On The Pitch

Last year a new concussion testing system was released called Impact. A number of media outlets ran news stories that were quasi advertisements for the new system, but they still highlighted the dangers kids can face from concussions in youth sports:

Doctors have concluded that concussions are especially dangerous for children and teenagers and, as CBS News correspondent Trish Regan reports, that means more time on the bench for many young players.

Kerry Aldrich, 15, suffered a concussion playing varsity soccer for The Potomac School in McLean, Va., three weeks ago when she did a face-first dive and violent somersault. “I had a really bad headache,” Aldrich told Regan. “I could not concentrate during my classes. I was really dizzy, just tired the whole day.”

Her doctor, Gerard A. Gioia, Ph.D., a director of the Children’s National Medical Center in Washington, D.C., said it was time for her to take a timeout from the sport. “We don’t want athletes to be playing while they’re symptomatic,” Dr. Gioia said. “It’s very dangerous situation.”

Concussions, once considered minor conditions, are now being recognized as serious medical problems with potentially permanent consequences, Regan says.

Let me state right now that it really bothers me to read stories like the one from news outlets like CBS that come across as real news, that instead are just meant to advertise something. The CBS story makes it seem like this is all research vs. a commercial product that’s already on the market. But the Impact system is a for profit diagnostic product. At least the UPI story made it fairly clear they were writing about a commercial venture. But I digress.

One of the worst things about concussions is that many kids who have them don’t realize it and neither do their parents. This is why it can be so important for coaches to keep an eye out for injuries that likely could have caused concussions. Another little known fact about concussions is that girls are much more likely to suffer them than boys are. A NY Times article did a great job highlighting the risks with some real life examples:

According to the study to be published in the Journal of Athletic Training, football has the highest rate of concussions in high school sports, with 47 such injuries per 100,000 player games or practices. Girls soccer was second highest with 36 per 100,000, followed by boys soccer (22) and girls basketball (21).

Most soccer concussions are caused by hard falls to the ground or collisions with other players. Heading the ball is not a primary cause, studies have determined, because the impact is not of sufficient force to send the brain crashing into the skull.

Attempts at heading do engender many concussions, however, as players’ heads collide in battles for the ball. This has led to the increased use of padded headbands designed to lessen the forces of many blows, but their effectiveness remains the subject of debate.

One study published this summer said that such headgear appeared to reduce concussions among soccer players, but some coaches and doctors fear that their use could foster more aggressive play. Hannah Stohler said she wore one only temporarily. “It was really distracting,”? she said, “and I didn’t feel it was going to make much difference.”?

Recognizing the risks and how prevalent concussions are in youth sports, the CDC put together a fantastic coaches kit to help education coaches about concussions:

Concussions can happen to any athlete-male or female-in any sport. Concussions are a type of traumatic brain injury (TBI), caused by a blow or jolt to the head that can range from mild to severe and can disrupt the way the brain normally works. Coaches, athletic directors and trainers play a key role in helping to prevent concussion and in managing it properly if it occurs.

To reduce the number of this type of injury, the Centers for Disease Control and Prevention (CDC), with the support of partners and experts in the field, has developed a tool kit for coaches titled, Heads Up: Concussion in High School Sports. This kit contains practical, easy-to-use information including a video and DVD featuring a young athlete disabled by concussion, a guide, wallet card and clip board sticker for coaches, posters, fact sheets for parents and athletes in English and Spanish, and a CD-ROM with downloadable kit materials and additional concussion-related resources.

You can order the kit on DVD, or view the materials and videos online. They also provide PDF stickers and posters for coaches which are ideal for soccer leagues to hand out. The Coaches Guide provides a wealth of valuable information. The National Academies Press also has a booklet about concussions in youth soccer: Is Soccer Bad for Children’s Heads?. Just create a free account to download and view the PDF.

So if you coach youth soccer, especially at the older age levels where the speed and intensity is high, you really need to educate yourself about concussions, recognizing events that may have caused them, and watching for symptoms.

Now about the Impact test…

Concussion diagnosis has always been imprecise given the wealth of symptoms that can indicate a concussion or something else. The Impact test is different because it requires all athletes to have a ‘baseline’ evaluation done when they are healthy. Once a player is injured, they take a 2nd ‘post injury’ test and the results compared to the baseline results to see if a player has a concussion or not. Subsequent tests can be used to track a players recovery and allow trainers and doctors to better understand when a player is really ‘ready’ to return to play.

Obviously I’m not qualified to make a judgment on the effectiveness something like this. On the surface it makes a lot of sense. But it’s important to realize that using the system means every one of your players has to have a baseline test performed. This can represent a sizable expense, especially if you’re a youth soccer club. I personally don’t like Impact’s price structure. ‘Non-academic’ organizations like competitive level youth soccer leagues would need to pay $10 per player to have a baseline test done. Yet schools (high schools and colleges) only pay around $1-$2 per test. This may be due to schools having trainers that can be trained and lower support costs, but the price difference seems pretty drastic. Both types of organizations are non-profit. Why an academic institution merits such a drastic discount is puzzling.

Of course, given the annual cost of top level competitive youth soccer, $10 per player is a small expense.

Are any select youth leagues out there using the Impact system? I would expect many high schools and colleges to, but I wonder if even the most organized youth leagues would be able to implement a program to evaluate all their players for baseline readings.

So if you coach a team or administer a league, be sure to download the CDC materials and share them with your peers! Your kids will be glad you did!