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Posted at 02:12 PM ET, 07/19/2011

World Cup Soccer: thrilling headers raise a concern

Among the many beautiful elements of the Women’s World Cup final between the U.S. and Japan this past Sunday were the powerful headers. American player Abby Wambach has made it clear that heads are as important as feet in soccer.

Like most any elite sport, though, there’s a downside to pushing the body that hard. Headers can take a toll. As American children increasingly embrace soccer, there’s a new concern among experts about the risk of concussions.
Japan’s defender Saki Kumagai and USA’s midfielder Carli Lloyd vie for the ball. (Johaness Eisele - AFP/Getty Images)

Shane Caswell, associate professor of athletic training and director of the Sports Medicine Assessment, Research and Testing Laboratory in George Mason University’s College of Education and Human Development, recently partnered with Fairfax County Schools to examine the concussion trends of more than 150,000 student athletes for 11 consecutive years, between 1997 and 2008.

He found some disturbing trends.Overall, the results of the study show an increase in concussion rate of more than 16.5 percent annually among all 12 sports studied.

Soccer accounted for the majority of concussions girls suffered, about a quarter of the total.

It’s not all soccer’s fault. The culprits for boys were most often football, lacrosse and wrestling.

Caswell was one of the supporters of a new Virginia law that’s intended to mitigate the damage a concussion can cause. Now, Virginia athletes face a new set of rules, including being benched after a concussion. The new legislation [pdf] was adopted in January and went into effect July 1.

I asked Caswell about his study and the new rules. Here’s our Q & A:

Q. Is this new Virginia law necessary?

A. Absolutely, concussion is a serious public health problem, which, if not properly recognized and cared for, can have long-term consequences or even death as a result of “second-impact syndrome.” A recently published study examining Epidemiology of Sudden Death in Young, Competitive Athletes Due to Blunt Trauma (by Matthew Thomas et al., Pediatrics, 2011) reported that 12 percent of the high school football players who died as a result of blows to the head or neck had a reported history of persistent concussive symptoms within the previous four weeks.

This is a chain of events that is consistent with “second-impact syndrome”and if recognized and properly managed by a qualified healthcare professional like a certified athletic trainer or physician is likely preventable. ... Virginia’s law is an important step toward ensuring that our coaches, parents, students and school staff are properly educated regarding the signs and symptoms of concussion and that when a concussion is suspected the student may return to participation on the same day and without first being evaluated and cleared by a qualified medical professional.

Q..Does the new law go against the sports culture of “suck it up”?

A. No, when it comes to concussion, a culture of “suck it up” is dangerous. I understand the importance of sport in helping to teach our youth to be tough and develop the ability to deal with and overcome adversity. However, concussion is a serious injury and not to be taken lightly. Quite simply, coaches should not be telling children suspected of having a concussion to “suck it up” or use sayings like “you just got your bell rung.”

These attitudes diminish the seriousness of concussions and could have dire consequences. In my opinion, schools and youth leagues alike should require safety education coaches and other volunteers who work with young athletes. Perhaps those who refuse to acknowledge the seriousness of important health issues like concussion and persist in encouraging the “suck it up” culture should not be coaching.

Q. How can you tell if an athlete has suffered a concussion?

A. Concussions can be challenging to diagnose. Presently, no clinically useful biological markers exist and diagnosis largely depends upon a clinician’s ability to properly evaluate his or her patient’s symptoms. For this reason, the Virginia law and others like it mandate that all athletes suspected of suffering a concussion be removed from participation and be evaluated by a certified athletic trainer or other qualified medical professional. In addition, a gradual, progressive and supervised return to participation is required prior to being cleared to play.

Q.What do you say to a parent who reads this and says, “sports are too dangerous, I’m going to enroll my daughter in dance class instead?”

A.I say that participation in sport does increase ones chances for suffering injuries like concussion. However, concussions are not limited to contact sports and activities. Concussions happen to dancers, golfers, swimmers, cheerleaders and even drama club members. Ultimately, I believe that the positive health benefits of sport and physical activity greatly outweigh the risks.

Q.Your study found an overall increase in concussions in girls’ and boys’ sports. You have said that much of that increase might be due to increased reporting. Might there be other reasons?

A.Yes, we observed a dramatic 4.5-fold increase in concussion over an 11-year period. There might be several reasons for our observations. Among these could be an increased public understanding of the signs and symptoms associated with concussion. Recently, the extensive media coverage helped to educate the public about the seriousness of this public health issue. As a result, athletes, teammates, coaches, and parents might be more willing to report a concussion. This is a positive sign that strides are being made in overcoming the culture of ignorance that fuels the fear that you are not tough if you tell someone you think you suffered a concussion.

By  |  02:12 PM ET, 07/19/2011

 
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