Ask The Doctors: Hard Contact In Soccer Can Lead To Concussion

Julia Taffuri (left) practices again with Notre Dame Prep teammates, including Hannah Hudson, after suffering a concussion during a soccer game.(Photo: Cheryl Evans/The Republic)

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Three weeks ago, Scottsdale's Julia Taffuri took a ball to the face while competing in Southern California with her Sereno Soccer Club team. After being knocked to the ground, she popped back up, dusted herself off and finished the half.

When she returned to the sideline, however, she started repeating herself and asking unlikely questions, including, "Where are we?" Her coaches immediately pulled her from the game, fearing what was confirmed later that day in a hospital: She had suffered a concussion.

Incidents like Taffuri's aren't unique. But alarming new studies reveal the sport is among the leaders in concussed athletes, putting coaches and parents on alert and prompting many in the medical profession to call for limitations on what young athletes are allowed to do on the soccer field.

RELATED: World Cup soccer coverage

"The only time kids get hit in the head as frequently as they do in sports is in cases of abuse," said Chris Nowinski, a former Harvard football player and professional wrestler who has been at the forefront of concussion education. "Yet if you put it in the context of sports, it suddenly seems OK."

Just weeks from the start of the FIFA World Cup in Brazil, soccer remains a popular participatory sport among youths in the United States. U.S. Youth Soccer reported more than 3 million members in 2013. The National Federation of State High School Associations saw an increase in soccer players of 7.4 percent in the last four years.

Those facts are being overshadowed by far more sobering ones. Next to football, girls soccer produces more concussions at the high-school level than any other sport, according to a study published in Pediatrics. Boys soccer ranked fourth. Additionally, older or retired soccer players who had suffered concussions were significantly more impaired in "conceptual thinking, reaction time and concentration" than their non-soccer counterparts, according to a study in the research journal Brain Injury.

The biggest contributor to concussions in soccer is the header, the act of redirecting an airborne ball with the head and a strategy used at all levels of the sport. Many soccer players head the ball about six to 12 times during a match, according to a study by the Albert Einstein College of Medicine, and more in practices.

No news rattled the soccer community more, however, than a February report that the first case of chronic traumatic encephalopathy, a progressive degenerative disease caused by repetitive brain trauma, was found in an American soccer player.

Pat Grange, a former star player at the University of New Mexico, died in 2012 at 29 of amyotrophic lateral sclerosis, more commonly known as Lou Gehrig's disease. His brain was donated for examination to Boston University's Dr. Ann McKee, a neuropathologist at the forefront of CTE diagnosis among athletes. It is believed the disease was triggered by brain trauma.

"Dr. McKee said Pat's front lobe was more deteriorated than any 29-year-old brain she'd seen," said Grange's mother, Michele Grange.

CTE was once believed to be unique to boxers but has been diagnosed recently in the donated brains of former football and hockey athletes as well as a baseball player. Symptoms of the disease, which can take years to appear, often include memory loss, depression and dementia.

"Pat did headers all day," Michele Grange said. "He had two older brothers, and he would just throw up that ball and head it for hours."

The scrutiny on the NFL and a multimillion-dollar concussion lawsuit filed by more than 4,000 players have been a wake-up call for other sports. Nowinski wishes awareness would happen even faster but knows the fear of litigation is a deterrent. Already well-known as an advocate of concussion prevention, he received a rude awakening when he tried to attend the fourth international Conference on Concussion in Sport.

"To be honest, I went to the Zurich meeting in 2012 at FIFA headquarters and they nearly locked me out," he said. "They literally would not let me in. ... I think the risk and liability (in soccer) is going to be just as big. Unfortunately, when money gets involved, priorities change.

"But I think the evidence is clear. When you put a sensor on a soccer player or a football player, at the end of the game you find the same numbers."

It's not just the governing bodies that are hesitant. Athletes also are turning a blind eye, said David Dodick, a neurologist at the Mayo Clinic in Scottsdale and director of its concussion and headache programs.

"A lot of them don't want to know because the less they know the better," he said. "There's cognitive dissonance. They have fun with what they're doing. They don't want to let their teammates down. They don't want to come out of the game because they know they're going to be replaced and they may not get that position back."

That mentality is even worse in other countries, said Steve Devick, producer of "Head Games: The Global Concussion Crisis," a documentary based on Nowinski's book on head trauma in football.

"We're about 10 years ahead of the rest of the world," he said at a premiere of the movie recently at the Mayo Clinic Hospital in Phoenix. "They look at substitution as kind of like cheating."

Locally, there seems to be a growing sense of responsibility about young athletes and concussions.

In 2011, the Arizona Interscholastic Association, the governing body for high-school sports in the state, mandated that all athletes from its 275 member high schools must take an online education test about concussions. That same year, a state law was passed that required officials to remove athletes from play upon suspicion of a concussion and demanded clearance from a physician or trainer in order to return to play.

In addition to the Mayo Clinic, the Barrow Neurological Institute, A.T. Still University in Mesa and the CACTIS Foundation have been strong advocates in the education and prevention of sports concussions.

Kevin Rowe, founder of the law offices of Lerner and Rowe, is the father of a 12-year-old who plays for the Scottsdale Blackhawks U-13 team. Last year, his goalie daughter, Taylor, took a knee to the head. What initially was thought to be a concussion turned out to be a skull fracture.

He is grateful for the newfound awareness about head injury and remembers how different it was when he played soccer at the University of Washington.

"To be honest, it wasn't even talked about," he said. "It was, 'Take a drink of water and come back in.' "

His daughter now wears a protective headband that is marketed as helping to prevent the risk of head injury, although medical experts say there is no conclusive research yet that shows currently available protective gear works.

Many back a movement to take headers out of the youth game.

"I like to think (of that kind of trauma) as shaken-baby syndrome," Grange said. "I have a grandson. He's 5. He plays soccer. We love soccer. But he's not going to be doing headers over and over."

"I think reform is simple," Nowinski said. "Don't hit (young soccer players) in the head until a certain age, and then ease them into it."

Greg Terhune, a former professional soccer player who coaches with the Scottsdale Blackhawks as well as the Arizona Olympic Development Program, understands the concern but sees delaying the instruction of headers as challenging, too.

"It's a slippery slope," he said. "If you don't teach them at a young age, are you deterring their athletic ability as they get older? It feels like there's no happy medium."

Most agree there is great value in the medical community stepping in because it can be hard for athletes and their families to be objective in matters of concussion.

The father of 17-year-old Julia Taffuri, who attends Notre Dame Preparatory High School in Scottsdale and was awarded a scholarship to the University of Massachusetts beginning in 2015, is grateful others were advocates for her daughter's health.

"My wife and I are competitive people," Luke Taffuri said. "You ask your kids how they feel and you trust them. If we didn't have this, I would have probably sent her back to practice."

Julia, too, acknowledges it was hard to embrace the idea of sitting out. She failed an online test several times that measured memory and other cognitive functions before being cleared to play a week ago.

"It was hard, but I understand," she said. "I don't want another concussion or suffer headaches (in the future) and things like that."

Taffuri is taking her future seriously. Nowinski hopes others do, too.

"Why are we hitting our kids in the head for sport?" he said.

Concussion symptoms

The five most common reported symptoms of sports-related concussions:

Headache: 94.3 percent.

Dizziness/unsteadiness: 75.5 percent.

Difficulty concentrating: 53.9 percent.

Confusion/disorientation: 44 percent.

Visual disturbance/sensitivity to light: 34.4 percent.

Source: American Journal of Sports Medicine, 2011

Recovery

A concussion requires plenty of rest, for both the body and the brain, for the first 24 hours and beyond. Here are some actions you should begin right away:

• Get six to eight hours of sleep.

• Avoid activities that could lead to a second concussion, such as contact sports and driving.

• Let others know you have a concussion in case you need help.

• Drink plenty of water to stay hydrated.

• Avoid alcohol and drugs.

• Avoid caffeine and energy drinks.

• Don't take sedatives or other drugs unless instructed by your doctor.

Source: Defense Centers of Excellence

Source : http://www.azcentral.com/story/sports/soccer/2014/05/30/soccer-headers-leading-concussion/9798431/

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