Keep Your Head in the Game

With concussion awareness and prevention at an all-time high, some sports are transforming their rules at the youth level.

Amid a sea of flailing appendages and twisted bodies, all frantically fighting for position in either blocking or opening a lane for the incoming corner kick, the great Cristiano Ronaldo sneaks into a small gap in direct line with the vector of the dappled ball. 

Transforming himself into a human projectile, Ronaldo springs head first and nearly parallel to the ground, striking the inbound missile with his neurocranium’s left parietal. The ricochet results in the ball sailing past all defenders and into the back of the net as the crowd roars its approval and astonishment.

The play helps Portugal eliminate Morocco from the 2018 World Cup and will further inspire the dreams of millions of children around the world. 

Ronaldo’s header, as a testimony to his own brilliance and uncommon athleticism, stands as just another day at the office for one of the world’s greatest soccer players. Ronaldo’s header also represents a simple fact of how soccer has always been played and perhaps always will, especially at the highest levels.

The good news is that millions of inspired children immediately raced outside to emulate Ronaldo’s acrobatics.

The bad news is that millions of inspired children immediately raced outside to emulate Ronaldo’s acrobatics.

And therein lies the conundrum for youth soccer in particular but organized youth sports in general. The manner in which the elites ply their trades at the highest levels of sport may enthrall the masses but may also encourage play that puts growing brains at risk.

Greater concerns over head injuries in sports have prompted a re-evaluation of our beloved pastimes and even a movement to alter their rules and the very manners in which they are played.

In the last decade, terms such as CTE (chronic traumatic encephalopathy) have become prominent in the lexicon of sport, especially contact sports such as football and even soccer and lacrosse. At all levels, the notion of concussion seems to be taken much more seriously than 20 years ago.

“We used to just think, ‘oh, you got your bell rung—shake it off and get back out there,’” says Vince Arnold, president of the Marion County Youth Football League. “But we know more about head injuries these days and see how serious these injuries need to be taken.”

According to the Centers for Disease Control and Prevention, the number of reported concussions in organized youth sports has doubled in the past 10 years, and emergency room visits for concussions in children ages 8 to 13 has doubled.

Not surprisingly, football earns the dubious distinction as leading all youth sports in terms of concussion rates among competitors, followed by ice hockey, soccer and lacrosse.

The most recent statistics compiled by Head Case Company Sports Concussion show that in football there were 64 to 76 concussions per 100,000 exposures (one exposure being an organized practice or game). In ice hockey, the number was 54, while in boys lacrosse 40 and girls soccer 33.

That football, with bodies colliding on every play, remains the highest risk is of little surprise to anyone, and the past decade has seen many rules changes in an attempt to minimize those risks. The concussion risks in soccer may seem a bit more subtle, but they are garnering much scrutiny recently.

A recent study published in Neurology claims that players who headed an average of 125 balls over two weeks were three times more vulnerable to concussion than players who headed less than four in that same time period.

Would the answer be to make heading illegal in soccer? While Ronaldo continues to dazzle crowds with header goals, it’s not ever likely to happen at the highest levels, but at the youth level, we are already there.

In 2015, the U.S. Soccer Federation, in response to a class-action lawsuit from parents of youth soccer players, issued new guidelines banning players under age 10 from heading the ball in practices and games. That rule is being taken seriously by local leagues.

“Heading is a critical part of the game,” says Josh Scroggie, president of Big Sun Youth Soccer League and a former Ocala Star-Banner Soccer Player of the Year. “The first year, the rule was implemented was extremely difficult. Those kids had been used to doing it, and now you’re telling them they can’t do it anymore. At first there was the thought that, ‘Oh, this is the end of soccer as we know it,’ but it really hasn’t been that big of a deal.”

For Scroggie and others, there was a fear that banning headers would lead to a greater amount of high kicks that can result in injury, but what may be happening is a better focus on developing other vital skills in the sport.

“At first, trust me, all the coaches were opposed (to the rule) and thought it was ridiculous,” says Scroggie. “But, like everything else, as time goes on, you accept it. It’s at a developmental stage for the kids—they’re not too concerned about the loss of game tactics. It’s hard to argue with it.”

For one local physician, the new rule banning headers is a welcome one. Dr. Howard Rogers works in the Children’s Emergency Department at Florida Hospital Ocala, and he has seen his share of youth sports injuries.

“The rule makes sense,” Rogers says. “I would say [heading] can be a relatively dangerous thing based on several factors, such as how fast the ball is coming in. I would support, from a medical perspective, the notion that heading the ball increases the risk for head injury, and it’s not worth it for a kid under 13 to try and develop that skill.”

For BSYSL, taking on the threat of head injuries means more than just banning headers for the young players but also instituting necessary protocols in terms of head injuries. For starters, one cannot become a certified coach or manager until a concussion protocol test administered by the Florida Youth Soccer Association has been passed. 

“We have our administrators do it as well,” Scroggie says. “To be on the board, you have to take it.”

BSYSL also follows the guidelines set forth by the CDC’s Heads Up Concussion program, which offers training to coaches and trainers. At tournaments, there is always at least one trainer on hand. Players who sustain a head injury or are even suspected of such are immediately removed from the game or practice and undergo evaluation.

Protocols are similar in the MCYFL, which last season boasted of over 1,200 participants. Coaches must be certified in teaching proper tackling techniques in which the head may not be used to lead or be the target. Penalties are assessed for “targeting” defenseless players in an effort to change the culture of the game.

“Teaching the proper, safe techniques is important at this level,” Arnold said. “The game of football is going to look different in the future, but I think it’s for the better.”

Dr. Rogers certainly agrees with that sentiment. He played football in high school and college and considers himself a “purist” in terms of how the game is played, but he welcomes changes that should make the sport safer.

“Football is a game of violent contact—it’s not a contact sport, it’s a collision sport,” Rogers said. “The challenge for the football purist is to figure out how to change the rules of the game but also preserve the game. The question is, ‘Are we preserving young peoples’ brains?’ People need to understand the fact that the game of football is looking different because they’re trying to prevent head injuries.”

So what is the world coming to? Young soccer players can no longer head the ball? Hard tackles draw penalty flags in football?

The concussion culture in sports will change the way sports look in the future, and it starts with the implementation of change at the level of organized youth leagues. MCYFL and BSYSL have certainly embraced changes, but no clear data is yet available as to whether these changes have made a discernible impact.

Perhaps the surest way to prevent head injuries in children would be to avoid organized sports altogether. This, however, would belie the nature of head injuries incurred in the everyday life of youth. According to the American Association of Neurological Surgeons, there are nearly twice as many head injuries resulting from cycling than from football.

Dr. Rogers says the majority of injuries that come through the emergency ward at Florida Hospital Ocala are not related to organized sports.

“Falling off playground equipment, falling on tile floors—we see more things like that,” Rogers said. “We can’t put them in bubble wrap. We can’t protect them all the time, but we want to be smart about how we approach something that is likely to cause a head injury.

“Do we sanction a sport in which a person can get a significant head injury? The answer is, of course, ‘yes’ at this point,” adds Dr. Rogers. “But they’re trying to decrease the head injuries that are there, and my hope, as a football fan, is that it’s successful. I don’t want these kids that we’re watching play having head injuries that will affect their cognitive abilities later on.”

Diagnosing A Concussion

There is no medical test to determine a concussion, which does not show on a CT scan or leave blood markers. According to Dr. Rogers, a concussion is diagnosed based solely on a person’s mentation or mental activity. 

“Perhaps they have a headache; perhaps they’re just not thinking right. I like to think that most of them have that glassy-eyed, just-woke-up look in their eyes. I typically see those football players on Friday nights and sometimes on Saturday mornings with MCYFL.”

Did you know? In soccer and other sports, girls have nearly twice the rate of concussions as boys and endure a significantly longer recovery time. At this time, there are only theories as to why this is the case. Those theories range from the difference in head sizes and strengths of necks to perhaps a girls’ greater willingness to report her injury.

Did you know? In high school sports, concussion rates as a percentage of total injury in football are lower than in girls soccer. According to the American Academy of Orthopaedic Surgeons, the concussion rate in high school football for 2014-2015 was 24.7 percent, but for girls soccer, it was 34.5 percent.

Did you know? In 2015, Florida became the first state to require concussion training for high school athletes. The Florida High School Athletics Association also conducts concussion baseline testing before each season to measure various cognitive functions in athletes. Any athlete suspected of a concussion then undergoes the test a second time for a comparative analysis, and that athlete is not allowed to compete again until test results are satisfactory.

Did you know? Each year there are up to 3.8 million sports-related concussions in the United States.

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