CYSA - District 8 
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Player Health & Safety







             

The sport of soccer has a common problem that exists with many contact sports, the risk of concussions.  This nationwide problem was recognized by US Youth Soccer in 2011.  US Youth Soccer took steps to partner with the Center for Disease Control, in placing CDC information on concussions on their web site.

Concussions have been a relatively unknown factor for soccer coaches, as the topic has essentially never surfaced.  This does not mean that concussions have not existed in soccer, it just simply means that concussions may have not been diagnosed, or handled based on incomplete/false assumptions.  Leagues for the most part may not have provided information to coaches, parents, or themselves, for learning how to identify and properly handle a player with a concussion, as the information was not easily available in the past.  This serious topic has escaped the limelight for years.  The same has existed in other sports.  The focus on concussions was brought to the attention of the public through many stories surfacing from the NFL, regarding concussions to football players, and related corresponding research.  This has led to increasing awareness and protective measures applied to protect players of the National Football League (NFL).  There has also been movement in various state legislative bodes to pass laws regarding concussions (California has passed AB 25 and has a second bill in the works, aimed directly at high school coaches, requiring more training, AB 1451, which goes into effect in January, 2013).

The reason for increased awareness and discussion of concussions is based on the medical communities increased focus on concussions, which began in the mid 2000's.  There has been a widespread collection of statistics, and individual victims commentaries that have been documented, in increasing numbers.  What has become of concern is what is happening to youths playing sports.  It has been documented that a youth player is at a much higher risk when a concussion occurs.  The age old statement that a youth player will 'grow out of it' does not apply to concussions.  A developing youth brain is more susceptible to future impaired brain functions, if a concussion is not handled properly.  A concussion can hinder the normal development of a youth brain. 

The vast majority of soccer coaches, parents, and soccer league administrators grew up during a time period when the general thought was 'play on'.  Getting your 'bell rung', or getting 'knocked silly', were just acronyms which acknowledged the hit, with little understanding of what the hit could mean to the players health.  In addition to this atmosphere, players were given the impression that not playing due to an injury was frowned upon.  The team 'needed you', and unless you could not stand, walk, or run, you could play.  The current medical knowledge on concussions is in total contrast to this.  The theme now is 'when in doubt, sit them out'.  For a parent/coach, who played sports 'in the day', this can be a challenging item to deal with.  Their past playing experience, and the past attitude towards injuries, may cloud their judgment on handling a concussion situation.  They may not want their son/daughter to appear 'weak', be called a 'sissy', or worst, may be afraid of losing a spot on the team, or playing time  This same frame of thought applies to the youth players, who do not want to 'disappoint' their coach/parent/team.  All parties must be educated on concussions.

All parties must come to the realization that the protection of the players health, and their future life, is way more important than the outcome of any particular game, or a player just playing in a game, on any particular day.

What is a concussion? 

¨ A concussion is a brain injury, sometimes referred to as traumatic brain injury (TBI).  Communications pathways within the brain become damaged, causing impairment of brain functionality.  It can cause current and future problems with the health of an individual, depending on treatment and severity.

What can cause a concussion? 

¨ A blow to the head

¨ A violent collision with another player, goal post,  or the ground.

¨ Being struck in the head by a ball

¨ An improper snap of the head, attempting to head a ball

¨ See brain reaction here



The concussion is caused by the violent whiplash shaking of the brain inside of the skull.  A concussion is  often considered an invisible injury.  It is possible for a player to have a concussion, but to show no immediate signs/symptoms of one.  There is a false misconception that a person blacks out when they get a concussion. This is not correct, as a person can receive a concussion and not black out.  It simply depends on the person and the circumstances of the concussion.  A concussion is a Traumatic Brain Injury (TBI).   
All concussions are serious and must be reviewed by medical personnel.


 

 

 

 

 

 

 

 

 



The following videos will provide concussion information, from the victims view:

 High School Player 

Comeback player

Don-t Hide It, Report it! #1


Don't Hide It, Report it! #2 

 
How do you tell if a player has suffered a concussion?


                   Concussions can be interpreted through 'signs', or 'symptoms'.  The concussion 'signs' are visible by observing the player.  Concussion 'symptoms' are what the player is feeling, which has to be reported to the coaching staff.  Some 'signs', such as vomiting, or foaming at the mouth (a critical situation, requiring immediate medical attention) are visible, if they occur on the field.  Some of the symptoms may occur away from the field, requiring that the player report these items to either coach or parents.



 
What do you do if a concussion is suspected in a player?

Review the signs/symptoms that a player may have.  One field test is to mention something to a player and have them walk to the furthest flag pole on the field and back.  Ask them to repeat what was mentioned to them, before they took the walk.  This could give an indication of how the brain is processing information, and memory retention.  If they do not recall what was spoken about, they are done playing for the day.  In all cases where it is felt that the player may have a concussion, the player should be immediately pulled from play.  You may ask them questions that they should know:

     What city are they in
     What field are they at
     How did they get to the field
     What is the name of their team
     What is the name of their father/mother
     What position do they play on the team

For younger children, asking questions may pose a problem, as depending on the severity of the concussion, they may be crying, or generally upset.

The current recommended procedure is that the player should not be allowed to play unless they have a written document from a medical professional, releasing them to play.  This will also depend on any policies or procedures that the league/club has for handling concussions.  Players pulled from play for a suspected concussion should be closely watched by their parents.  It is possible that the full impact of a concussion could occur after the game is well over.  This could be the result of progressive damage occuring in the brain, which might manifest itself at a later time point.  If the player has previously taken a baseline test, (see the 'baseline testing' section for more information) prior to the season starting, a physician could have another baseline test taken and then compare the preseason test with the post concussion test.  This would enable the doctor to immediately identify any issues with the brain.

What should a coach NOT do, if a youth player is suspected of having a concussion

A coach should not indicate through body expressions that they are upset that the player is not in the game.  They should not vocally indicate to anyone on the sideline that they 'need/could use' the player back in the game, or that there is now a 'problem' playing.  Youth players are heavily influenced by their coaches, and they don't want to disappoint them, or feel that they are letting the team down.  In rare instances, they may feel that their ability to play on the team might be jeopardized if they stay out of the game.  The player may not tell the coach exactly how they are feeling, if they are thinking any of those items.  If sitting out, 'under watch', they may state that they are feeling o.k., when they are really not, just to get back into play.  The coach needs to insure that they have an atmosphere where a youth player feels comfortable about telling their coach exactly how they feel.  This is an item that a coach should emphasize during the season, for practices, and for games.  This is an item that should be discussed with the team before the first practice takes place.  The youth player should understand that is it o.k. to tell about items that may be affecting their health on the field, and ability to play.  The coach plays a key part in creating and encouraging this atmosphere.  The player should be aware that it is o.k. to sit the game out, if there is potential that they may have suffered a concussion.

Concussion Baseline Testing

          
US Youth Soccer (USYS) has partnered with Axon Sports to provide baseline testing for players.  USYS players get a 15% discount on their tests, if purchased individually.  It is possible that a league/club can get a larger discount by purchasing a package for their usage.  Axon is also partnered with the Mayo Clinic, a nationally/internationally known medical facility, which is heavily involved in concussion research and education.  

            Baseline testing thru Axon involves a test taken through the usage of the internet with the player using their own computer system.  This test uses various methods to test brain functionality.  The results of the test gives a snapshot of how the brain is processing and responding to information, at that point in time.  If a concussion occurs, a 'post-concussion' baseline test is taken.  A physician can then compare the preseason test with the post-concussion test.  Differences in the test can inform the physician as to any issues with the brain and help to determine needed treatment.  This is a tremendous asset to the physician in prescribing the correct treatment path, and determing the severity of the concussion.  In major league sports, it is now virtually mandatory that an athlete get baseline tests done.  This has also started to migrate its' way into some high school concussion programs.  The reality is that a baseline test taken prior to the start of a season is a major safety item for a player.  It can be used to quickly determine the health of the brain.

The following items are information relating to the Axon baseline testing program:

          USYS Partnership With Axon

          Axon Baseline Testing FAQS

          Axon Baseline Testing Parent Flier

          Axon Baseline Testing League/Club Flier

          Axon Cognitive Baseline Test Video

          Mayo Clinic Baseline Testing Video


The following videos describe concussion symptoms and signs:


    
What are the symptoms of concussion

    
Difference Between Signs Of A Concussion And Symptoms

    
Recognizing Sports Concussions:  Keep Youth Athletes Safe  (13 min., very good)

What are the consequences of a player continuing to play with a concussion?

It has been identified that young children are more susceptible to problems from concussions, due to the developmental stages of their brain.  There is also a condition termed ‘second impact syndrome’ (SIS), which can affect anyone with a concussion.  This occurs when a party that has received a concussion receives another concussion, before the brain is allowed to heal.  This can happen immediately, with a hit causing a second concussion, or it can happen at another close time point.  The key to SIS injuries is that the first concussion was not handled properly, the player did not receive medical review, and that the brain was not given a time to rest and recover.  This can delay recovery, and could potentially cause long-term health consequences, or can include death.  Concussions are essentially nothing to be trifled with, and definitely not ‘toughed out’. 

When to seek immediate medical attention:

If any of these symptoms appear, it is time for a hospital visit, immediately:   

    • Headaches that worsen
    • Seizures
    • Neck pain
    • Foaming at the mouth
    • Very drowsy, can't be awakened
    • Repeated vomiting
    • Increasing confusion or irritability
    • Weakness, numbness in arms and legs
    • Unable to recognize people/places, less responsive than usual

Post-concussion syndrome 

A post-concussion syndrome can develope when concussions symptoms persists for weeks/months.  These are recurring symptoms, such as headaches or dizziness.   An individual with post-concussion syndrome may exhibit symptoms of a person having Attention Deficit Disorder, Adjustment disorder, or a mood disorder.  There have been reports of sufferers reporting memory and socialization problems, frequent headaches and personality changes.

               Trait Displayed

 Attention deficits, difficulty sustaining mental effort          
 Fatigue and tiredness
 Impulsivity, irritability
 Low frustration threshold
 Temper outbursts and changes in mood
 Learning and memory problems
 Impaired planning and problem solving
 Inflexibility, concrete thinking
 Lack of initiative
 Dissociation between thought and action
 Communication difficulties
 Socially inappropriate behaviours
 Self-centeredness and lack of insight
 Poor self-awareness
 Impaired balance
 Dizziness and Headaches
 Personality changes

 

Standard tests typically do not show any form of brain damage.  A person with Post-concussion syndrome may be considered to be a 'hot head', having a 'short fuse', or as having either a mood disorder or anger problem, or as having a personality or psychological disorder.

Case example video.

The following site has demonstrative information on parties that have suffered from Post-concussion syndrome:   http://www.sportsconcussions.org/ibaseline/
 






                                                                    


The Centers for Disease Control and Prevention (CDC)  has concussion information posted on their site at http://www.cdc.gov/concussion/HeadsUp/youth.html.  They give comprehensive information on concussions, with links to other sites also. 

There are specific packages tuned to coaches, players, and parents, giving information that they need to diagnose concussions.  The following lists the Concussion ‘fact sheet’, from the CDC, for each soccer party 

For Coaches: http://www.cdc.gov/concussion/pdf/coaches_Engl.pdf

For Parents: http://www.cdc.gov/concussion/pdf/parents_Eng.pdf

For Players: http://www.cdc.gov/concussion/pdf/athletes_Eng.pdf

The above information comes from the training packages that the CDC has put together, which contain a wealth of information on concussions.  The following shows the packages and the materials in each package on the CDC site:

                           

The CDC site has an excellent training material, available on-line, and on a training disk that you can request.  This disk must be ran on a computer. 

Review the offered material at http://www.cdc.gov/concussion/HeadsUp/online_training.html .  If you wish to request the training material on disk, send a request to: 

     ncipcdirinfo@cdc.gov

     Use a subject line with the following:  Request For Training Disk
 
If you want to take the on-line test, go to here

It is possible for a league to develop a program which includes this test as part of coaching requirements.  When the test is completed, a certificate is made available to the test taker.  A league could require a coach to submit this certificate, to show that they have taken a concussion awareness test.  The league could develop other classroom presentations to augment this course, for a broader concussion perspective.

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US Youth Soccer

On the US Youth Soccer education site, you can take the CDC concussion course on-line, through US Youth Soccer.  This course has a certificate that you get when you have  completed the course.  You must be a registered user on the US Youth Soccer site, or you may register when logging in:  The following shows the screen presented, and what you need to do for registration:

Go to the following site to register/log-in
:
     https://education.usyouthsoccer.org/





After you have registered, you may log in and select the concussion course.  You do not have to complete the course all at once, as the site tracks and keeps your progress.  When you log in, it will show you the course(s) that you are taking and your progress in the course, as follows:


LOGIN WINDOW:







COURSE HISTORY WINDOW:





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Mayo Clinic

The Mayo Clinic, a national/international medical center, also has information on concussions, here, and participates in concussion research.

Diagnosing and Treating Sports-Related Concussions

Concussion In Children: What Are The Effects


The Mayo Clinic has also started up a new Facebook page, for sharing concussion information:
     Mayo Facebook
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Neurosurgery Experts Discuss Concussions

The topic of concussions is being actively discussed in the neurosurgery departments of hospitals, as indicated by this write-up.

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National Institutes of Health (NIH)

The National Institutes of Health (NIH) has a nice brochure on TBI, named 'National Institute of Neurological Disorders and Stroke'.  This is a an intensive document on Traumatic Brain Injuries, found here.

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Neuroscience For Kids

A document that outlines concussion issues for youth soccer players.
here

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WebMD:  Girl's Soccer:  Concussion Risk

Discussion surrounding concussion risks pertaining to female soccer players.
here

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National Institutes of Health (NIH)

The National Institutes of Health (NIH) has a nice brochure on TBI, named 'National Institute of Neurological Disorders and Stroke'. This is a an intensive document on Traumatic Brain Injuries, found here.

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momsTEAM

A site that has sports information for parents.  On their 'Health & Safety' page, they have a Youth Sports
Safety Center' section, which gives information on concussions.
here

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Congressional Brain Injury Task Force

A federal congressional committee that is tasked on investigating concussions in society.
here

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National Athletic Trainers Association

The athletic trains association is comprised of athletic trainers, those sought after individuals who staff
game sidelines to evaluate and assist athletes of all sports regarding sports injuries.  Their web site,
here, has an excellent video entitled 'If In Doubt, Sit Them Out', which goes through concussions from
beginning to end, using professional athletes here
 

The following are other good videos produced by the NATA:

The Importance Of Athletic Trainers

Heads Up - Football Injuries

Concussions In Football

NOTE:  The videos on football above are not totally inclusive only to football.  When soccer
players challenge each other in heading the ball, or in some kicking situations, they place
their bodies in a precarious position in the same manner as a football player.  Concussions
do not discriminate due to the type of sport being played.

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Sportconcussions.com

This site has information on baseline testing.
here






What leagues need to review regarding concussions


The following portrays a common soccer incident

 

  • What rules/procedures does the league have in handling a potential concussion situation? 
  • Have coaches been shown information that will enable them to protect the safety of their players, by being able to better identify a concussion and take action on it?
  • With concussions, it is paramount that all parties concerned, coaches, parents, and players, are made aware of the signs of a concussion.  What has been done to insure that this has happened?
  •  Does the league maintain a library of concussion related information for presentation at registrations, for curious parents/coaches?
  •  Is a league mechanism established to receive/process a medical clearance from a doctor, authorizing a player to return to play?

 

League Developed Concussion Program

· Program needs to be researched and documented by a person, or league committee with progress checks established, to report to the league board.  ‘Concussions awareness forms’ would have to be created for coaches/players/parents.  At the same time, the board will need to pinpoint the part that will be responsible for the enforcement of the league program.  This would include the receival and review of all required signed Concussion Awareness forms from coaches, players, and parents. 

· League board needs to review proposed program and vote on it.

· The handling of the forms would require additional pressure to the league’s system, as these forms should be signed and handed in before play starts.  For parents and players to sign the forms, some thought would have to be given to how/when this might be accomplished.

· New league policy will need to be dispersed to the personnel working with recreational and competitive teams.  Pre-season meetings, well in advance of coaches getting teams would need to be held.

· All of the above will require a good degree of new documentation to be prepared, or incorporation of existing documentation from the CDC into a league coherent program.

· If leagues are going to require that all of their coaches and assistants be trained, there would be work to do.  All coaches and assistant coaches would be notified that this meeting would be required, for them to receive coaching credentials.  Both the coach and assistant coach need to be fully aware of concussions and the league policy, as one of them might be handling the team on their own during season play.

The above is just a quick review of a potential policy creation strategy. Overall, it will take time, and will be labor intensive.  There are potential ways to make it a lot less of an impact, for all leagues, but this is for the leagues to think out. 

 Possible Stumbling Blocks

· Resistance from competitive thinking parties (a coach/parent that may be inclined to tell a player to 'tough it out', to get the player back on the field quickly.  May also take the form of a coach that comments to a player sitting out that 'we sure could use you', as an indirect statement to a young player.  Young players are very susceptible to comments from their coach.  Neither the coach, or the parent can 'see' a concussion, unless the signs/symptoms are highly visible.  This results in a concussion being an 'invisible' injury to them, which they have a hard time relating to (which is why all parties must be educated).  A player feeling some concussion related issues may not also speak freely about them, either because they don't know the severity of the situation, or because they do know.

·
 Lack of volunteer(s) to initially spear head project

· Lack of league consensus on concussions

· Lack of volunteers to monitor/enforce project

· Lack of volunteer to document project

· Poor committee operation

· Lack of league administrative leadership to push the project

 

 

                          Copyright © 2011. District VIII Web Master.  All rights reserved.  No parts of this material may be
                                                               reproduced on a web site, or copied into a document.





                                                                         Soccer Goal Safety
 
Soccer goals represent a potential safety hazard to players & spectators.  Goals must be checked for anchoring, whether used by players, or around spectators.  The hazard comes from the potential for an unanchored goal to tip over.  This can be possible when high winds are blowing, or from a party attempting to grab the overhead cross bar and hang from it.  Tipping goals have caused injuries and deaths to parties struck by them.  It is the responsibility of the party setting the goals up to insure that the goals are properly anchored to the ground.  It is the responsibility of referees to check goals for anchoring, prior to each game starting, and insuring that there are anchors on each goal.  A game may not be played when goals are not anchored.  There are a number of methods for securing goals, which range from anchors on each leg, to anchors on the rear bar of the goal.  The following resources provide information for the anchoring and securing of goals.

A further step for safety is the coach informing their goalie(s) that they are to never attempt to hold onto the goal crossbar.  It has been demonstrated by interviews with goalies that most were never told to not attempt holding onto the overhead crossbar during a game/practice.  The coach should explain why the goalie should not do this, outlining the potential safety concerns.

Incidents Involving Soccer Goals

 

 ACL Injury In Female Soccer Players
   
There is a consensus in the medical community that female soccer players injure their ACL at a significantly higher rate over male soccer players.  This is solely based on the different physical make-up of female vs. male players.  It has been recommended that female players need further conditioning, to help reduce the potential for ACL issues.  US Youth Soccer has recommendations regarding this here.
   
                 Video on the female soccer player and their ACL here
                 Video on KneeBOUND program for ACL protection here
                 Video on ACL Injury Prevention Exercises (PEP program) here





    

 Injury Prevention With FIFA 11 & 11+ Programs



                          Copyright © 2011. District VIII Web Master.  All rights reserved.  No parts of this material may be
                                                               reproduced on a web site, or copied into a document.

 

 

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