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Dr. Vernon Williams: Concussion Prevention: Balancing Knee-Jerk Reactions with Accurate Medical Information


Concussion Prevention: Balancing Knee-Jerk Reactions with Accurate Medical Information

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.