Concussions: Prevention and recovery for soccer players

Dr. O'Brien concussions in soccer players thriving lead image
PHOTO ILLUSTRATION: PATRICK BIBBINS/BOSTON CHILDREN’S HOSPITAL

As kids and teens get ready for the start of a new school year, many will be lacing up their cleats in anticipation of the coming soccer season. Playing soccer brings together all the benefits of rigorous exercise, fun with friends and an unlimited abundance of orange slices. However, participation also comes with the risk of injury.

Concussions, a type of traumatic brain injury, are all too common in the soccer world. It’s clear that the protection mouth guards provide is far from sufficient for protecting your child from a concussion. So, if soccer’s protective equipment can’t keep players safe, what can?

Dr. Michael O’Brien, director of the Sports Concussion Clinic at Boston Children’s Hospital, helps athletes who have sustained concussions get back in the game and works with athletes to prevent sports injuries, including concussions. His advice to players, parents and coaches on what athletes can do to reduce the risks of concussions revolves around effective and clear communication.

Kicking off a healthy season

The soccer season officially starts in the fall, but O’Brien argues that the season for concussion prevention is year-round. “The truth is technology and equipment have been fairly disappointing in demonstrating real concussion prevention. However, if we focus on improving each individual athlete’s body control, we reduce the risk of awkward falls or collisions taking place,” he says.

The biggest concern for concussions are the ones that go unreported or unrecognized.” ~ Dr. Michael O’Brien

O’Brien believes it is the responsibility of the athlete to come into the season having already prepared their bodies for athletic competition. He suggests everything from non-contact ball handing drills and cross-training to balance and posture exercises. The more comfortable a soccer player is with their ball handling skills, the less likely they are to be looking at the ground while dribbling the ball. This will help them be more aware of their surroundings and reduce the possibility of colliding with other players. “Learning to control the body and by extension, the ball, may translate to fewer concussions, not to mention better performance,” O’Brien says.

Coaching to avoid concussions

Coaches have their own role to play in supporting and improving an athlete’s body and ball control habits. “When running practices, we want to make sure coaches are clearly demonstrating drills to athletes at low speeds first,” O’Brien explains. “Athletes need to know what it feels like to do each drill properly at low speeds so they’re more in control of their body at medium and high speeds.” The motion sequences learned in practice repeat thousands of times after practice ends through “motor pattering.” Even in sleep, the motions practiced on the field are further engrained into the athlete. “This is actually where a lot of motor learning occurs,” says O’Brien. “That’s why it’s essential that these techniques, at slow speeds, are done properly in the beginning.”

Additionally, coaches need to effectively organize and manage players when there are many balls being kicked around during practice. “You’d be surprised how many concussions we get from multiple balls flying around and someone gets hit inadvertently,” says O’Brien. In soccer, the most common causes of concussions are head-to-head or head-to-ground collisions with an awkward fall — but unexpected ball to head contact can also result in a concussion. “That’s why it’s important for the coach to communicate with players so they know what they’re expected to do and when.”

Time out

When players experience headaches, nausea, dizziness or vomiting after a head collision, communication is key. “The biggest concern for concussions are the ones that go unreported or unrecognized,” explains O’Brien. “There’s a window of vulnerability where sustaining more collisions can escalate symptoms, prolong recovery and even lead to long-term issues.”

Many people attribute concussion treatment to strict, prolonged rest in a dark room until symptoms subside, but O’Brien is quick to debunk this myth. “It’s actually quite the opposite. We’re trying to mitigate de-conditioning. Sitting in a dark room can promote irritability, trouble sleeping and other symptoms that we’re trying to prevent.” Instead, O’Brien suggests “complete rest” for the first two to four days, where an athlete may be kept out of school if their symptoms are significant, followed by what he calls “reasonable rest,” in which the athlete begins to be reintroduced to light or medium exercise and cognitive activity.

Safe and effective recovery

O’Brien states that the first step to recovery (of the 5 stages for concussion return-to-play) is engaging in light cognitive activity, stretching and “level one” exercises, which an athlete can perform without getting out of breath. “The goal is two-fold: First, we want to prevent de-conditioning. Second, we want to activate the athlete’s metabolism,” he says. He also encourages athletes to ask for help or consider temporary academic accommodations if necessary. “Getting people to feel like themselves is a big part of recovery, but we want to do that in a way where we aren’t provoking further symptoms.”

When athletes can accomplish light cognitive and physical activity without provoking further symptoms, they can move onto level two exercises, which are slightly more strenuous. Level three and four exercises require higher-intensity physical exertion and include activities that involve change of direction and ball handling, but the exercises are still non-contact. Only after an athlete is symptom-free and can tolerate all levels of exercise — as well completes a cognitive assessment — can they go back into practices and games with contact.

While this may seem straightforward, O’Brien understands the complexities of treating a condition that doesn’t have an outwardly objective measure of recovery. Trainers need to know their athletes, athletes need to know themselves, and both need to speak up when they notice something isn’t right. “That’s why it often comes down to a matter of trust and communication between athlete and trainer,” he says. “It’s their responsibility to keep the lines of communication open, and for coaches and parents to encourage players to speak up when they feel out of sorts.”

Learn more about the Sports Concussion Clinic at Boston Children’s Hospital.