Tag Archives: neck

Concussion Expert Speaks Out About U.S. Soccer Federation Heading Guidelines

Bianca Edison, MD, MS, FAAP, an attending physician in the Children’s Orthopaedic Center and assistant clinical professor of Orthopaedics at the Keck School of Medicine of the University of Southern California, penned an essay in response to the U.S. Soccer Federation’s new guidelines regarding the technique of heading in practice and in regulation play:

“As a sports medicine physician who treats many youth who have suffered from concussion-related injuries at Children’s Hospital Los Angeles, as well as a mother of two young children, I commend the U.S. Soccer Federation for taking a leadership role in being a catalyst for change and injury reduction in youth soccer. Banning heading for children under the age of 10 can help reduce risk of injury as one’s neck and trunk strength at those ages is not as well developed, nor is the coordination of those muscles to help keep stability to the head when initiating contact with the ball. Moreover, young children may often become fearful of the ball when it is approaching their head, forgetting about proper technique.

“While new guidelines and recommendations from the USSF on heading can help reduce risk to the brain, neck and spine, heading only accounts for a small portion of why concussions occur in soccer. Collision, rather than purposeful heading, has been found in recent studies to be the most likely cause for acute head injuries in soccer. Head-to-head, head-to-body part, and head-to-ground collisions in soccer account for most concussions.

“I would challenge the USSF and its affiliates to use their player safety campaign as an opportunity for proactive awareness and education regarding injury risk and management, to include concussion. As heading is still included in many sports leagues within these age groups as well as older age groups, it is important for athletes to learn proper heading techniques, even if not using regularly during game play.

“Age-appropriate players should have proper instruction on correct heading technique and emphasis should also be placed on neck and trunk strengthening exercises. Drills to develop neck strength and skills using beach or light-weight dry foam balls can be done to teach form without exposure to recurrent head trauma. Developing these skills is essential to appropriate implementation later.

“At the Children’s Hospital Los Angeles Sports Medicine program, we often provide our athletes with neck strengthening exercises to work on at home and integrate into practice. Players should never be forced to head a ball if they are fearful. The ball should be the age-appropriate size, water-resistant, and inflated properly. Goal posts should be padded and other equipment outfitted correctly.

“While regulations regarding play are important, education is even more critical. Awareness of the signs and symptoms of concussion, and knowledge on concussion management and return to play protocols are important to prevent serious injury. Efforts to ensure that young athletes feel comfortable notifying someone when they are hurt keeps our young kids healthy. Those efforts also help to maintain the longevity of their athletic careers. The USSF’s recommendations are wide-reaching, as more than 3 million youth are registered to play. As the governing body over the sport in the United States, the organization’s guidelines about heading will help raise awareness that concussions are a significant risk in soccer. Everyone — coaches, parents and athletes — needs to be serious about recognizing and addressing such an injury.”

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Girls Hockey Players More Susceptible to Concussions than Similarly Aged Boys Football Players

The venerable Globe and Mail of Toronto, quoting from Women’s Sports Foundation research, has reported that girls hockey players suffer concussions at a greater rate than their male counterparts on the football field.

“Across all sports in the study, the highest rate of concussion was reported not by male football players, but by female hockey players,” according to the Foundation.

The article went on to cite a Washington Post Commentary by Marjorie A. Snyder, senior director of research for the Foundation, who said that “studies show that female softball players experience concussions at double the rate of male baseball players and that the injuries were also higher for basketball and soccer.”

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Study Looks at Overlap Between Symptoms of Concussions and Neck Injuries

By Ellen Goodman

Athletes and others reporting cognitive difficulties after a head injury are usually diagnosed as having had a concussion. But is it really a concussion? A new study published by University at Buffalo medical faculty finds that many of the same symptoms are common to concussions and to injuries to the neck and/or balance system, known collectively as cervical/vestibular injuries.

The research was based on responses about symptoms from 128 patients – some of whom were professional athletes – who were being treated at UB’s Concussion Management Clinic in the School of Medicine and Biomedical Sciences.

It was published online ahead of print last week in the Clinical Journal of Sport Medicine.

The purpose of the study was to determine how to distinguish between concussion injury and neck injury, based on symptoms.

“Based on our research, we conclude that some patients who have been told they’ve suffered a concussion, and whose symptoms persist for several months may actually have suffered a neck injury, rather than a concussion, or in addition to a concussion,” says John J. Leddy, MD, clinical professor in the UB Department of Orthopaedics and senior author.

He embarked on the study based on his experience as director of the UB Concussion Management Clinic.

“I’d seen enough patients in our clinic, some previously diagnosed with post-concussion syndrome, who continued to experience symptoms even after passing our treadmill test, which indicates full recovery from concussion,” says Leddy, who sees patients through UBMD, the physician practice plan of the UB medical school.

“The symptoms for both conditions are so nonspecific that it’s really hard to make a diagnosis based on them,” Leddy continues, “so we had to find another way to discriminate between them.”

To determine which of the respondents had probably sustained a concussion and which more likely had a neck injury, the UB researchers used the graded treadmill test developed by Leddy and co-author Barry Willer, PhD, UB professor of psychiatry.

“The treadmill test helps us make a first delineation between what I call physiologic concussion and other possible causes of cognitive symptoms,” says Leddy.

“Because a concussion is a brain injury, we thought that cognitive symptoms would be more likely associated with concussions,” he says. “Surprisingly, that didn’t turn out to be the case. People who have had neck injuries can also have problems with concentration and with memory. They feel like they’re in a fog, which is exactly what people report after concussion.”

Symptoms reported by both groups were headache, dizziness, blurred vision, poor concentration and memory deficits.

Patients in both groups filled out a detailed questionnaire concerning their symptoms. These responses were then correlated to their treadmill test results.

“Then we did some sophisticated statistical analysis,” says Leddy. “Even when we looked at the data in multiple ways, there was really no way to separate out the two groups based on their symptom patterns alone.”

Determining which condition a patient has experienced is critical, Leddy explains, because courses of treatment are very different.

“The treatment for a neck injury is actually to be more active, to do physical and vestibular therapy, to have a more active intervention, whereas after a concussion, exercise must begin slowly and incrementally after a period of rest,” he says.

Leddy notes that more research should be done on larger samples concerning concussion and neck injury.

In the meantime, he says, patients who think they’ve had a concussion and whose symptoms have not diminished after several months, should instead be examined for neck and vestibular injury by a sports medicine physician, a neurologist or a physiatrist, a specialist in rehabilitation medicine.

“I think a lot of practitioners listen to the symptoms and just chalk it up to concussion,” he adds, “but if they also examined the neck in these people, they might discover that a neck injury is involved and that’s a treatable problem.”

Physical symptoms specific to neck injuries include tenderness, neck spasms, reduced motion and reduced perception of where the head is in relation to the body, Leddy explains.

Co-authors with Leddy and Willer are John G. Baker, PhD, UB Department of Nuclear Medicine; Asim Merchant, MD and Jason Matuszak, MD, of the UB Department of Family Medicine; John Picano, an MD candidate at UB and Daniel Gaile, PhD, of the UB Department of Biostatistics.

The UB Concussion Management Clinic is a joint effort between the Department of Orthopaedics and the Department of Psychiatry.

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