Keeping your head
Football and head injuries
Over 900 soccer-related head injuries are reported to ACC each year, around 6% of total injuries. But this may not be the whole story. International data suggests that head injuries may make up as much as 22% of all football injuries.
Head injuries are sustained in a number of ways - from heading the ball, being hit by the ball, elbow or head to head contact - and may include lacerations and concussion. Unlike other injuries those to the head and neck can be catastrophic.
Concussion is a worrying injury that if not dealt with properly can have dire consequences. While proper heading of the ball should not result in concussion, poor technique, or the ball striking your head forcefully from close range, can cause damage.
So what is concussion?
A concussion is a temporary impairment of brain function due to trauma. This can be due to a blow to the head, face, jaw, or even hard contact or fall. It’s important to understand that you don’t have to lose consciousness to have had a concussion. The majority of concussions occur without loss of consciousness (LOC). The concussed player may display any or all of the symptoms or signs listed in the table below.
What actually happens?
Concussion results when the brain suddenly shifts or shakes inside the skull and knocks against the skull's bony surface. A hard hit to the body can cause the brain to twist, potentially causing shearing of the brain nerve fibres. In the minutes to days following a concussion, brain cells remain in a vulnerable state and temporarily, the brain doesn’t function normally. During this time it is more vulnerable to a second head injury.
Approximately 85-90% of concussions aren’t reported until after the session or game – a highly risky practice. To reduce the risks of serious injury occurring, everyone needs to be concerned if a player receives a blow to the head and encourage the affected party to share information with the people surrounding them.
A word to coaches
A player may be reluctant to report symptoms of concussion for fear of being removed from the game or it jeopardizing their future. You need to make players aware of the permanent repercussions of a concussion.
If you suspect a concussion, remove the player from the game or practice. No matter how important they are or the game is, or how much the player wants to stay on, it’s not worth the risk. Returning to play while still symptomatic increases the risk of further concussion, more severe and prolonged symptoms, and the risk of other injury.
Remember: If in doubt, sit ‘em out!
Often, concussions can go untreated - even unnoticed - because few symptoms are visible to casual observers. In some cases, the symptoms may not be identified until the player recovers to the point where increased exertion causes symptoms to worsen.
ACC and New Zealand Football produce a sideline concussion checklist in a handy wallet card format. The card guides you through the process of what to do if you suspect concussion. Call 0800 THINKSAFE (844 657) to order a free copy (quote order number ACC2170).
How do you treat about concussion?
A concussion usually resolves itself uneventfully. But as it always has the potential to cause serious harm every case must be checked by a doctor as soon as possible. If symptoms have not gone within 10 days (simple concussion), you need to consult with a concussion expert.
The best medical management for a concussion is rest. If you’ve suffered a concussion you may feel lethargic and tired. That’s the brain signalling rest is needed – it’s vital that you listen to it. Fighting it is likely to make things worse and you’ll be less able to cope.
When dealing with symptoms, only medications prescribed or approved by the doctor should be taken. Avoid alcohol until you’re fully recovered. Although in most cases symptoms resolve spontaneously within a couple of weeks, in some cases healing can take considerably longer. Family or friends should be consulted before making any important decisions.
Returning to play
You need to rest until all your symptoms have disappeared. The return to play process is gradual, and begins only after the medical doctor has given clearance to return to activity. You can then follow a step-wise return to play protocol, like the one below. If any symptoms/signs return during this process, you must be re-evaluated by a physician and must not return to play. Remember, symptoms may return later that day or the next, not necessarily when exercising!
Step 1.
No activity, only complete rest. Proceed to step 2 only when symptoms are gone.
Step 2.
Light aerobic exercise, such as walking or stationary cycling. Monitor for symptoms and signs. No resistance training or weight lifting. Progress to increased intensity and duration as tolerated (i.e. no symptoms next day).
Step 3.
Sport specific activities and training – e.g. ball work and higher intensity running.
Step 4.
Drills without close physical contact. May add light resistance training at Step 3 or 4 and progress to heavier weights.
The time needed to progress from non-contact to contact exercise will vary with the severity of the concussion and the player. Go to Step 5 after medical clearance.
Step 5.
Resume normal team training.
Step 6.
Return to match play.
Note: You should proceed through return to play steps only when you don’t experience symptoms or signs. Remember these are steps, not days! It may take more than one day to progress from one step to the next, especially if symptoms have lasted for a while. If symptoms or signs return, you should return to the previous step, and be re-evaluated by a physician.
How can you minimize the risk of concussion?
- Encourage fair play within your team and league
- Use only plastic coated balls and replace damaged balls and balls that have lost their water resistance
- Use the appropriate sized ball for the age and gender of the group playing.
- Teach players to head correctly and to maintain eye contact with the ball before and after contact is made
- Ensure the head and neck are kept rigid at impact. Only once this basic technique has been mastered, can the player then progress to the standing jump and finally to the running jump
- Encourage players to develop strong neck musculature, to help keep the neck rigid at impact and strong hip flexor and abdominal muscles to assist technique
- Use ‘no heading’ rules for younger players
- Encourage goal keepers especially to wear a mouth guard – they may reduce concussion from blows to the jaw
- Use padded goalposts where possible.
Coping with Concussion
If you, your player, son, daughter or friend has suffered a concussion and it’s getting them down, direct them to the following information.
- When coping with a concussion, it’s not uncommon to become overwhelmed by a variety of emotions.
- Often you feel concerned, anxious and sometimes depressed. The first part of the healing process is knowing that these emotions are normal.
- After any injury, most players go through an initial stage of denial or disbelief. You may refuse to believe that you’re injured or unable to participate in the sport you love.
- It’s extremely tough to realise that after sustaining a concussion, your body may not be able to respond as it did before. Other emotions such as anger and depression are also common.
- It’s quite common to become very angry at your teammates, coaches, staff, family and friends. As you continue to become more aware about the extent of your injury, depression may set in – this may include self-pity, crying, insomnia, etc.
- When you’re unable to play and participate in your sport, you may begin to doubt your abilities. And if your team is successful without your participation you may struggle with your personal worth and worry about regaining your place. These are all normal feelings. But remember that if you try to play while concussed you won’t be able to play at your best and may be even more likely to lose your place.
- It’s not uncommon to want to isolate or alienate yourself. Try not to do this: continue to participate in team functions and activities, as your step-wise recovery allows you. Allow yourself time to mourn and be sad and then move on. Leave the ’should’ves’ or ’would’ves’ out of the picture and focus on the future.
- Set yourself goals and maintain a positive attitude. Some athletes have learned personal relaxation methods such as imagery and progressive relaxation methods to improve their coping skills.
- The first thing to fail when you get tired is your concentration. If there’s something important you need to get done, it’s best to complete it when you’re fresh after resting. When your attention starts to fade, stop, rest again and write down the important things for later.
- The concussion may make you a bit clumsy and slow – try not to get frustrated and take more care and time as you move around and do things.
- If noise and bright light bother you, try to avoid it as much as possible. Think about wearing sunglasses everywhere, even indoors.
- Lastly, it is important to be patient. You may experience considerable emotional pressure to return to play. Emotion might tell you that you can play hurt, but the reality is that risk of re-injury is too great. It can result in permanent damage and seriously affect your quality of life. Don’t rush your recovery as it will only lead to negative results.
