Earlier this week, U. S. Soccer announced limitations on the use of headers in youth soccer as part of the resolution in a concussion lawsuit which was filed against U.S. Soccer, United States Youth Soccer Association, American Youth Soccer Organization, U.S. Club Soccer and the California Youth Soccer Association.

To help reduce concussions in youth soccer, a new initiative will be launched to focus on four areas that include prevention and education, according to a U.S. Soccer press release:

  • Education and awareness about concussions
  • Return -to -play protocols after a suspected concussion for youth players
  • Changes to substitution rules in the game so players can be evaluated for a concussion without fear of penalty
  • Banning heading the ball for children 10 and under and limiting its use in practice in the 11 to 13 age group.

It is important to note that while these rules will be mandated for the U.S. Soccer and the other defendants  and their youth teams and academies, for most local youth organizations where these organizations don't have jurisdiction, the new guidelines can only be recommendations. More specific details on this initiative will be coming in the next month.

The hope is that by restricting the use of headers in young players that not only will there be less concussions, but also less sub-concussive events, a new category that has emerged in the last five or so years, according to Brian Cammarota, a physical therapist and athletic trainer and partner at Symetrix Sports Performance.

"Sub-concussive events, or events that are not recognized or diagnosed as a concussion, are now being followed and researched to determine if they in fact lead to similar changes in the brain as a larger blow. Early research has shown that many multiple sub-concussive events show similar neurophysiological changes to the brain that are also experienced by an individual with a larger concussion.1,2,3,4 ," he explained.

"Most of the research is fairly new and performed on high school and college football players 1,2,3,4 thus there is certainly additional research that needs to be performed before a conclusive cause and effect can be established.  However, limiting the number of blows to the head regardless of the intensity may be just as important as limiting one much larger significant blow. "

Cammarota believes that limiting head balls among young soccer players is an excellent move to protect young developing brains and will likely help prevent brain injuries among soccer players.

"An important consideration to remember is the effect sport specialization is having on soccer and sub-concussive events.  Currently in the US, there are more players playing year round soccer than ever before. 15 years ago, we played soccer for 3 to 6 months than moved onto baseball, basketball or another sport.  With year round soccer, these players are never taking a break from head balls, their number of impacts to the head are likely double or triple of a player 15 years ago. Their brains may never truly recover," he said.

Dr. Steven Stache, Jr., a sports medicine physician at Rothman Institute who specializes in concussion management, also agrees that this new regulation is a good thing. "It is a step in the right direction to reduce concussions. Both education and decreasing the exposure rate are very important  because collision will always be a part of sports and there is no evidence that wearing protective gear makes a difference."

Dr. Stache, however, did note that while limiting the use of headers will reduce the number of concussions in youth players, it will not completely eliminate them from the sport. A recent study in JAMA Pediatrics that looked at the link between heading the ball and concussions in high school soccer found that reducing athlete-athlete overall contact during the game would be more effective.

How these new regulations will be policed at the local level and how this might change the way players are trained or the game is played probably won't be realized for awhile, but anything that protects our youth from serious brain injury is a win-win for players, parents and coaches alike.

Surprisingly though some online reactions to this news have been negative with people concerned about how it will affect the competitiveness of the game. Where do you stand on the limiting headers for our young players?

References

1)      Marchi N. Bazarian JJ. Puvenna V. et al.  Consequences of Repeated Blood Brain Barrier Disruption in Football Players. PLOS. 2011;39(4):843-50.

2)      Bazarian JJ.  Zhu T. Blyth BBorrino AZhong J.. Subject-specific changes in brain white matter on diffusion tensor imaging after sports-related concussion. MagnReson Imaging. 2012;30(2):171-80.
Doi 10.1016/j.mri.2011.10.001.

3) Breedlove EL. Robinson M. Talavage TM. Morigaki KE. Yoruk U. O'Keefe K. King J. Leverenz LJ. Gilger JW. Nauman EA. Biomechanical correlates of symptomatic and asymptomatic neurophysiological impairment in high school football. J Biomech. 2012 Apr 30;45(7):1265-72.
doi: 10.1016/j.jbiomech.2012.01.034. Epub 2012 Feb 28.

4) Talavage TM. Nauman EA. Breedlove EL. et al. Functionally-Detected Cognitive Impairment in High School Football Players without Clinically-Diagnosed Concussion.J Neurotrauma. 2014 Feb 15; 31(4): 327–338
doi: 10.1089/neu.2010.1512PMCID: PMC3922228

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