Concussion Prevention: Balancing Knee-Jerk Reactions with Accurate Medical
Concussions are serious. And the recent media attention given to them with
regard to the world of professional sport has created a beneficial “trickle
down” effect of prevention conversations taking place in nearly
every sport and at all levels. The great news is: concussive injuries
are getting the critical attention they deserve. But in a rush to ensure
protection for athletes, I worry that some proposed “concussion
protection” protocols are based less upon accurate scientific information
and more on knee-jerk reactions.
As an illustration, a recent JAMA Pediatrics study highlights the danger
in banning certain aspects of soccer play in an effort to reduce concussion
incidence in young athletes. Since the basic rules of soccer do not allow
for players to grab the ball with their hands, “heading” involves
the act of controlling or redirecting with the head, a ball that has become
airborne. Among soccer populations at nearly every level, heading is a
skill that is difficult to master but extremely important to the game.
Yet among soccer experts and enthusiasts, “headers” are widely
believed to be the leading cause of concussion in soccer players. As a
result, many experts have called for a ban on heading the ball in youth soccer.
But the author of the JAMA study cites a different, scientific perspective
for concussion injuries in youth soccer. She suggests that the forceful
player-to-player contact that often occurs during such header plays is
what is actually to blame for the concussions, not the sole act of the
head making contact with the ball. Now, one could argue that eliminating
headers would thus eliminate forceful and aggressive player collisions,
but that isn’t necessarily true and addressing the header alone
doesn’t lead us to the root of the problem or to the best possible
concussion protection for athletes.
Instead, the author offers that a focus on actual enforcement of existing
rules on rough play would be more likely to dramatically lower the concussion
rate, without changing the culture of the sport by eliminating heading
alone. This finding comes from an analysis of data collected over a nine-year
period. The data paints the picture of heading as the most concussion-prone
activity. Now, if the researchers stopped there, a ban on heading makes
sense. But they didn’t. Instead they dug deeper into each of those
heading-related concussions. What they found makes a big difference: up
to 78 percent of header-related concussions were attributed to body-on-body
contact between soccer players, not on the head’s contact with the
ball itself. With this additional information in mind, the question then
becomes: if heading is banned, is the danger of forceful body-on-body
contact eliminated? The answer is no.
While any attempts at concussion prevention are to be applauded, it is
important for us neurologists to help the public understand the science
behind these types of brain injury. Doing so aids in ensuring that players
in every sport and at any level, are appropriately protected from aspects
of play that are most likely to result in brain injury. But the conversations
have obviously started and it’s our job to ensure they’re
as productive as possible – for the protection and safety of every
athlete’s brain around the world.