Management of concussion in soccer
- 659 Downloads
When participating in contact sports, (mild) head trauma is a common incident—observed in both professional and amateur sports. When head trauma results in transient neurological impairment, a sports-related concussion has occurred. Acute concussion, repetitive concussions, as well as cumulative “sub-concussive” head impacts may increase the risk of developing cognitive and behavioral deficits for athletes, as well as accelerated cerebral degeneration. While this concept has been well established for classic contact sports like American Football, Rugby, or Boxing, there is still an awareness gap for the role of sports-related concussion in the context of the world’s most popular sport—Soccer.
Here, we review the relevance of sport-related concussion for Soccer as well as its diagnosis and management. Finally, we provide insight into future directions for research in this field.
Soccer fulfills the criteria of a contact sport and is characterized by a high incidence of concussion. There is ample evidence that these events cause functional and structural cerebral disorders. Furthermore, heading, as a repeat sub-concussive impact, has been linked to structural brain changes and neurocognitive impairment. As a consequence, recommendations for the diagnosis and management of concussion in soccer have been formulated by consensus groups. In order to minimize the risk of repetitive concussion in soccer the rapid and reliable side-line diagnosis of concussion with adoption of a strict remove-from-play protocol is essential, followed by a supervised, graduated return-to-play protocol. Recent studies, however, demonstrate that adherence to these recommendations by players, coaches, clubs, and officials is insufficient, calling for stricter enforcement. In addition, future research to solidify the pathophysiological relevance of concussion for soccer athletes seems to be needed. Advanced neuroimaging and neurochemical biomarker analyses (e.g. S100β, tau and neurofilament light (NfL)) may assist in detecting concussion-related structural brain changes and selecting athletes at risk for irreversible damage.
Sports-related concussion represents a genuine neurosurgical field of interest. Given the high socioeconomic relevance, neurosurgeons should get involved in prevention and management of concussion in soccer.
KeywordsBrain imaging Chronic traumatic encephalopathy Concussion Concussion biomarkers Functional brain imaging Post-concussion syndrome Repetitive head trauma Return to sport Soccer Standard concussion assessment tool Sports-related concussion Tau Traumatic brain injury
Concussion in Sports Group
Chronic traumatic encephalopathy
Default mode network
Diffusion tensor imaging
Fédération Internationale de Football Association
Functional magnetic resonance imaging
Glial fibrillary acidic protein
Magnetic resonance imaging
Magnetic resonance perfusion
Magnetic resonance spectroscopy
National Football League
Neuron specific enolase
Positron emission tomography
Return to sport
Sport Concussion Assessment Tool
Second impact syndrome
Traumatic brain injury
Transcranial magnetic stimulation
Compliance with ethical standards
This article does not contain any studies with human participants or animals performed by any of the authors.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Alosco M, Kasimis A, Stamm J et al (2017) Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes. Transl Psychiatry. https://doi.org/10.1038/tp.2017.197
- 12.Collie A, Maruff P (2003) Computerised neuropsychological testing. Br J Sports Med. https://doi.org/10.1136/bjsm.37.1.2
- 16.Davis G (2017) Sport concussion assessment tool - 5th edition. Br J Sports Med. https://doi.org/10.1136/bjsports-2017-097506SCAT5
- 24.Gavett BE, Stern RA, Mckee AC (2011) Chronic traumatic encephalopathy: a potential late effect of sport-related concussive and subconcussive head trauma 1. Clin Sports Med. https://doi.org/10.1016/j.csm.2010.09.007
- 43.Kunz M (2007) 265 million playing football. Fifa Mag:10–15Google Scholar
- 45.Leininger BE, Gramling SE, Farrell AD, Kreutzer JS, Peck Iii EA (1991) Neuropsychological deficits in symptomatic minor head injury patients after concussion and mild concussion. J Neurol Neurosurg Psychiatry 54:846–847Google Scholar
- 54.Makdissi M, Cantu RC, Johnston KM, McCrory P, Meeuwisse WH (2013) The difficult concussion patient: what is the best approach to investigation and management of persistent (> 10 days) postconcussive symptoms? Br J Sports Med 47(5):308–313Google Scholar
- 61.McCrory P, Feddermann-Demont N (2017) What is the definition of sports-relted concussion: a systematic review. Zurich Open Repos Arch Univ Zurich. https://doi.org/10.1136/bjsports-2016-097393
- 65.McCrory P, Meeuwisse W, Dvorak J et al (2017) Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. https://doi.org/10.1136/bjsports-2017-097699
- 66.McKee AC, Cantu RC, Nowinski CJ, Tessa Hedley-Whyte E, Gavett BE, Budson AE, Santini VE, Lee H-S, Kubilus CA, Stern RA (2009) Chronic traumatic encephalopathy in athletes: progressive tauopathy following repetitive head injury. J Neuropathol Exp Neurol 68(7):709–735CrossRefPubMedPubMedCentralGoogle Scholar
- 69.Meaney DF, Smith DH (2011) Biomechanics of concussion. Clin Sports Med. https://doi.org/10.1016/j.csm.2010.08.009
- 71.Millspaugh JA (1937) Dementia pugilistica. US Nav Med Bull 35:297–303Google Scholar
- 75.O’Connor KL, Baker MM, Dalton SL, Dompier TP, Broglio SP, Kerr ZY (2017) Epidemiology of sport-related concussions in high school athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 through 2013–2014. J Athl Train 52(3):175–185CrossRefPubMedPubMedCentralGoogle Scholar
- 85.Shahim P, Gren M, Liman V et al (2016) Serum neurofilament light protein predicts clinical outcome in traumatic brain injury. Nat Publ Gr. https://doi.org/10.1038/srep36791
- 88.Shahim P, Tegner Y, Marklund N, Blennow K, Zetterberg H, Shahim C (2018) Neurofilament light and tau as blood biomarkers for sports-related concussion. Neurology. https://doi.org/10.1212/WNL.0000000000005518
- 95.Terry DP, Huebschmann N, Maxwell B, Cook N, Mannix R, Zafonte RD, Seifert T, Berkner PD, Iverson GL (2018) Pre-injury migraine history as a risk factor for prolonged return to school and sports following concussion. J Neurotrauma. https://doi.org/10.1089/neu.2017.5443
- 97.Turner RC, Lucke-Wold BP, Robson MJ, Omalu BI, Petraglia AL, Bailes JE, Hayes RL, Mondello S, Biomarkers B (2013) Repetitive traumatic brain injury and development of chronic traumatic encephalopathy: a potential role for biomarkers in diagnosis, prognosis, and treatment? Front Neurol. https://doi.org/10.3389/fneur.2012.00186
- 99.Yengo-Khan A, Hale A, Zalneraitis B, Zuckerman S, Sills A, Solomon G (2016) The sport concussion assessment tool: a systematic review. Neurosurg Focus. https://doi.org/10.3171/2016.1.FOCUS15611