This month we wanted to share with you a pertinent article produced by the CDC and featured in the NSCAA Soccer Journal that highlights the increasing rate of diagnosed concussions in soccer, and the potential dangers posed by this trend. Soccer is often overlooked as a concussion hazard, especially in a country dominated by the other 'football.' Given the debilitating nature of recent high-profile cases in the MLS and WPS, it is clear that this issue needs exposure and correction.

Also in this issue, we recap February's extremely informative SPEC presentation by Chris Hamblin of College Soccer Advantage. He guided our players, parents and coaches through the often-perplexing college recruiting process. We bring you notes, suggestions and must-read tips from the experts.

Finally we bring you a compilation of images from last month's Soccer Champions Coaches' Clinic held at Mohegan Sun, CT. A number of our club teams participated and had the opportunity to be coached by some of the most recognized and celebrated names in the coaching community. Thank you all for your participation and enthusiasm!

We hope you enjoy this edition of the SoccerPlus Education Center newsletter. Please e-mail us with any questions, comments or reading material you would like us to share with the SoccerPlus family in future editions.
 

Heads Up! Concussion in High School Sports
Center for Disease Control

Adapted and featured in Soccer Journal:
by Robert J. Elbin, Anthony P. Kontos and Tracey Couassin

About 300,000 sport-related concussions occur every year in the United States. Although sports such as football, rugby and ice hockey receive more attention for concussion, studies show that soccer players also are at risk. In fact, it estimated that every year in the United States, 6 percent of high school and 5 percent of college soccer players have a concussion. Therefore, it is important for coaches, parents, and players to be able to recognize concussions and their resulting effects. They should also be aware of the methods that can be utilized to help prevent concussion.

WHAT IS A CONCUSSION?
A concussion can occur when a player’s head
directly contacts an opponent, the ball, the goal post or the ground. A concussion can also occur without direct contact when a player’s head comes to an abrupt halt (“whiplash”), causing the brain to ricochet against the inside of the skull. The resulting forces can damage blood vessels and neurons, resulting in swelling and bleeding in the brain. Unlike an injury such as a sprained ankle, which has a fairly predictable set of progressive and visible symptoms, an injury involving the brain is more complex and less visible than injuries to other parts of the body. In fact, some researchers have begun referring to concussion as the “invisible injury.”

SIGNS AND SYMPTOMS
The complexity of the brain and the location of a concussion combine to create a wide variety of symptoms, cognitive impairments and performance difficulties. The signs and symptoms a player experiences following a concussion are influenced by the area of the brain that was affected. For example, a player who goes up for a flick-on header and strikes the back of his head (an area of the brain responsible for vision) on the defending player’s forehead may experience visual symptoms such as blurry or double vision or sensitivity to light.`

Researchers have examined these symptoms and cognitive impairments in an attempt to understand and predict recovery from concussion. One symptom that has been associated with concussion is loss of consciousness (LOC), or being “knocked out.” A common misconception is that an athlete must have LOC in order to have a concussion; however, only about 6 to 10 percent of all concussions involve LOC. Players are more likely to experience headache, dizziness, confusion, disorientation and memory loss from a concussion. Coaches should become familiar with the signs and symptoms in Table 1 to better recognize potential concussions in their players. The presence of any of these symptoms warrants holding a player out of practice or a game.
 

CONCUSSION REPORTING
A sports medicine professional is responsible for diagnosing, managing and making critical return-to-play decisions on behalf of an athlete that suffers a concussion; however, the “invisible” nature of this injury discussed above can make these responsibilities difficult. Unlike other injuries, detecting a concussion often relies on an athlete telling coaches, parents or sports medicine personnel that they are experiencing symptoms such as headaches or balance problems. Athletes may not tell anyone about their symptoms because they do not want to be removed from participation or do not realize that these symptoms may be signs of a concussion. In addition, social pressures also may prohibit athletes from disclosing their symptoms for fear of ridicule by their teammates or coaches. As a result, many soccer-related concussions go undetected.

CONCUSSION MANAGEMENT
Experts that study the effects of concussion recently have made recommendations for managing this injury. They urge a conservative approach toward every concussion, regardless of severity, and stress that concussed athletes be prohibited from re-entering competition regardless of their status on the sideline. Allowing an athlete to return to play before the brain is completely healed can place that athlete at an increased risk of another concussion, long-term symptoms, severe cognitive difficulties and, in rare cases, death. Coaches need to realize the dangers associated with returning an athlete to play too soon and should work with sports medicine professionals to keep players safe and avoid these potentially dangerous consequences.


CONCUSSION TESTING

Computerized ImPACT testing can reveal the extent of a concussion and determine the athlete's fitness to return to play

A concussion can evolve in the days following injury. In addition to reported and observed symptoms, less overt mental changes can be readily tracked using a computerized neuropsychological test (e.g., ImPACT, CogSport). Computerized neuropsychological tests, which resemble simple video games and measure reaction
time, memory and processing speed, compare pre- and post-concussion
cognitive performance. This management tool is growing in popularity because of its cost effectiveness and ease of administration—most test licenses cost between $500 and $1,000 for a league or team. These tests provide a method of concussion management that is more reliable than self-reporting by athletes. It is recommended that whenever possible these concussion tests be used by soccer leagues or teams.

RETURN TO PLAY
In general, recovery from concussion can take three to 14 days. Numerous factors may influence the length of recovery time from concussion. Studies have shown that a prior history of concussion can lead to longer recovery times and higher risk for another concussion, especially in younger athletes. In addition, females have been found to be at a higher risk of concussion and take longer to recover than males. Factors such as age, gender and history of concussion make managing this injury difficult. Concussion is unpredictable, and no two athletes will exhibit identical symptoms.

Athletes are considered to be recovered when they are symptom-free at rest and during exercise; however, coaches and sports medicine professionals must count on athletes being truthful in reporting their symptoms during the recovery period. Again, athletes may lie about their symptoms in order to return to play before they are ready. Returning an athlete too soon can have serious consequences if that athlete suffers another concussion before the first one heals completely.

Studies have shown that cognitive recovery can be delayed for up to 24 hours after the concussion has occurred. Lingering effects from a concussion can increase the risk of a player sustaining another concussion or making their existing injury worse if they return to play too soon. This could result in a player missing even more time because of the concussion. In rare instances, players who sustain a minor blow to the head while still symptomatic from an ongoing concussion could die from something called Second Impact Syndrome.

If players still have any symptoms or cognitive problems, they should not be allowed to return to play. As a general rule, “when in doubt, leave them out.” In other words, err on the side of the player’s safety.

PROTECTIVE HEADGEAR: WHAT DOES THE RESEARCH SAY?
In the past decade several companies (e.g., Full90, Kangaroo) have begun marketing protective headgear for soccer players. The purpose of protective headgear for soccer is to decrease the force of impact to the head from a ball, another player, ground or goalpost. Reducing these forces that are absorbed by the skull might, in theory, reduce the risk of concussion; however, there is debate surrounding the use of protective headgear in soccer. Some believe that protective headgear will provide a false sense of security, possibly encourage more risk-taking by players and possibly lead to the deterioration of heading skills. Others believe it is long overdue in the only sport where players purposely propel the ball with their heads.

This debate, along with manufacturer claims regarding the effectiveness of their products, has prompted researchers to begin to evaluate the effectiveness of these products. Thus far, the research findings on headgear effectiveness are mixed. Findings do suggest that headgear is useful in reducing lacerations and bruises to the head and part of the face; however, most studies suggest that wearing these products will not reduce the risk for a concussion. Recent research concluded that headgear was not effective in decreasing the forces associated with heading a soccer ball, but might be effective in reducing forces associated with head-to-head contact. Earlier reports have found headgear to be effective at higher speeds, but not effective at lower speeds that are more common in soccer. There are few studies that have evaluated the usefulness of protective headgear in soccer, and there is a definite need for more studies in this area. However, coaches that support wearing these protective devices should understand that no current protective headgear will prevent a concussion in soccer.

SUMMARY
Concussion is an injury that coaches, parents and players should take very seriously. It may be difficult for players to admit to their coaches or sports medicine staff that they have concussive symptoms (i.e., headaches) for fear of being removed from participation or ridicule from teammates and others. However, coaches and parents should encourage athletes to be truthful about their injuries and support decisions made by their sports medicine staff members. They should also become familiar with the signs and symptoms of concussion and should not allow a player who has a concussion return to the field in the same game or practice. It is important for coaches not to pressure athletes into returning to play before they are completely recovered – even for a championship game. In most instances these decisions will be made by sports medicine personnel; however, club and recreational coaches often will find themselves as the only person in a position to make a return-to-play decision on the field. Coaches should err on the side of caution. Players will be served best if coaches support them and keep them involved with team functions and activities when they are injured. A concussed athlete may feel withdrawn from the sport environment, and coaches are in an ideal position to make athletes feel that they are still part of the team even when they are injured. In summary, concussion can be a serious injury if mismanaged, but with proper education and precautions, concussed soccer players can experience a full recovery and return successfully to participation.
 

Navigating the College Soccer Recruiting Process

1) RESEARCHING SCHOOLS

+  What do you want out of your college soccer career? Understand the challenges and rewards

+ College Soccer Opportunities, NCAA I, II & III, NAIA, NJCAA
    -  Total # of Men's Programs = 1,214 (NCAA = 783)
    -  Total # of Women's Programs = 1,367 (NCAA = 968)

+  Variables to Consider
   - Academic Level
   - Academic Offerings
   - Geographic Location
   - Climate
   - Size of School
   - Urban vs. Rural
   - Cost
   - Level of Soccer Program
   - Impact You May Have on Program

2) TARGETING SCHOOLS

+ Narrow down your list, find schools that will be the right fit
   - Set realistic expectations both academically and athletically, use coaches for
     honest opinion
   - Watch college soccer
   - Understand the recruiting cycle, roster size, graduating class size
   - Student-Athlete not Athlete- Student
   - Understand what your role may be on a team, Impact, Core or Depth
 

3) COMMUNICATING WITH COLLEGE COACHES

+ Parents Role in the Process
   - Let the athlete lead the process, coaches want to deal with prospects not parents
   - Be realistic about your child's ability and opportunity.
   - Guide them, advise them and support them. Help organize the process and
     materials.

6) PREPARATION

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