 headed 0 to 5 times, 185 headed 6 to 15 times, 160 headed more than 15 times per match, and 125 headed 0 to 5 times, 174 headed 6 to 15 times, and 160 headed more than 15 times per training session during their careers. The prevalence of cognitive impairment was 9.78% (0-5 times), 14.78% (6-15 times), and 15.20% (>15 times) per match (P = .51). Compared with players reporting 0 to 5 headers per match, the AORs were 2.71 (95% CI, 0.89-8.25) for players reporting 6 to 15 headers per match and 3.53 (95% CI, 1.13-11.04) for players reporting more than 15 headers per match (P = .03 for trend). Corresponding AORs for heading frequency per training session were 2.38 (95% CI, 0.82-6.95) for those reporting 6 to 15, and 3.40 (95% CI, 1.13-10.23) for those reporting more than 15 in comparison with those who reported 0 to 5 (P = .03 for trend). Concussion involving memory loss was also associated with a greater risk of cognitive impairment (AOR, 3.16; 95% CI, 1.08-9.22). Similar results were observed with other cognitive tests and self-reported physician-diagnosed dementia/Alzheimer disease. Conclusions and Relevance The findings of this study suggest that repetitive heading during a professional soccer career is associated with an increased risk of cognitive impairment in later life. Further study is needed to establish the upper threshold for heading frequency to mitigate this risk.
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Affiliation(s)
- Shima Espahbodi
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
| | - Eef Hogervorst
- NCSEM, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Tara-Mei Povall Macnab
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
| | - Ahmed Thanoon
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
| | - Gwen Sacha Fernandes
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bonnie Millar
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Ashley Duncan
- National Institute for Health Research ARC EM, University of Nottingham, Nottingham, UK
| | - Maria Goodwin
- NCSEM, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Mark Batt
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK
| | | | - Gordon Fuller
- Centre for Urgent and Emergency Research, University of Sheffield, Sheffield, UK
| | - Eamonn Ferguson
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- School of Psychology, University of Nottingham, Nottingham, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Tobias Bast
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- School of Psychology, University of Nottingham, Nottingham, UK
- Neuroscience@Nottingham, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Weiya Zhang
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, Academic Rheumatology, City Hospital, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
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9
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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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10
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Peek K, Versteegh T, Veith S, Whalan M, Edwards S, McKay M, Gardner AJ. Injury-Reduction Programs Containing Neuromuscular Neck Exercises and the Incidence of Soccer-Related Head and Neck Injuries. J Athl Train 2023; 58:519-527. [PMID: 36645836 PMCID: PMC10496449 DOI: 10.4085/1062-6050-0340.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
CONTEXT Concern is growing among soccer players, coaches, and parents regarding head and neck injuries, including concussion, particularly from heading a ball. Thus, we need to explore soccer-specific head injury risk-reduction initiatives. One such initiative is to condition the neck musculature of young players by adding neuromuscular neck exercises to existing injury-reduction exercise programs. OBJECTIVE To investigate the effect of neuromuscular neck exercises completed as part of an injury risk-reduction exercise program on the incidence of soccer-related head and neck injuries in adolescent soccer players. DESIGN Prospective cohort study. SETTING Two sports high schools and 6 soccer clubs during the 2021 soccer season. PATIENTS OR OTHER PARTICIPANTS A total of 364 male and female soccer players, aged 12 to 18 years. INTERVENTION(S) Members of 1 sports high school and 2 soccer clubs performed neuromuscular neck exercises as part of an injury-reduction program during training (neck training group). Members of another sports high school and 4 soccer clubs performed an injury-reduction program but without neck exercises (comparison group). MAIN OUTCOME MEASURE(S) Self-reported injury data were collected from each player at the end of the season and used to calculate incidence rate ratios (IRRs) with 95% CIs. RESULTS In total, 364 players completed the study, including 146 players in the neck training group and 218 players in the comparison group. Despite players in the neck training group being less likely to self-report a concussion (IRR = 0.23; 95% CI = 0.03, 1.04) and pain on heading a ball (IRR = 0.62; 95% CI = 0.34, 1.07), only a lower incidence of possible concussive events (IRR = 0.38; 95% CI = 0.14, 0.90; P < .05) was significant. CONCLUSIONS Integrating neuromuscular neck exercises into injury-reduction exercise programs has the potential to reduce the risk of adolescent soccer players sustaining a possible concussive event, concussion, or pain on heading a ball.
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, University of Sydney, New South Wales, Australia
| | | | - Stella Veith
- Centre of Medical and Exercise Physiology, School of Medicine, University of Wollongong, New South Wales, Australia
| | - Matt Whalan
- Centre of Medical and Exercise Physiology, School of Medicine, University of Wollongong, New South Wales, Australia
| | - Suzi Edwards
- Discipline of Physiotherapy, University of Sydney, New South Wales, Australia
| | - Marnee McKay
- Discipline of Physiotherapy, University of Sydney, New South Wales, Australia
| | - Andrew John Gardner
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
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11
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Ueda P, Pasternak B, Lim CE, Neovius M, Kader M, Forssblad M, Ludvigsson JF, Svanström H. Neurodegenerative disease among male elite football (soccer) players in Sweden: a cohort study. Lancet Public Health 2023; 8:e256-e265. [PMID: 36934741 DOI: 10.1016/s2468-2667(23)00027-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/15/2023] [Accepted: 02/02/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Football (soccer) players might be at increased risk of neurodegenerative disease, which has led to questions regarding the safety of the sport and recent measures introduced by football associations to reduce heading of the ball. We aimed to assess the risk of neurodegenerative disease among male football players in the Swedish top division Allsvenskan, compared with matched controls. METHODS In this cohort study, we identified all male football players (amateurs and professionals) who had played at least one game in Allsvenskan from Aug 1, 1924 to Dec 31, 2019 and excluded players whose personal identity number could not be retrieved or be identified in the Total Population Register, and those who were not born in Sweden and who had immigrated to the country after age 15 years. Football players were matched with up to ten controls from the general population according to sex, age, and region of residence. We used nationwide registers to compare the risk of neurodegenerative disease (diagnoses recorded in death certificates, during hospital admissions and outpatient visits, or use of prescription drugs for dementia) among football players versus controls. We also assessed each type of neurodegenerative disease (Alzheimer's disease and other dementias, motor neuron disease, and Parkinson's disease) separately, and compared the risk of neurodegenerative disease among outfield players versus goalkeepers. FINDINGS Of 7386 football players who had played at least one game in the top Swedish division between Aug 1, 1924, and Dec 31, 2019, 182 players were excluded for an unretrievable personal identity number, and 417 were excluded due to their number not being identified in the Total Population Register. After a further exclusion of 780 players and 11 627 controls who were born outside of Sweden and who had immigrated to the country after age 15 years, 6007 football players (510 goalkeepers) were included in the study population along with 56 168 matched controls. During follow-up to Dec 31, 2020, 537 (8·9%) of 6007 football players and 3485 (6·2%) of 56 168 controls were diagnosed with neurodegenerative disease. The risk of neurodegenerative disease was higher among football players than controls (hazard ratio [HR] 1·46 [95% CI 1·33-1·60]). Alzheimer's disease and other dementias were more common among football players than controls (HR 1·62 [95% CI 1·47-1·78]), significant group differences were not observed for motor neuron disease (HR 1·27 [0·73-2·22]), and Parkinson's disease was less common among football players (HR 0·68 [0·52-0·89]). The risk of neurodegenerative disease was higher for outfield players than controls (HR 1·50 [95% CI 1·36-1·65]) but not for goalkeepers versus controls (HR 1·07 [0·78-1·47]), and outfield players had a higher risk of neurodegenerative disease than did goalkeepers (HR 1·43 [1·03-1·99]). All-cause mortality was slightly lower among football players than controls (HR 0·95 [95% CI 0·91-0·99]). INTERPRETATION In this cohort study, male football players who had played in the Swedish top division had a significantly increased risk of neurodegenerative disease compared with population controls. The risk increase was observed for Alzheimer's disease and other dementias but not for other types of neurodegenerative disease, and among outfield players, but not among goalkeepers. Our study expands on the data that can be used to assess and manage risks in the sport. FUNDING Karolinska Institutet, The Swedish Research Council for Sport Science, Folksam Research Foundation, Hedberg Foundation, Neurofonden, and Åhlen Foundation.
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Affiliation(s)
- Peter Ueda
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Björn Pasternak
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Carl-Emil Lim
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Manzur Kader
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Forssblad
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Henrik Svanström
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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12
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Haase FK, Prien A, Douw L, Feddermann-Demont N, Junge A, Reinsberger C. Cortical thickness and neurocognitive performance in former high-level female soccer and non-contact sport athletes. Scand J Med Sci Sports 2023; 33:921-930. [PMID: 36746873 DOI: 10.1111/sms.14324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 01/03/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Long-term effects of playing soccer (football) on the brain structure and function of the brain are vividly debated. While some studies showed differences in neurocognitive performance and structural brain changes in retired male players, data on female players are scarce. The present study compares cortical thickness and neurocognitive performance in former high-level female soccer (SOC) and non-contact sport athletes (CON). METHODS 3 T T1-weighted 3D MPRAGE MRI was performed, and vertex-wise cortical thickness was analyzed using FreeSurfer (v. 6.0.0). Neurocognitive performance in seven domains of SOC and CON was assessed. A multivariate linear model was used to analyze interactions with respect to heading frequency and a history of concussion. RESULTS SOC (n = 15, mean age 38.3 ± 5.1 years) and CON (n = 16, mean age 36.6 ± 5.8 years) had a similar cortical thickness and performed similarly in the neurocognitive tests except for verbal memory and psychomotor speed, where SOC performed significantly worse than CON. Moderate headers had a significantly larger cortical thickness than rare headers in the right inferior parietal region. Visual memory and cortical thickness were positively correlated in the group of frequent headers and negatively correlated in CON, but not in the other header groups. PERSPECTIVE In contrast to previous reports in male soccer players, female players did not reveal cortical thinning in comparison with control athletes, whereas neurocognitive profiles of female soccer players might not significantly differ from male athletes. Small sample sizes, subjective header assessment, and the case-control study design require a cautious interpretation.
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Affiliation(s)
| | - Annika Prien
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany.,Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Linda Douw
- Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nina Feddermann-Demont
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Astrid Junge
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Claus Reinsberger
- Institute of Sports Medicine, Paderborn University, Paderborn, Germany
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13
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Peek K, McKay M, Fu A, Meyer T, Oxenham V, Esopenko C, Caccese J, Andersen J. The effect of ball characteristics on head acceleration during purposeful heading in male and female youth football players. SCI MED FOOTBALL 2022; 5:195-203. [PMID: 35077287 DOI: 10.1080/24733938.2021.1897657] [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] [Indexed: 10/22/2022]
Abstract
Objective: The objective of this cross-sectional study was to explore the effects of different ball types and characteristics on head acceleration during purposeful heading in youth football players. Methods: Experienced male and female players (n = 61) aged between 12-17 years completed heading trials with 4 different balls (Ball 1 mass 192 grams (g), pressure 5.0 pounds per square inch (psi); Ball 2 432 g, 5.0 psi; Ball 3 255 g, 5.0 psi; Ball 4 430 g, 10.5 psi) whilst wearing a head-mounted accelerometer and gyroscope. Balls 1, 2 and 4 were size 5 balls; Ball 3 was a size 4 ball.Results: Multivariate analysis of variance and post-hoc univariate analyses revealed a statistically significant difference between ball type and head acceleration during heading for both linear acceleration (adjusted R2 = 0.68; F = 140.90; p = <0.001) and angular velocity (adjusted R2 = 0.28; F = 26.52; p = <0.001). Ball 1 (lightest size 5 ball) and Ball 3 (size 4 ball) demonstrated linear head accelerations up to 59% lower (p = <0.01) when compared with Ball 4 (size 5 regulated match ball).Discussion: Head acceleration during purposeful heading is influenced by changes to ball pressure, ball size and/or ball mass. Changing ball characteristics, particularly in youth football training when heading is being taught, should be an easy strategy to implement.
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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, Australia
| | - Marnee McKay
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Allan Fu
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Medical Faculty, Saarland University, Saarbrücken, Germany
| | - Vincent Oxenham
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.,Department of Neurology, Royal North Shore Hospital, Sydney, Australia
| | - Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, Rutgers Biomedical Health Sciences, Newark, USA
| | - Jaclyn Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, USA
| | - Jordan Andersen
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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14
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Abstract
Purpose: To quantify the incidence and characteristics of purposeful headers and unintentional head impacts in football (soccer) in boys' football over three seasons.Methods: This retrospective longitudinal study analysed purposeful headers and unintentional head impacts collected over three seasons (under-10 to under-12) using match video analysis from boys' team in Australia. Total headers and head impacts, as well as incidence rate (IR) per 1000 match-hours for different match characteristics, were calculated.Results: Total number of headers and heading IR increased significantly (r = 0.99) with age from under-10 (n = 29; IR: 483) to under-12 (n = 149; IR: 1515). All but three players (87%) were observed to head the ball at least once during a season (mean: 10, range 0-25) with the accumulative number of headers performed by out-field players over three seasons ranging from 6 to 40. Players in defensive positions (n = 121) headed the ball more frequently than midfielders (n = 83) or attackers (n = 53). Five (IR: 22) unintentional head impacts were observed, of which four required medical attention.Conclusion: Although the number of headers performed by young players in under-10 to under-12 age groups was low, the range of headers performed by individuals varied greatly. These results could be used to guide age-specific heading coaching practices.
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, University of Sydney, Lidcombe, Australia
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Florian Beaudouin
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Marnee McKay
- Discipline of Physiotherapy, University of Sydney, Lidcombe, Australia
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15
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Peek K, Andersen J, McKay MJ, Versteegh T, Gilchrist IA, Meyer T, Gardner A. The Effect of the FIFA 11 + with Added Neck Exercises on Maximal Isometric Neck Strength and Peak Head Impact Magnitude During Heading: A Pilot Study. Sports Med 2022; 52:655-668. [PMID: 34590247 PMCID: PMC8480461 DOI: 10.1007/s40279-021-01564-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Higher neck strength has been postulated to reduce head impact magnitude during purposeful heading in football. OBJECTIVES This pilot trial explored the effect of a neck exercise programme on (1) neck strength and (2) head impact magnitude during heading in male and female adolescent football players. METHODS Boys and girls (aged 12-17 years) were randomised by team to the intervention (5 weeks of supervised neuromuscular neck exercises integrated into part 2 of the FIFA 11 + , completed three times per week) or the control group (usual part 2 of the FIFA 11 + , no neck exercises). Outcomes included isometric neck strength and head impact magnitude (peak linear acceleration and peak angular velocity) during standardised heading from a throw-in (at baseline and 6 weeks) plus completion of an evaluation survey by intervention players and coaches. RESULTS In total, 52 players (n = 31 intervention; n = 21 control) completed the study. Mixed-model analysis of variance (ANOVA) revealed significant differences in neck strength variables (p < 0.001), peak linear acceleration (p = 0.04) and peak angular velocity (p = 0.04) between the intervention and control groups over time. Intervention players demonstrated increases in mean composite neck strength (53.8% intervention vs 15.6% control) as well as decreases in mean peak linear head acceleration during heading (- 11.8% vs - 5.0%) from baseline to follow-up. Reduction in peak angular velocity was more pronounced in girls (- 27.7%) than boys (- 11.5%) in the intervention group. The addition of neck exercises into part 2 of the FIFA 11 + was feasible and accepted by players and coaches. CONCLUSION On average, players who completed neck exercises demonstrated an increase in isometric neck strength and a decrease in head impact magnitude during heading. These exercises were easily incorporated into usual training. Australian New Zealand Clinical Trials Registry (no: ACTRN12619001375145).
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown, Sydney, NSW, Australia.
| | - Jordan Andersen
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Marnee J. McKay
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown, Sydney, NSW Australia
| | - Theo Versteegh
- School of Physical Therapy, Western University, London, ON Canada
| | - Ian A. Gilchrist
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON Canada
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Medical Faculty, Saarland University, Saarbrücken, Germany
| | - Andrew Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia ,Hunter New England Local Health District Sports Concussion Research Program, Calvary Mater Hospital, Waratah, NSW Australia
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16
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Müller C, Zentgraf K. Neck and Trunk Strength Training to Mitigate Head Acceleration in Youth Soccer Players. J Strength Cond Res 2021; 35:S81-S89. [PMID: 33065700 DOI: 10.1519/jsc.0000000000003822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carsten Müller
- Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany.,University Sports, University of Münster, Münster, Germany; and
| | - Karen Zentgraf
- Department of Movement Science and Training in Sports, Institute of Sport Sciences, Goethe-University Frankfurt, Frankfurt, Germany
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17
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Dadashi E, Entezami P, De Tommasi C. Epidural hematoma from impact while zorbing. Brain Inj 2021; 35:1645-1646. [PMID: 34487474 DOI: 10.1080/02699052.2021.1973103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Injuries suffered while participating in extreme sports account for numerous emergency department visits. Isolated head injuries are a common presentation. Zorbing is an activity native to New Zealand. Like many emerging extreme sports there is little information regarding its safety. We conservatively managed a patient who suffered a skull fracture and epidural hematoma while zorbing. Publications (especially in the medical literature) are lacking regarding zorbing-related injuries. We hope that presenting this case will help elucidate the possibility of severe head injury despite the protective bubble offered by the sport.
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Affiliation(s)
| | - Pouya Entezami
- Department of Neurosurgery, Albany Medical Center, Albany, New York, USA
| | - Claudio De Tommasi
- Department of Neurosurgery, Christchurch Public Hospital, Canterbury District Health Board, Christchurch, New Zealand
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18
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Eye tracking to assess concussions: an intra-rater reliability study with healthy youth and adult athletes of selected contact and collision team sports. Exp Brain Res 2021; 239:3289-3302. [PMID: 34467416 DOI: 10.1007/s00221-021-06205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
Eye movements that are dependent on cognition hold promise in assessing sports-related concussions but research on reliability of eye tracking measurements in athletic cohorts is very limited. This observational test-retest study aimed to establish whether eye tracking technology is a reliable tool for assessing sports-related concussions in youth and adult athletes partaking in contact and collision team sports. Forty-three youth (15.4 ± 2.2 years) and 27 adult (22.2 ± 2.9 years) Rugby Union and soccer players completed the study. Eye movements were recorded using SMIRED250mobile while participants completed a test battery twice, with a 1-week interval that included self-paced saccade (SPS), fixation stability, memory-guided sequence (MGS), smooth pursuit (SP), and antisaccades (AS) tasks. Intra-class correlation coefficient (ICC), measurement error (SEM) and smallest real difference (SRD) were calculated for 47 variables. Seventeen variables achieved an ICC > 0.50. In the adults, saccade count in SPS had good reliability (ICC = 0.86, SRD = 146.6 saccades). In the youth, the average blink duration in MGS had excellent reliability (ICC = 0.99, SRD = 59.4 ms); directional errors in AS tasks and gain of diagonal SP had good reliability (ICC = 0.78 and 0.77, SRD = 25.3 and 395.1%, respectively). Four metrics were found in this study to be reliable candidates for further biomarker validity research in contact and collision sport cohorts. Many variables failed to present a sufficient level of robustness for a practical diagnostic tool; possibly, because athletic cohorts have higher homogeneity, along with latent adverse effects of undetected concussions and repetitive head impacts. Since reliability of a measure can influence type II error, effect sizes, and confidence intervals, it is strongly advocated to conduct dedicated reliability evaluations prior to any validity studies.
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19
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Gilbert AW, Bering JM, Anderson LC. Addressing head injury risk in youth football: are heading guidelines the answer? SCI MED FOOTBALL 2021; 6:340-346. [DOI: 10.1080/24733938.2021.1967435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Alexander W. Gilbert
- 133 Union Street East, Dunedin
- Centre for Science Communication, University of Otago, Dunedin, New Zealand
| | - Jesse M. Bering
- Centre for Science Communication, University of Otago, Dunedin, New Zealand
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20
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Asken BM, Rabinovici GD. Professional Soccer and Dementia Risk-The Ugly Side of the Beautiful Game. JAMA Neurol 2021; 78:1049-1051. [PMID: 34338741 DOI: 10.1001/jamaneurol.2021.2246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Breton M Asken
- Department of Neurology, University of California, San Francisco, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco, San Francisco
| | - Gil D Rabinovici
- Department of Neurology, University of California, San Francisco, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco, San Francisco.,Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco.,Memory and Aging Center, University of California, San Francisco.,Associate Editor, JAMA Neurology
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21
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Russell ER, Mackay DF, Stewart K, MacLean JA, Pell JP, Stewart W. Association of Field Position and Career Length With Risk of Neurodegenerative Disease in Male Former Professional Soccer Players. JAMA Neurol 2021; 78:1057-1063. [PMID: 34338724 PMCID: PMC8329793 DOI: 10.1001/jamaneurol.2021.2403] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Question What is the association of field position, career length, and playing era with risk of neurodegenerative disease in male former professional soccer players? Findings In this cohort study of 7676 Scottish male former professional soccer players and 23 028 general population control individuals matched by sex, year of birth, and area socioeconomic status, risk of neurodegenerative disease among former soccer players varied by field position and career length but was similar across era of participation. Meaning In this study, risk of neurodegenerative disease was higher among former professional soccer players with longer careers and among those in nongoalkeeper positions, indicating that factors associated with nongoalkeeper positions should be scrutinized to mitigate risk; meanwhile, strategies to reduce head impact exposure may be advisable to reduce negative outcomes in this population. Importance Neurodegenerative disease mortality is higher among former professional soccer players than general population controls. However, the factors contributing to increased neurodegenerative disease mortality in this population remain uncertain. Objective To investigate the association of field position, professional career length, and playing era with risk of neurodegenerative disease among male former professional soccer players. Design, Setting, and Participants This cohort study used population-based health record linkage in Scotland to evaluate risk among 7676 male former professional soccer players born between January 1, 1900, and January 1, 1977, and 23 028 general population control individuals matched by year of birth, sex, and area socioeconomic status providing 1 812 722 person-years of follow-up. Scottish Morbidity Record and death certification data were available from January 1, 1981, to December 31, 2016, and prescribing data were available from January 1, 2009, to December 31, 2016. Database interrogation was performed on December 10, 2018, and data were analyzed between April 2020 and May 2021. Exposures Participation in men’s soccer at a professional level. Main Outcomes and Measures Outcomes were obtained by individual-level record linkage to national electronic records of mental health and general hospital inpatient and day-case admissions as well as prescribing information and death certification. Risk of neurodegenerative disease was evaluated between former professional soccer players and matched general population control individuals. Results In this cohort study of 30 704 male individuals, 386 of 7676 former soccer players (5.0%) and 366 of 23 028 matched population control individuals (1.6%) were identified with a neurodegenerative disease diagnosis (hazard ratio [HR], 3.66; 95% CI, 2.88-4.65; P < .001). Compared with the risk among general population control individuals, risk of neurodegenerative disease was highest for defenders (HR, 4.98; 95% CI, 3.18-7.79; P < .001) and lowest for goalkeepers (HR, 1.83; 95% CI, 0.93-3.60; P = .08). Regarding career length, risk was highest among former soccer players with professional career lengths longer than 15 years (HR, 5.20; 95% CI, 3.17-8.51; P < .001). Regarding playing era, risk remained similar for all players born between 1910 and 1969. Conclusions and Relevance The differences in risk of neurodegenerative disease observed in this cohort study imply increased risk with exposure to factors more often associated with nongoalkeeper positions, with no evidence this association has changed over the era studied. While investigations to confirm specific factors contributing to increased risk of neurodegenerative disease among professional soccer players are required, strategies directed toward reducing head impact exposure may be advisable in the meantime.
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Affiliation(s)
- Emma R Russell
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Daniel F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Katy Stewart
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,Hampden Sports Clinic, Hampden Stadium, Glasgow, United Kingdom
| | - John A MacLean
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,Hampden Sports Clinic, Hampden Stadium, Glasgow, United Kingdom
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - William Stewart
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.,Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
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22
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Bretzin AC, Covassin T, Wiebe DJ, Stewart W. Association of Sex With Adolescent Soccer Concussion Incidence and Characteristics. JAMA Netw Open 2021; 4:e218191. [PMID: 33904911 PMCID: PMC8080231 DOI: 10.1001/jamanetworkopen.2021.8191] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/10/2021] [Indexed: 01/02/2023] Open
Abstract
Importance Because of the negative consequences of concussion, considerable research efforts have been directed toward understanding the risk factors for sport-related concussion (SRC) and its outcomes to better inform strategies for risk reduction. Girls are suggested to have an increased risk of concussion, warranting exploration into sex-dependent variations in concussion presentation and management, with the potential that this information might inform sex-specific rules directed toward risk reduction within sports. Objective To compare sex-associated differences in epidemiology and concussion management in adolescent soccer players within a prospective, longitudinal high school injury surveillance project. Design, Setting, and Participants This prospective, longitudinal cohort study assessed male and female soccer athletes from all high schools in the Michigan High School Athletic Association (MHSAA) during academic years 2016-2017 to 2018-2019. Exposures Sport-related concussion captured in the MHSAA Head Injury Reporting System. Main Outcomes and Measures Outcomes included details regarding each documented SRC event, including injury mechanism, immediate management, and return-to-play time. Multiple comparisons were made between male and female athletes regarding SRC risk, mechanism, short-term management, and outcomes. Results A total of 43 741 male and 39 637 female soccer athletes participated in MHSAA soccer during the 3 consecutive academic years of study (2016-2017: n = 751 schools; 2017-2018: n = 750 schools; and 2018-2019: n = 747 schools). During the 3 years of surveillance, 1507 of the 83 378 soccer athletes (1.8%) were reported to have SRC during soccer participation, including 557 boys (37.0%) and 950 girls (63.0%). Documented SRC risk in female soccer participants was greater than in male soccer participants (risk ratio, 1.88; 95% CI, 1.69-2.09; P < .001). Male soccer athletes most often sustained SRC from contact with another player (48.4%), whereas SRCs in female soccer players recorded in the Head Injury Reporting System were most often from nonplayer contact events (41.9%; P < .001). Adolescent male soccer players with a documented SRC were more likely to be removed from play on the day of injury (odds ratio, 1.54; 95% CI, 1.15-2.06; P = .004). Although the overall median time to return to play was 11 days (interquartile range [IQR], 7-15 days), male athletes typically returned 2 days earlier than female athletes (median, 10 [IQR, 7-14] days vs 12 [IQR, 7-16] days; Peto test P < .001). Conclusions and Relevance In this cohort study, sex-associated differences were revealed among adolescent soccer athletes in SRC risk, mechanism of injury, immediate management, and outcomes in injuries documented in a statewide injury reporting system. Thus, consideration might be given to sex-specific approaches to participation and concussion management in the sport.
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Affiliation(s)
- Abigail C. Bretzin
- Penn Injury Science Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing
| | - Douglas J. Wiebe
- Penn Injury Science Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - William Stewart
- Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
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23
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Beaudouin F, Demmerle D, Fuhr C, Tröß T, Meyer T. Head Impact Situations in Professional Football (Soccer). Sports Med Int Open 2021; 5:E37-E44. [PMID: 33718592 PMCID: PMC7946547 DOI: 10.1055/a-1338-1402] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022] Open
Abstract
To assess head impact incidents (HIIs) and to distinguish diagnosed head injuries from other incidents, a video observation analysis of match HIIs was conducted in the German Bundesliga (2017/18 season). Video recordings of each match were screened to identify the respective events. Head injury data were identified by a prospective injury registry. HII and head injury incidence rates (IR) were calculated with 95% CIs. The total number of HIIs was 1,362 corresponding to an IR of 134.9/1000 match hours (95% CI 127.9–142.2). In 123 HII (IR 12.2, 95% CI 10.2–14.5) the contact was classified as severe. Head contact with the opponent was the most frequent cause (85%). The most frequent mechanism was in 44% (combined) the arm and elbow-to-head, followed by head-to-head and hand-to-head contacts (each 13%). In 58%, the HIIs occurred during header duels. Twenty-nine head injuries were recorded (IR 2.9, 95% CI 2.0–4.1). Concussions/traumatic brain injuries accounted for 48%, head/facial fractures 24%, head/facial contusions 21%, and lacerations/abrasions 7%. The number of HIIs not classified as concussions/more severe trauma was high. Identification of HIIs and head injury severity should be improved during on-field assessment as many head injuries might go unrecognised based on the large number of HIIs.
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Affiliation(s)
- Florian Beaudouin
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Daniel Demmerle
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Christoph Fuhr
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Tobias Tröß
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
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24
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Holtzhausen LJ, Souissi S, Sayrafi OA, May A, Farooq A, Grant CC, Korakakis V, Rabia S, Segers S, Chamari K. Arabic translation and cross-cultural adaptation of the Sport Concussion Assessment Tool 5 (SCAT5). Biol Sport 2021; 38:129-144. [PMID: 33795922 PMCID: PMC7996381 DOI: 10.5114/biolsport.2020.97673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/25/2020] [Accepted: 07/17/2020] [Indexed: 11/18/2022] Open
Abstract
The aim was to create a Modern Standard Arabic SCAT5 version for different Arabic dialects. This translation and cross-cultural adaptation was performed in eight stages: initial translations, reconciliation of translations and cultural adaptation, back translation, appraisal of back translations, validation of the translation, review and adjustment by reconciliation committee, pretesting in 12 football players and document finalisation. As an alternative to the problematic Months In Reverse Order Test (MIROT) in Arabic, the Serial 3s test (32 Arabic and 30 English participants), the Days of the Week Backwards test (DWBT), and the 'Adding Serial 3s' test were tested (30 English and 30 Arabic participants) for accuracy, difficulty and time of completion. The Arabic SCAT5 was similar and comparable to the original English version (7-point Likert scales =< 2). Testing of the pre-final version of the Arabic SCAT5 took 20.4 (SD 3.4) and 17.7 (SD 3.0) minutes respectively to complete and was found acceptable in terms of clarity, understandability, grammatical correctness and coherence. The Arabic Serial 3s test (subtraction version) was unsuitable due to high completion time, low pass rate and high difficulty perception [time = 47.2 (SD 28.0) s; accuracy = 55.2%; difficulty = 3.2 (SD 1.1)]. The Arabic DWBT was too fast and undemanding for concentration testing [time = 4.6 (SD 1.5) s; accuracy = 90%; difficulty = 1.1 (SD 0.3)]. The Adding Serial 3s tests produced similar completion times [18.4 (SD 6.8) vs. 21.1 (SD 5.3), p = 0.088], accuracy (100%) and self-rated difficulty [English = 2.0 (SD 0.7) vs. Arabic-speaking participants = 2.1 (SD 0.8), p = 0.512] and was therefore adopted to replace the MIROT. This culturally adapted Arabic-SCAT5 questionnaire is the first concussion assessment tool available for Arabic-speaking healthcare providers and athletes. Sport Concussion Assessment Tool 5 (SCAT5). Biol Sport. 2021;38(1):129-144.
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Affiliation(s)
- Louis J. Holtzhausen
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Weil Cornell Medical College in Qatar, Doha, Qatar
- Division Sports Medicine, University of Pretoria, South Africa
- Department of Exercise and Sports Science, University of the Free State, Bloemfontein, South Africa
| | - Sofiane Souissi
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Omar Al Sayrafi
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Awartani May
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | | | | | - Safia Rabia
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Weil Cornell Medical College in Qatar, Doha, Qatar
| | - Souhaila Segers
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Karim Chamari
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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25
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Peek K, Vella T, Meyer T, Beaudouin F, McKay M. The incidence and characteristics of purposeful heading in male and female youth football (soccer) within Australia. J Sci Med Sport 2021; 24:603-608. [PMID: 33414022 DOI: 10.1016/j.jsams.2020.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/25/2020] [Accepted: 12/14/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To quantify the incidence and characteristics of purposeful headers and unintentional head impacts during male and female youth football (soccer) games in Australia. DESIGN Cross-sectional observational study. METHODS Ten match-videos (total n=110) per playing age (under 13-20 males; under 13-17 females) from the 2019 National Premier League season were coded for purposeful headers and unintentional head impacts. Total headers and head impacts as well as incidence rate (IR) per 1000 match-hours for different match characteristics were calculated. RESULTS Purposeful headers accounted for 99% (n=4615, IR:1618) of total head impacts. The IR of purposeful headers per 1000 match-hours was highest for under-15 males (IR:2117) and under-17 females (IR:2090) followed by under-20 males (IR:1761). Midfielders completed the most headers in all female age groups (mean IR:713) and under 13-14 males (mean IR:891), with defenders completing the most headers in under 15-20 males (mean IR:760). Heading duels accounted for 16% of total headers with most headers performed during free play (68%), throw-ins (15%), free kicks (12%) and corner kicks (5%). Only 57 head impacts (IR:20) were coded as unintentional head impacts resulting from being struck by the ball or opponent body part with 4 (IR:1.4) requiring medical attention. CONCLUSIONS Heading is a complex skill. Given the propensity of youth players of all ages to purposefully head the ball, consideration should be given to coaching heading technique based on specific game scenarios for their playing position and age group. The findings of this study can be used to inform heading guidelines.
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia.
| | - Teale Vella
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Medical Faculty, Saarland University, Germany
| | - Florian Beaudouin
- Institute of Sports and Preventive Medicine, Medical Faculty, Saarland University, Germany
| | - Marnee McKay
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia
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26
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Prien A, Feddermann-Demont N, Verhagen E, Twisk J, Junge A. Neurocognitive performance and mental health of retired female football players compared to non-contact sport athletes. BMJ Open Sport Exerc Med 2020; 6:e000952. [PMID: 33312682 PMCID: PMC7716672 DOI: 10.1136/bmjsem-2020-000952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 11/25/2022] Open
Abstract
Background Adverse long-term effects of playing football due to repetitive head impact exposure on neurocognition and mental health are controversial. To date, no studies have evaluated such effects in women. Aims To (1) compare neurocognitive performance, cognitive symptoms and mental health in retired elite female football players (FB) with retired elite female non-contact sport athletes (CON), and to (2) assess whether findings are related to history of concussion and/or heading exposure in FB. Methods Neurocognitive performance, mental health and cognitive symptoms were assessed using computerised tests (CNS-vital signs), paper pen tests (Category fluency, Trail-Making Test, Digit Span, Paced Auditory Serial Addition Test), questionnaires (Hospital Anxiety and Depression Scale, SF-36v2 Health Survey) and a symptom checklist. Heading exposure and concussion history were self-reported in an online survey and in a clinical interview, respectively. Linear regression was used to analyse the effect of football, concussion and heading exposure on outcomes adjusted for confounders. Results FB (n=66) performed similar to CON (n=45) on neurocognitive tests, except for significantly lower scores on verbal memory (mean difference (MD)=−7.038, 95% CI −12.98 to –0.08, p=0.038) and verbal fluency tests (MD=−7.534, 95% CI –13.75 to –0.46, p=0.016). Among FB weaker verbal fluency performance was significantly associated with ≥2 concussions (MD=−10.36, 95% CI –18.48 to –2.83, p=0.017), and weaker verbal memory performance with frequent heading (MD=−9.166, 95% CI –17.59 to –0.123, p=0.041). The depression score differed significantly between study populations, and was significantly associated with frequent heading but not with history of concussion in FB. Conclusion Further studies should investigate the clinical relevance of our findings and whether the observed associations point to a causal link between repetitive head impacts and verbal memory/fluency or mental health.
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Affiliation(s)
- Annika Prien
- Fakultät Humanwissenschaften, MSH Medical School Hamburg, Hamburg, Germany.,Amsterdam Collaboration on Health & Safety in Sports, Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Nina Feddermann-Demont
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,Swiss Concussion Center (SCC), Schulthess Klinik, Zurich, Switzerland
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands.,Department of Human Biology, Division of Exercise Science and Sports Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Jos Twisk
- Epidemiology and Biostatistics, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Astrid Junge
- Fakultät Humanwissenschaften, MSH Medical School Hamburg, Hamburg, Germany.,Swiss Concussion Center (SCC), Schulthess Klinik, Zurich, Switzerland
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27
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Russell ER, McCabe T, Mackay DF, Stewart K, MacLean JA, Pell JP, Stewart W. Mental health and suicide in former professional soccer players. J Neurol Neurosurg Psychiatry 2020; 91:1256-1260. [PMID: 32694163 PMCID: PMC8747033 DOI: 10.1136/jnnp-2020-323315] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/06/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There is growing recognition of an association between contact sports participation and increased risk of neurodegenerative disease, including Alzheimer's disease and chronic traumatic encephalopathy. In addition to cognitive impairment, a range of mental health disorders and suicidality are proposed as diagnostic features of traumatic encephalopathy syndrome, the putative clinical syndrome associated with chronic traumatic encephalopathy. However, to date, epidemiological data on contact sport participation and mental health outcomes are limited. METHODS For a cohort of former professional soccer players (n=7676) with known high neurodegenerative mortality and their matched general population controls (n=23 028), data on mental health outcomes were obtained by individual-level record linkage to national electronic records of hospital admissions and death certification. RESULTS Compared with matched population controls, former professional soccer players showed lower risk of hospital admission for anxiety and stress related disorders, depression, drug use disorders, alcohol use disorders and bipolar and affective mood disorders. Among soccer players, there was no significant difference in risk of hospitalisation for mental health disorders between outfield players and goalkeepers. There was no significant difference in rate of death by suicide between soccer players and controls. CONCLUSIONS Among a population of former professional soccer players with known high neurodegenerative disease mortality, hospital admissions for common mental health disorders were lower than population controls, with no difference in suicide. Our data provide support for the reappraisal of currently proposed diagnostic clinical criteria for traumatic encephalopathy syndrome, in particular the inclusion of mental health outcomes.
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Affiliation(s)
- Emma R Russell
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Thomas McCabe
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Daniel F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Katy Stewart
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Hampden Sports Clinic, Hampden Park, Glasgow, UK
| | - John A MacLean
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Hampden Sports Clinic, Hampden Park, Glasgow, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - William Stewart
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK .,Department of Neuropathology, NHS Greater Glasgow and Clyde, Glasgow, UK
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28
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Abstract
This article focuses on 3 concepts that continue to be investigated in the search for the holy grail of concussion-a valid diagnostic test. Imaging advances are discussed with optimism that functional MRI and diffusion tensor imaging may be available clinically. Biomarkers and the use of genetic tests are covered. Sideline accelerometer use may help steer discussions of head trauma risk once technology exists to accurately estimate acceleration of the brain. In the meantime, strategies including allowing athletes to be substituted out of games for an evaluation and video review in elite sports can improve recognition of sports-related concussion.
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Affiliation(s)
- Hamish Kerr
- Sports Medicine, Department of Medicine, Albany Medical College, 1019 New Loudon Road, Cohoes, NY 12047, USA.
| | - Bjørn Bakken
- Department of Medicine, Albany Medical Center, 1019 New Loudon Road, Cohoes, NY 12047, USA
| | - Gregory House
- Department of Family and Community Medicine, Albany Medical Center, 391 Myrtle Avenue, Albany, NY 12208, USA
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29
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Salvarani CP, de Medeiros LR, Sapatero FH, de Castro DC, Tomazini VS, Micheletti Sotocorno LH, Teixeira da Costa PS, Pimenta BB, de Oliveira DA, Dias EA, Colman da Silva EV. Concussion among soccer players in the 2017 Brazilian championship - the gap between protocol and medical practice. Concussion 2020; 5:CNC83. [PMID: 33204495 PMCID: PMC7653505 DOI: 10.2217/cnc-2020-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The present study aims to report traumatic brain injury (TBI) among soccer players in the 2017 Brazilian Soccer Championship and discuss the protocols for concussion evaluation. Materials & methods This is an observational study utilizing video analysis of 380 matches. TBI was considered as any event in which one or more soccer player(s) had a head trauma. For potential concussion diagnosis, we analyzed players with one of the following signs: slowness to get up, disorientation, motor incoordination, loss of consciousness, head clutching and impact seizure. Results There were 374 TBIs in total. The average time for medical assessment was 1'35". 13 players had concussion with an average time of 3'19″ for medical evaluation. Four players were replaced after having a concussion. Conclusion There is a gap between concussion protocols and medical practices in Brazilian elite soccer. Further discussion about soccer replacement rules are imperative.
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Affiliation(s)
- Cármine Porcelli Salvarani
- State University of Maringá, Medicine Department - Division of Neurosurgery, Avenida Mandacaru 1590, Bloco S 05, Sala 10, Hospital Universitário, Maringá, PARANÁ, CEP 87083-240, Brazil
| | - Lucas Ribeiro de Medeiros
- State University of Maringá, Medicine Department - Division of Neurosurgery, Avenida Mandacaru 1590, Bloco S 05, Sala 10, Hospital Universitário, Maringá, PARANÁ, CEP 87083-240, Brazil
| | - Fernando Henrique Sapatero
- State University of Maringá, Medicine Department - Division of Neurosurgery, Avenida Mandacaru 1590, Bloco S 05, Sala 10, Hospital Universitário, Maringá, PARANÁ, CEP 87083-240, Brazil
| | - Diego Ciotta de Castro
- State University of Maringá, Medicine Department - Division of Neurosurgery, Avenida Mandacaru 1590, Bloco S 05, Sala 10, Hospital Universitário, Maringá, PARANÁ, CEP 87083-240, Brazil
| | - Vinícius Simon Tomazini
- State University of Maringá, Medicine Department - Division of Neurosurgery, Avenida Mandacaru 1590, Bloco S 05, Sala 10, Hospital Universitário, Maringá, PARANÁ, CEP 87083-240, Brazil
| | - Leonardo Henrique Micheletti Sotocorno
- State University of Maringá, Medicine Department - Division of Neurosurgery, Avenida Mandacaru 1590, Bloco S 05, Sala 10, Hospital Universitário, Maringá, PARANÁ, CEP 87083-240, Brazil
| | - Paulo Sérgio Teixeira da Costa
- State University of Maringá, Medicine Department - Division of Neurosurgery, Avenida Mandacaru 1590, Bloco S 05, Sala 10, Hospital Universitário, Maringá, PARANÁ, CEP 87083-240, Brazil
| | - Bruno Bueno Pimenta
- State University of Maringá, Medicine Department - Division of Neurosurgery, Avenida Mandacaru 1590, Bloco S 05, Sala 10, Hospital Universitário, Maringá, PARANÁ, CEP 87083-240, Brazil
| | - Diego Almeida de Oliveira
- State University of Maringá, Medicine Department - Division of Neurosurgery, Avenida Mandacaru 1590, Bloco S 05, Sala 10, Hospital Universitário, Maringá, PARANÁ, CEP 87083-240, Brazil
| | - Eduardo Almeida Dias
- State University of Maringá, Medicine Department - Division of Neurosurgery, Avenida Mandacaru 1590, Bloco S 05, Sala 10, Hospital Universitário, Maringá, PARANÁ, CEP 87083-240, Brazil
| | - Eduardo Vinícius Colman da Silva
- State University of Maringá, Medicine Department - Division of Neurosurgery, Avenida Mandacaru 1590, Bloco S 05, Sala 10, Hospital Universitário, Maringá, PARANÁ, CEP 87083-240, Brazil
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30
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Cognitive Ageing in Top-Level Female Soccer Players Compared to a Normative Sample from the General Population: A Cross-sectional Study. J Int Neuropsychol Soc 2020; 26:645-653. [PMID: 32098636 DOI: 10.1017/s1355617720000119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is an ongoing debate on the potential negative effect of contact sport participation on long-term neurocognitive performance due to inherent exposure to concussive and subconcussive head impacts. The aim of the present study was to investigate whether cognitive ageing is exacerbated in elite soccer players compared to the general population. METHOD Neurocognitive performance in 6 domains was compared between 240 elite soccer players and a normative sample from the general population (n = 585) using the computerised test battery CNS Vital Signs. We used two-way factorial ANOVA to analyse the interaction between age groups (15-19, 20-29, 30-39, 40-49 years) and study population (female soccer players vs. norm sample) in their effects on neurocognitive performance. RESULTS We found no significant interaction effect of age group and study population in five of six test domains. For processing speed, the effect of age was more pronounced in female soccer players (F = 16.89, p = .002). Further, there was a clear main effect of study population on neurocognitive performance with generally better scores in soccer players. CONCLUSIONS Elite female soccer players generally performed better than the norm sample on tests of cognitive function, and further, cognitive ageing effects were similar in elite soccer players and controls in all but one domain. A lifespan approach may facilitate insightful future research regarding questions related to long-term neurocognitive health in contact sport athletes.
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31
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Abstract
Repeated purposeful heading in soccer has come under increased scrutiny as concerns surrounding the association with long-term neurodegenerative disorders in retired players continue to grow. Although a causal link between heading and brain health has not been established, the "precautionary principle" supports the notion that soccer governing bodies and associations should consider implementing pragmatic strategies that can reduce head impact during purposeful heading in youth soccer while this relationship is being investigated. This Viewpoint discusses the current evidence to support low-risk head impact reduction strategies during purposeful heading to protect young, developing players, and how such strategies could be implemented now while research and debate continue on this topic. J Orthop Sports Phys Ther 2020;50(8):415-417. doi:10.2519/jospt.2020.0608.
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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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Feddermann-Demont N, Chiampas G, Cowie CM, Meyer T, Nordström A, Putukian M, Straumann D, Kramer E. Recommendations for initial examination, differential diagnosis, and management of concussion and other head injuries in high-level football. Scand J Med Sci Sports 2020; 30:1846-1858. [PMID: 32557913 PMCID: PMC9290574 DOI: 10.1111/sms.13750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/09/2020] [Accepted: 06/04/2020] [Indexed: 12/22/2022]
Abstract
Head injuries can result in substantially different outcomes, ranging from no detectable effect to transient functional impairments to life‐threatening structural lesions. In high‐level international football (soccer) tournaments, on average, one head injury occurs in every third match. Making the diagnosis and determining the severity of a head injury immediately on‐pitch or off‐field is a major challenge for team physicians, especially because clinical signs of a brain injury can develop over several minutes, hours, or even days after the injury. A standardized approach is useful to support team physicians in their decision whether the player should be allowed to continue to play or should be removed from play after head injury. A systematic, football‐specific procedure for examination and management during the first 72 hours after head injuries and a graduated Return‐to‐Football program for high‐level players have been developed by an international group of experts based on current national and international guidelines for the management of acute head injuries. The procedure includes seven stages from the initial on‐pitch examination to the graduated Return‐to‐Football program. Details of the assessments and the consequences of different outcomes are described for each stage. Criteria for emergency management (red flags), removal from play (orange flags), and referral to specialists for further diagnosis and treatment (persistent orange flags) are provided. The guidelines for return to sport after concussion‐type head injury are specified for football. Thus, the present paper presents a comprehensive procedure for team physicians after a head injury in high‐level football.
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Affiliation(s)
- Nina Feddermann-Demont
- University Hospital and University of Zurich, Zurich, Switzerland.,Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Georges Chiampas
- US Soccer Federation, Chicago, IL, USA.,Departments of Emergency and Orthopedics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbruecken, Germany
| | - Anna Nordström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Margot Putukian
- University Health Services, Princeton University, Princeton, NJ, USA.,Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dominik Straumann
- University Hospital and University of Zurich, Zurich, Switzerland.,Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Efraim Kramer
- Division of Sports Medicine, University of Pretoria, Pretoria, South Africa
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Beaudouin F, Gioftsidou A, Larsen MN, Lemmink K, Drust B, Modena R, Espinola JR, Meiu M, Vouillamoz M, Meyer T. The UEFA Heading Study: Heading incidence in children's and youth' football (soccer) in eight European countries. Scand J Med Sci Sports 2020; 30:1506-1517. [PMID: 32335945 DOI: 10.1111/sms.13694] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022]
Abstract
To assess the real-life magnitude of the heading incidence in children's and youth' football in eight European countries with different "football cultures," a cross-sectional observational design, in which one match per team in 480 different teams from eight European countries (2017/18-2018/19), was recorded by video. One training session was recorded in 312 teams. Clubs with Under-10, Under-12 (female/male/mixed), and Under-16 female and male teams were eligible to participate. Heading frequencies and types were analyzed. Results are presented as headers per match/training and per team. Incidence rates (IR) per 1000 match/training hours were calculated. Under-10 teams carried out the lowest average number of headers per match (8.8), followed by Under-16 female (17.7), Under-12 (18.4), and Under-16 male (35.5). Total number of headers per match and team varied between countries. 80% of the total number of headers were single intentional headers, 12% heading duels, 3% unintentional headers by getting hit, and 5% others (trends apparent in all age groups). Three head injuries occurred during match play corresponding to an IR of 0.70 (95% CI, 0.23-2.16). The lowest number of headers per training and team was found in Under-10 (21.3), followed by Under-16 females (34.1), Under-12 (35.8), and Under-16 males (45.0). In conclusion, this large-scale study presents novel data about the number and type of headers in youth' football throughout Europe. A more precise understanding of the heading incidence, specifically in young players, is mandatory for the debate of restrictions on heading in youth football.
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Affiliation(s)
- Florian Beaudouin
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Asimenia Gioftsidou
- Department of Physical Education and Sport Sciences, Democritus University of Thrace, Komotini, Greece
| | - Malte Nejst Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Koen Lemmink
- Center of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Barry Drust
- Sport and Exercise Sciences, John Moores University, Liverpool, UK
| | - Roberto Modena
- CeRiSM Research Center Sport Mountain and Health, University of Verona, Verona, Italy
| | | | - Mihai Meiu
- Romanian Football Federation, Bucharest, Romania
| | - Marc Vouillamoz
- Union des Associations Européennes de Football (UEFA), Nyon, Switzerland
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
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Higher neck strength is associated with lower head acceleration during purposeful heading in soccer: A systematic review. J Sci Med Sport 2019; 23:453-462. [PMID: 31780360 DOI: 10.1016/j.jsams.2019.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/27/2019] [Accepted: 11/07/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To systematically review the literature to investigate the potential relationship between neck strength and head acceleration during purposeful heading in soccer. DESIGN Systematic review. METHODS Comprehensive search of five electronic databases: EMBASE, MEDLINE, CINAHL, SportsDiscus and Web of Science. Studies were included if they reported data on the relationship between neck strength and head impact and/or acceleration during purposeful soccer heading, published in English (or translation available). RESULTS From an initial search of 1174 potentially eligible papers, five cross-sectional studies met the eligibility criteria for inclusion in this review. Data from cross-sectional studies indicate that higher neck strength is associated with lower head acceleration during purposeful heading in soccer (p=<0.05; r<-0.5). CONCLUSION This review provides evidence that higher neck strength may lower head acceleration during purposeful heading in soccer. Further research is required to determine the most effective method to strengthen the neck musculature in soccer players.
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Ramkumar PN, Navarro SM, Haeberle HS, Luu BC, Jang A, Frangiamore SJ, Farrow LD, Schickendantz MS, Williams RJ. Concussion in American Versus European Professional Soccer: A Decade-Long Comparative Analysis of Incidence, Return to Play, Performance, and Longevity. Am J Sports Med 2019; 47:2287-2293. [PMID: 31303010 DOI: 10.1177/0363546519859542] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The incidence and effect of sports-related concussions (SRCs) within the global sport of professional soccer is poorly described. PURPOSE To comparatively examine the effects of SRC on athletes in Major League Soccer (MLS) and the English Premier League (EPL) in terms of incidence, return to play (RTP), performance, and career longevity. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Contracts, transactions, injury reports, and performance statistics from 2008 to 2017 were obtained and cross-referenced across 6 publicly available websites detailing MLS and EPL data, including official league publications. For each league, players who sustained a concussion were compared with the 2008-2017 uninjured player pool. RTP and games missed were analyzed and compared. Career length was analyzed with Kaplan-Meier survival curves. Player performance changes were evaluated before and after concussion. RESULTS Of the 1784 eligible MLS and 2001 eligible EPL players evaluated over the 10-year period, the incidence of publicly reported concussions per 1000 athlete-exposures was 20.22 and 18.68, respectively (P = .53). The incidence of reported concussions steadily increased in both leagues. MLS players missed a mean 7.3 games after concussion (37.0 days missed); EPL players missed a mean 0.6 games after concussion (10.9 days missed) (P < .0001, P < .0001). Statistical performance in terms of games started, assists, shots on goal, and total shots after concussion was significantly reduced at all nongoalie positions for players in the EPL; however, MLS nongoalie positions with concussion had no significant decreases in these categories. Goalies in both leagues had no significant change in performance or games started. The probability of playing a full season after concussion was not significantly decreased when compared with the uninjured pool in both leagues. CONCLUSION This study established the SRC incidence among elite soccer players in 2 international professional leagues and identified major RTP and performance differences between EPL and MLS players. While career longevity was unaffected, the approach to managing concussion as in MLS may better promote player safety and preserve on-field performance.
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Affiliation(s)
- Prem N Ramkumar
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Heather S Haeberle
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Bryan C Luu
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Albert Jang
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Lutul D Farrow
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Riley J Williams
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Liller KD, Morris B, Yang Y, Bubu OM, Perich B, Fillion J. Injuries and concussions among young children, ages 5-11, playing sports in recreational leagues in Florida. PLoS One 2019; 14:e0216217. [PMID: 31091293 PMCID: PMC6519825 DOI: 10.1371/journal.pone.0216217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background The specific research aims of this study included: 1) Conduct an epidemiologic analysis of recreational sports injuries among 1500 children, ages 5–11 in Florida: and 2) Utilize the computerized pediatric concussion tool from ImPACT Applications, Inc. for baseline and follow-up testing to better understand these injuries. This research followed a prospective surveillance design utilizing a large cohort of children, ages, 5–11, who play recreational football, soccer, and baseball/softball in Florida. The study venue was a large athletic facility in Hillsborough County, Florida. The sports observed were soccer (girls’ and boys’), baseball, softball, and football. Internal and external advisory boards were consulted throughout the study. Methods Certified Athletic Trainers (ATCs) were hired to use High School Reporting Information Online (RIO) for injuries and the Ipad-administered pediatric concussion tool developed by ImPACT Applications, Inc for baseline/follow-up concussion data. Results Over the course of the project, 26 RIO-reported injuries were reported. Football and soccer produced the greatest rate of injuries. There were 12 concussions which comprised nearly half of all the RIO injuries (46%). We conducted 882 baseline concussion tests and 13 follow-up tests over the 2 years. Conclusions To the best of our knowledge, this is the first time data have been collected and reported on sports injuries in the study population. Future studies built on these findings will allow for the development of targeted guidelines and interventions for coaches, players, and parents so sports injury-related morbidity and mortality decrease in our youngest athletes.
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Affiliation(s)
- Karen D. Liller
- University of South Florida, Tampa, Florida, United States of America
- * E-mail:
| | - Barbara Morris
- Florida Hospital, Wesley Chapel, Florida, United States of America
| | - Yingwei Yang
- University of South Florida, Tampa, Florida, United States of America
| | | | - Brad Perich
- University of South Florida, Tampa, Florida, United States of America
| | - Jessica Fillion
- University of South Florida, Tampa, Florida, United States of America
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