The following statements are my opinions only, based on my experiences as a soccer coach. Physicians should be consulted on all matters relating to concussions. Parents and players should not rely on internet sources of information to make decisions relating to concussions.
There are an estimated 15-20 million kids playing soccer in this country. According to the CDC (Center for Disease Control and Prevention, press release, July 2007) an estimated 135,000 (65 percent) of sports and recreation related traumatic brain injuries (TBI) that were treated in emergency rooms each year occur in the young (5-18 yrs). A large number of these were soccer related. Considering that many who have concussions (TBI) with mild symptoms never go to an emergency room, it is easy to see the number rising significantly.
Attached to this post are links to the CDC where you can see their medical guidelines for managing concussions. I highly recommend downloading and printing these for reference. Below are some of my opinions and observations on the subject, but I am a coach not a Neurologist. I try to be current on recommendations from the medical and coaching community, but my opinions are NOT meant to replace the advice of a physician.
What is a concussion? Simply, a concussion occurs when there is a blow to the head or a sudden “jerking motion” of the head and neck. The brain moves suddenly within the skull and even when minor, results in a disruption to the normal physiological functioning of the brain. With soccer, this can occur when players go head to head, head to goal post, head to any other hard object (elbows, knees, ground, etc). Concussions should never be taken lightly, and all should be viewed as potentially life threatening if not managed correctly. It is well documented that deaths have occurred with young athletes who sustained concussions. Long term cognitive and learning disabilities can result from concussions.
Signs and Symptoms: Players may not exhibit any symptoms to the coach, and may not even notice themselves, but they still can be present. The list of symptoms is a long one ranging from being slightly dazed to full loss of consciousness. The list might also include: blurred vision, dizziness, weakness, in-coordination, nausea, loss of memory (post traumatic amnesia – PTA). Symptoms care be immediate or delayed as much as 24-48 hours. Coaches need to inform parents or responsible adult that the player hit their head during the game whether or not symptoms were present. Even without symptoms present at the time of the incident, parents should observe their player closely for the next couple of days for any changes or symptoms. I have seen reports of athletes hitting their head, having no symptoms at the time, and going home and going to sleep and dying in their sleep from a delayed cranial bleed. While this is rare, it is simply not worth the risk, so close observation is essential and seeking immediate medical attention when needed is very important.
What is a coach to do? The answer is a simple one. The player MUST be removed from the game (or practice) immediately. If a coach witnesses a player being struck on the head, they need to be checked by the coach ASAP, even if the player reports feeling fine. If there are symptoms present, to even the slightest degree, they are done for the game. If a player does not exhibit any symptoms whatsoever, there are varying opinions regarding return to play. Special caution should always be used with the younger player, as it is often difficult to determine through observation and interview if there are or are not any symptoms. It is the opinion of this writer that young players, especially those under 18 be removed from the remainder of the game and observed for delayed symptoms. Even if no apparent symptoms are present, they could develop later, so it is risky to return a player to the game under any circumstances. My favorite saying about this is: WHEN IN DOUBT, SIT THEM OUT!!! I read it somewhere a long time ago and believe it is a good rule to follow. Since coaches are usually the ones with the best view of the incident, and the first to assess the player, it is important that their observations be communicated to the parents so they may, in turn, report to the physician what happened. Coaches and parents should avoid giving their player medicine to alleviate symptoms (headache) as this can hide symptoms when assessed by the physician. Aspirin is an absolute NO NO, as it can result in increased bleeding in the brain should that be an issue. The physician will prescribe the appropriate medication if needed.
When to get medical assessment: 
In ALL CASES where a concussion occurs or is suspected, medical evaluation is required. The more serious the symptoms, the sooner the visit to the physician is required. With my players who I believed had mild concussions, I advised the parents to have them seen within 24 hrs if possible. Concussions with LOC (loss of consciousness, post traumatic amnesia, Nausea and vomiting or any other severe symptoms) should be seen immediately. Emergency transport is appropriate with any concussion where there is suspected neck injury or loss of consciousness for more than a few seconds.
My player had a concussion, when can he/she return to play? This is the $64,000 question (for those of you who remember the famous TV show of the 60’s). This is a decision that the medical professional will make after assessing the player. Depending on the severity of the concussion, number of concussions the player has had, the results of medical testing, the amount of time for the brain to recover can be anywhere from one week to several months. In some cases, where players have had multiple concussive events, it may be recommended that the player stop playing sports where there is high risk for concussions. Many professional athletes have retired from sports like football, due to repeated concussions and cognitive changes. Remember that the effects of concussions can be cumulative, with one building on another, and increased susceptibility for additional concussions. While there is still some disagreement among experts on when players can return to play after a concussion, one rule stands out that all agree upon. That being: A PLAYER CANNOT RETURN TO PLAY OR PRACTICE AS LONG AS ANY SYMPTOMS FROM THE PREVIOUS CONCUSSION REMAIN PRESENT. There is something called “Second Impact Syndrome”. It means that if a player has a second concussion before the symptoms of the first concussion have fully cleared, severe consequences are very likely, including death. The answer to the question of return to play is that ONLY THE PHYSICIAN CAN RECOMMEND WHEN A PLAYER MAY RETURN TO PLAY AFTER A CONCUSSION.
A note regarding physician release to return to sport. For my teams, All players MUST have a written note from the MD that they are ready to return to full play prior to being permitted on the field. Having said that, just having a note from the MD saying playing is OK, may not always be enough. I once had a player who sustained a mild concussion (her second in 6 mos) and I sent to her MD for assessment. She returned with a note saying she could play and she just had a “ding” not a concussion. (I particularly dislike the terms “ding” or “got their bell rung”, as they imply something mild. In reality they are concussions and should all be treated as such.) Back to my player. She was without symptoms at rest, but when given some physical challenges (running, jumping) she complained of headaches and dizziness. It was clear to me she still had symptoms, so I kept her out an additional week in spite of the release by the MD. Point is that not all physicians are knowledgeable in dealing with concussions, so a coach needs to use their good judgment. Note: Many players will be without symptoms at rest, but when given physical exertion tasks like running, jumping, soccer moves, the symptoms will return. Before players return to play after a concussion, regardless of how long it has been, they must be assessed in this manner…….physical challenges. This is, of course, once they have written release from their doctor.
Note: If you browse the Internet searching for information on concussions, you will find many references to grades of concussion (I, II, III) based on type, severity and duration of symptoms. There may be references to situations where players may return to the game the same day depending on which grade of concussion they have and other circumstances. THESE RECOMMENDATIONS ARE FOR FOR ADULTS, NOT YOUTHS. There is much variation in what you will see, and no consensus among health care professionals on dealing with adult concussions. Most all are in agreement that youth soccer players under the age of 18 must be treated differently and more conservatively than adults.
The Health and Well-being of the player is always more important than the game.
GET FREE HANDOUTS ABOUT CONCUSSIONS FROM CDC For copies of CDC handouts for coaches, parents and players which tell you all you need to know about concussions go to this link and download the handouts and flyers. These handouts can be carried with you for reference at games and practices.
As of March 20, 2009…………………….
Young actress dies after minor head trauma. This young woman fell while skiing on the bunny slope. She felt fine afterward, but was in a coma a few hours later and passed away within two days. Never take concussions lightly. Serious delayed effects can occur. It is wise to seek medical attention regardless of how minor the concussion may seem.
See also: How a hematoma can be missed.
Lessons learned from about accident saves young girl. Advice on head injuries in this article.
A Brief Comment on Heading the Ball: There are many conflicting theories regarding whether or not heading the ball causes concussions. My personal coaching philosophy on this has been the following: I do not introduce heading to my players until age 10, and then on a limited basis. I teach proper technique but do not encourage them to head in games and limit heading in practice to 10 reps. I also use slightly under-inflated balls for heading practice as I believe it reduces impact forces with the head. A study by Purdue University supports this concept. Once they reach age 12, I increase the time spent on heading at practice, but still try to keep the total number of head to ball contacts to a minimum. Heading is obviously part of the game, and players need to know how do perform this technique correctly. Players and parents who have significant concerns regarding the long term effects of heading the ball, should probably find another sport in which to participate that does not require this element, as heading is a normal part of the game of soccer.
Note: If you browse the internet, you will find references to concussion grading systems and situations where players can be returned to the same game under certain circumstances. This is OUTDATED information and not consistent with current recommendations for concussions, especially for the under 18 player.
My moto with younger players (under 18) is: “HIT YOUR HEAD AND HIT THE BENCH”. Certainly some mild glancing bumps to the head that occur in games need to be considered on case by case basis, but any significant head to object contact should result in removal from that game and further assessment.
Please visit the CDC link to download the most current information for coaches, players and parents regarding concussions.
http://www.cdc.gov/ConcussionInYouthSports/default.htm
General Concussion Info – National Athletic Trainer’s Association
I welcome comments from coaches, soccer officials, parents and players. Share your experiences in this area.
