Soccer Head InjuriesNeed to Know for Referees

Julie Eibensteiner PT, DPT, CSCSUSSF A License

CONCUSSION

• Mild Traumatic Brain Injury (mTBI)– Caused by jolting movement of brain in skull– Literally causes brain to bounce around or twist in

skull stretching and damaging brain cells.– Causes chemical changes with brain as a result of

damage which make brain more sensitive to any increased stress.

– VIDEO

CONCUSSION

• All concussions are SERIOUS. There is no such thing as just a “DING” or “GETTING BELL RUNG”

• Less than 10% of concussions involve a loss of consciousness (LOC)

• LOC does not necessarily indicate “severity”• Recognition and proper management when

they first OCCUR is essential (and can be lifesaving)

How often do they occur?

• From 2001-2009 the rate of TBI in sports for athletes <19 yrs old increased 57%. (CDC)

• US: 3.8 million per year in sport/rec; 50% unreported (BJSM 2013)

• Concussions can occur in any sport• Highest rates occur in FOOTBALL & GIRL’S SOCCER (CDC)• Account for 10% of all injuries in HS sports. 22% of all

soccer injuries (World Neurosurg 2012)• <15 yrs old = less prevalent

Mechanisms of Injury• Head hitting another head or elbow• Blow to body / Hitting Ground (40-67%)• Hitting goalpost (1%)• Goalkeepers being kicked in head• Contact with Ball (13-18%)

• FEMALES > MALES• Youth = prolonged recovery• #1 risk factor – previous history + type of activity

What about Headgear?

• No conclusive evidence it works.• Does NOT protect again jolting motions to

body/neck.• VIDEO

• No conclusive evidence mouthguards reduce injury either (BJSM 2009)

AMSSM position statement: concussion in sport. (BJSM 2013)

• Primary prevention of some injuries may be possible with modification and enforcement of the rules and fair play.

• Helmets, both hard (football, lacrosse and hockey) and soft (soccer, rugby) are best suited to prevent impact injuries (fracture, bleeding, laceration, etc.) but have not been shown to reduce the incidence and severity of concussions.

• There is no current evidence that mouth guards can reduce the severity of or prevent concussions.

BJSM 2013

• A second blow before the brain has recovered results in worsening metabolic changes within the cell.

• Experimental evidence suggests the concussed brain is less responsive to usual neural activation and when premature cognitive or physical activity occurs before complete recovery the brain may be vulnerable to prolonged dysfunction.

Recognizing a Concussion

• Forceful blow to head or body causing rapid movement of head.

• ANY change in athlete behavior, thinking, or physical functioning.

Signs Observed

• Possible LOC (even brief)• Trouble with balance / Clumsy• Confused / Forgetful / Unsure• Answers Questions Slowly• Can’t remember events before hit • Can’t remember events after hit• Behavior/Personality Changes

Symptoms Reported By Player

• Headache or pressure in head• Nausea / Vomiting• Dizziness• Sensitivity to Light / Blurry Vision• Sensitivity to Noise• Groggy, feels “off”, dazed, foggy• Confused• Concentration / Memory Problems

Managing Athletes with Possible Head Injury

• Medical Emergency (activate EMS)– Unresponsive Player– Severe Neck Pain (assume neck injury, do NOT

move) – Signs of significant neurological deterioration (IC

Bleeding)

Managing Athletes with Possible Head Injury

• Remove from play (STATE LAWS)• NO SAME DAY Return to Play • Assessment by Health Care Provider trained in

concussions• Monitor for deteriorating physical/mental

status. • Document Observations - LOC, Seizures,

Balance, ETC.

Health Care Assessment

• Clinical Examination• Neuropsychological Testing • SCAT 2

• NP Testing should not be used in isolation• Overall Effectiveness still not clear

• COGNITIVE REST IS A MUST!!!

Return to Play (RTP)

• Stepwise Progression (physical demands, sport specific demands, risk demands)

• No symptoms at rest No symptoms with full activity

• If presents with symptoms return to previous non-symptomatic step.

• No specific timeline…could be weeks…months. Must have medical clearance.

Short Term Risks of Early RTP

• Decreased reaction time = susceptible to another head injury

Long Term Risks of Early RTP

• Chronic cognitive dysfunction• Cascading of neurological impairments

• 2nd IMPACT VIDEO 1• 2nd IMPACT VIDEO 2

DISQUALIFICATION FROM SPORT (BJSM 2013)

• There are no evidence-based guidelines for disqualifying/retiring an athlete from a sport after a concussion. Each case should be carefully deliberated and an individualized approach to determining disqualification taken.

Important Considerations for Referees

• Recognition of possible Head Injury• Stopping Play – be proactive• Initial Assessment of Player• Need for Medical Attention• Managing the Environment (time, coaches,

field, parents, players)• Coordination with Health Care Team (if

present)

WHEN IN DOUBT, SIT THEM OUT.

Julie Eibensteiner PT, DPT, CSCSjeibensteiner@laurusrehab.comwww.laurusrehab.com

Woodbury, MN