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Cognitive Ageing in Top-Level Female Soccer Players Compared to a Normative Sample from the General Population: A Cross-sectional Study. J Int Neuropsychol Soc 2020; 26:645-653. [PMID: 32098636 DOI: 10.1017/s1355617720000119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is an ongoing debate on the potential negative effect of contact sport participation on long-term neurocognitive performance due to inherent exposure to concussive and subconcussive head impacts. The aim of the present study was to investigate whether cognitive ageing is exacerbated in elite soccer players compared to the general population. METHOD Neurocognitive performance in 6 domains was compared between 240 elite soccer players and a normative sample from the general population (n = 585) using the computerised test battery CNS Vital Signs. We used two-way factorial ANOVA to analyse the interaction between age groups (15-19, 20-29, 30-39, 40-49 years) and study population (female soccer players vs. norm sample) in their effects on neurocognitive performance. RESULTS We found no significant interaction effect of age group and study population in five of six test domains. For processing speed, the effect of age was more pronounced in female soccer players (F = 16.89, p = .002). Further, there was a clear main effect of study population on neurocognitive performance with generally better scores in soccer players. CONCLUSIONS Elite female soccer players generally performed better than the norm sample on tests of cognitive function, and further, cognitive ageing effects were similar in elite soccer players and controls in all but one domain. A lifespan approach may facilitate insightful future research regarding questions related to long-term neurocognitive health in contact sport athletes.
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Amitay N, Zlotnik Y, Coreanu T, Zeller L, Abu-Salameh I, Novack V, Ifergane G. Soccer heading and subclinical neuropsychiatric symptomatology in professional soccer players. Neurology 2020; 95:e1776-e1783. [DOI: 10.1212/wnl.0000000000010244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/17/2020] [Indexed: 12/17/2022] Open
Abstract
ObjectivesTo evaluate the association between postconcussive symptomatology and heading in professional soccer players, overcoming the bias of self-reported exposure, we evaluated several clinical neuropsychiatric symptoms using questionnaires after a thorough objective follow-up of players’ heading exposure throughout an entire season.MethodsWe collected heading data for all Israeli Premier League players for an entire season using a web-based platform for performance analysis, which enabled us to quantify the exact number of headers per player. Players filled out questionnaires regarding postconcussion symptoms, depression, anxiety, and sleep disorders. We tested the association between the number of headers and each outcome using a negative binomial regression corrected for the hours played.ResultsA total of 159 players were included, of whom 79 were considered in the high heading exposure group (49%), defined as more than median number of headings (1.34 per game hour). Among players without any past head injury, those with higher heading exposure were less likely to have postconcussion symptoms compared with players with low heading exposure (relative risk [RR] per heading per hour 0.94, 95% confidence interval [CI] 0.912–0.963). Players with high heading exposure had fewer depression symptoms (RR 0.98, 95% CI 0.961–0.997), anxiety (RR 0.98, 95% CI 0.958–0.997), and sleep disorders (RR 0.98, 95% CI 0.961–0.996).ConclusionProfessional soccer players with high heading rate do not display higher postconcussive symptomatology severity. Symptoms among players with low heading exposure might be explained by low resilience, possibly associated with an inferior heading technique. Alternatively, it can reflect heading-avoidant behavior.
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Mooney J, Self M, ReFaey K, Elsayed G, Chagoya G, Bernstock JD, Johnston JM. Concussion in soccer: a comprehensive review of the literature. Concussion 2020; 5:CNC76. [PMID: 33005435 PMCID: PMC7506470 DOI: 10.2217/cnc-2020-0004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Sports-related concussion has been examined extensively in collision sports such as football and hockey. However, historically, lower-risk contact sports such as soccer have only more recently garnered increased attention. Here, we review articles examining the epidemiology, injury mechanisms, sex differences, as well as the neurochemical, neurostructural and neurocognitive changes associated with soccer-related concussion. From 436 titles and abstracts, 121 full texts were reviewed with a total of 64 articles identified for inclusion. Concussion rates are higher during competitions and in female athletes with purposeful heading rarely resulting in concussion. Given a lack of high-level studies examining sports-related concussion in soccer, clinicians and scientists must focus research efforts on large-scale data gathering and development of improved technologies to better detect and understand concussion.
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Affiliation(s)
- James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Mitchell Self
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Galal Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - James M Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
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Champagne AA, Coverdale NS, Germuska M, Bhogal AA, Cook DJ. Changes in volumetric and metabolic parameters relate to differences in exposure to sub-concussive head impacts. J Cereb Blood Flow Metab 2020; 40:1453-1467. [PMID: 31307284 PMCID: PMC7308522 DOI: 10.1177/0271678x19862861] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/11/2019] [Indexed: 01/15/2023]
Abstract
Structural and calibrated magnetic resonance imaging data were acquired on 44 collegiate football players prior to the season (PRE), following the first four weeks in-season (PTC) and one month after the last game (POST). Exposure data collected from g-Force accelerometers mounted to the helmet of each player were used to split participants into HIGH (N = 22) and LOW (N = 22) exposure groups, based on the frequency of impacts sustained by each athlete. Significant decreases in grey-matter volume specific to the HIGH group were documented at POST (P = 0.009), compared to baseline. Changes in resting cerebral blood flow (CBF0), corrected for partial volume effects, were observed within the HIGH group, throughout the season (P < 0.0001), suggesting that alterations in perfusion may follow exposure to sub-concussive collisions. Co-localized significant increases in cerebral metabolic rate of oxygen consumption (CMRO2|0) mid-season were also documented in the HIGH group, with respect to both PRE- and POST values. No physiological changes were observed in the LOW group. Therefore, cerebral metabolic demand may be elevated in players with greater exposure to head impacts. These results provide novel insight into the effects of sub-concussive collisions on brain structure and cerebrovascular physiology and emphasize the importance of multi-modal imaging for a complete characterization of cerebral health.
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Affiliation(s)
- Allen A Champagne
- Centre for Neuroscience Studies, Queen’s
University, Kingston, ON, Canada
| | - Nicole S Coverdale
- Centre for Neuroscience Studies, Queen’s
University, Kingston, ON, Canada
| | - Mike Germuska
- Cardiff University Brain Research
Imaging Center, Cardiff University, Cardiff, UK
| | - Alex A Bhogal
- Department of Radiology, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Douglas J Cook
- Centre for Neuroscience Studies, Queen’s
University, Kingston, ON, Canada
- Department of Surgery, Queen’s
University, Kingston, ON, Canada
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Champagne AA, Distefano V, Boulanger MM, Magee B, Coverdale NS, Gallucci D, Guskiewicz K, Cook DJ. Data-informed Intervention Improves Football Technique and Reduces Head Impacts. Med Sci Sports Exerc 2020; 51:2366-2374. [PMID: 31269008 PMCID: PMC7028524 DOI: 10.1249/mss.0000000000002046] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Although sport participation is a key contributor to the physical and mental health of children and youth, exposure to subconcussive head impacts in football has raised concerns about safety for athletes. PURPOSE To demonstrate the efficacy of incorporating targeted football drills into a team's practice routine with the goal of improving players' technique and reduce exposure to subconcussive head impacts. METHODS Seventy high school football players (age, 16.4 ± 1.1 yr) were tested PRE season using a sport-specific functional assessment. Results from the testing were used to inform the design of a prepractice intervention aimed at improving tackling and blocking techniques while reducing exposure to head impacts. The assessment included drills which evaluated the players' ability to safely tackle, and block while simulating game-like situations. Testing was repeated at MID season (internal control) without an intervention, and again at POST season (experimental), after introduction of the prepractice intervention between these timepoints, administered twice weekly. All testing sessions were recorded, and subsequently reviewed by trained graders based on selected criteria defined by football coaches. A subset of 19 participants wore in-helmet accelerometers to assess the effectiveness of the intervention in decreasing head impacts during practice. RESULTS Significant improvements in blocking and tackling techniques were observed after the introduction of the intervention (P < 0.0001). Participating athletes also showed better techniques when evaluated in new game-like situations, postseason, providing evidence for proper acquisition and generalizability of these safer habits. Finally, frequency of head impacts (>15g) per practice was significantly reduced by ~30% after 1 month of training. CONCLUSION Our results suggest that data-informed methods can be used to improve coaching practices and promote safer play, which can have a positive public health impact moving forward.
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Affiliation(s)
- Allen A Champagne
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, CANADA
| | - Vincent Distefano
- School of Applied Child Psychology, McGill Connections Lab, Montréal, QC, CANADA
| | | | - Blaire Magee
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, CANADA
| | - Nicole S Coverdale
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, CANADA
| | | | - Kevin Guskiewicz
- Matthew Gfeller Sport-Related TBI Research Center, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Douglas J Cook
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, CANADA.,Department of Surgery, Queen's University, Kingston, ON, CANADA
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Beaudouin F, Gioftsidou A, Larsen MN, Lemmink K, Drust B, Modena R, Espinola JR, Meiu M, Vouillamoz M, Meyer T. The UEFA Heading Study: Heading incidence in children's and youth' football (soccer) in eight European countries. Scand J Med Sci Sports 2020; 30:1506-1517. [PMID: 32335945 DOI: 10.1111/sms.13694] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022]
Abstract
To assess the real-life magnitude of the heading incidence in children's and youth' football in eight European countries with different "football cultures," a cross-sectional observational design, in which one match per team in 480 different teams from eight European countries (2017/18-2018/19), was recorded by video. One training session was recorded in 312 teams. Clubs with Under-10, Under-12 (female/male/mixed), and Under-16 female and male teams were eligible to participate. Heading frequencies and types were analyzed. Results are presented as headers per match/training and per team. Incidence rates (IR) per 1000 match/training hours were calculated. Under-10 teams carried out the lowest average number of headers per match (8.8), followed by Under-16 female (17.7), Under-12 (18.4), and Under-16 male (35.5). Total number of headers per match and team varied between countries. 80% of the total number of headers were single intentional headers, 12% heading duels, 3% unintentional headers by getting hit, and 5% others (trends apparent in all age groups). Three head injuries occurred during match play corresponding to an IR of 0.70 (95% CI, 0.23-2.16). The lowest number of headers per training and team was found in Under-10 (21.3), followed by Under-16 females (34.1), Under-12 (35.8), and Under-16 males (45.0). In conclusion, this large-scale study presents novel data about the number and type of headers in youth' football throughout Europe. A more precise understanding of the heading incidence, specifically in young players, is mandatory for the debate of restrictions on heading in youth football.
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Affiliation(s)
- Florian Beaudouin
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Asimenia Gioftsidou
- Department of Physical Education and Sport Sciences, Democritus University of Thrace, Komotini, Greece
| | - Malte Nejst Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Koen Lemmink
- Center of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Barry Drust
- Sport and Exercise Sciences, John Moores University, Liverpool, UK
| | - Roberto Modena
- CeRiSM Research Center Sport Mountain and Health, University of Verona, Verona, Italy
| | | | - Mihai Meiu
- Romanian Football Federation, Bucharest, Romania
| | - Marc Vouillamoz
- Union des Associations Européennes de Football (UEFA), Nyon, Switzerland
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
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Sandmo SB, Filipcik P, Cente M, Hanes J, Andersen TE, Straume-Naesheim TM, Bahr R. Neurofilament light and tau in serum after head-impact exposure in soccer. Brain Inj 2020; 34:602-609. [DOI: 10.1080/02699052.2020.1725129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Stian Bahr Sandmo
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Peter Filipcik
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Martin Cente
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jozef Hanes
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Truls Martin Straume-Naesheim
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Department of Orthopedic Surgery, Haugesund Rheumatism Hospital, Haugesund, Norway
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Caccese JB, Best C, Lamond LC, Difabio M, Kaminski TW, Watson D, Getchell N, Buckley TA. Effects of Repetitive Head Impacts on a Concussion Assessment Battery. Med Sci Sports Exerc 2020; 51:1355-1361. [PMID: 30649104 DOI: 10.1249/mss.0000000000001905] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to determine the relationship between repetitive head impacts (RHI) and clinical concussion assessments across a season among collegiate football (FB) and women's soccer (WSOC) players. METHODS Fifteen male FB and 23 WSOC players participated in this study. Participants were included if they were medically cleared for unrestricted athletic participation. Participants were tested in a university athletic training room on two occasions: preseason (PRE) and postseason (POST). The outcome measures consisted of tandem gait (TG), Standardized Assessment of Concussion, Balance Error Scoring System, King-Devick (KD), clinical reaction time, and Immediate Post-Concussion Assessment and Cognitive Testing. Repetitive head impact during the season was quantified using the Head Impact Telemetry System (Simbex, NH) for FB and the Smart Impact Monitor (SIM; Triax Technologies, Norwalk, CT) for WSOC. Independent variables included total number of impacts, average magnitude of peak linear acceleration, cumulative linear exposure, and number of impacts ≥98g. RESULTS Results from direct-entry multiple regression analyses suggest significant associations between RHI and both visual memory (R = 0.670, F = 6.487, P = 0.002) and TG (R = 0.636, F = 3.841, P = 0.029) for WSOC and between RHI and KD (R = 0.756, F = 5.579, P = 0.013) for FB, whereby those with greater exposure performed worse. No other regression analyses within or across groups were significant. CONCLUSIONS These data suggest that RHI do not represent clinically meaningful changes on a multifaceted and multimodal concussion assessment battery. However, there may be subtle visual/vestibular impairments as observed by the associations between RHI and visual memory/TG among WSOC, RHI, and KD among FB.
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Affiliation(s)
- Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | | | - Lindsey C Lamond
- Department of Family Medicine, Wake Forest Baptist Health, Winston-Salem, NC
| | - Melissa Difabio
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Dan Watson
- University of Delaware Athletics, Newark, DE
| | - Nancy Getchell
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE
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Hunter LE, Freudenberg-Hua Y, Davies P, Kim M, Fleysher R, Stewart WF, Lipton RB, Lipton ML. BDNF Val 66Met Positive Players Demonstrate Diffusion Tensor Imaging Consistent With Impaired Myelination Associated With High Levels of Soccer Heading: Indication of a Potential Gene-Environment Interaction Mechanism. Front Neurol 2019; 10:1297. [PMID: 31920921 PMCID: PMC6918922 DOI: 10.3389/fneur.2019.01297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/25/2019] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to examine the potential effect modifying role of the BDNF Val66Met polymorphism on the association of soccer heading with white matter microstructure. We studied 312 players enrolled in the ongoing Einstein Soccer Study, a longitudinal study of amateur soccer player in New York City and surrounding areas. At enrollment and 2 years later, total heading in the prior 12 months (12-mo.) was estimated using an established self-report instrument and diffusion tensor imaging (DTI) was performed. Generalized Estimating Equations (GEE) logistic regression models were employed to test effect modification by the BDNF Val66Met polymorphism on the association between 12-mo. heading exposure and DTI. We identified a significant interaction of 12-mo heading*BDNF Val66Met genotype on the presence of low Radial Diffusivity, a DTI marker associated with myelination. Only Met (+) players demonstrated significantly reduced odds of low RD [OR (95 % CI): -2.36 (-3.53, -1.19)] associated with the highest vs. lowest quartile of 12-mo heading exposure. BDNF Val66Met (+) soccer players with long-term exposure to high levels of heading exhibit less low Radial Diffusivity, suggesting impaired re-myelination may be a substrate of the previously reported association between heading and poor functional outcomes in soccer players.
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Affiliation(s)
- Liane E. Hunter
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
| | - Yun Freudenberg-Hua
- Division of Geriatric Psychiatry, Northwell Health, Glen Oaks, NY, United States
- Litwin-Zucker Center for the Study of Alzheimer's Disease, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Peter Davies
- Division of Geriatric Psychiatry, Northwell Health, Glen Oaks, NY, United States
| | - Mimi Kim
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
| | - Roman Fleysher
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
| | | | - Richard B. Lipton
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
- Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
| | - Michael L. Lipton
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
- Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, United States
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Kenny RA, Mayo CD, Kennedy S, Varga AA, Stuart-Hill L, Garcia-Barrera MA, McQuarrie A, Christie BR, Gawryluk JR. A pilot study of diffusion tensor imaging metrics and cognitive performance pre and post repetitive, intentional sub-concussive heading in soccer practice. JOURNAL OF CONCUSSION 2019. [DOI: 10.1177/2059700219885503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Although soccer players routinely head the ball in practice and games, recent research has suggested that cumulative effects of repetitive heading may cause sub-concussive injury with accompanying effects on brain and behavior. The current study aimed to prospectively investigate the effects of repetitive, intentional heading in soccer practice on brain structure and cognitive function, using a within-subjects design. Methods Participants included 10 soccer players (mean age 20.09 years ± 2.88) who were examined immediately pre- and post-heading practice. An accelerometer was used to measure the force of the impact during soccer heading. Magnetic resonance imaging data were acquired on a 3 T GE Scanner with diffusion tensor imaging. Diffusion tensor imaging analyses were completed using functional magnetic resonance imaging of the brain software library’s Tract-Based Spatial Statistics to examine changes in both fractional anisotropy and mean diffusivity due to heading the soccer ball. Behavioral measures were also completed pre- and post-soccer heading and included the Sport Concussion Assessment Tool and three short-computerized executive function tasks; R studio was used to compare behavioral data within subjects. Results Accelerometer data revealed that none of the heading impacts were >10 g. At this level of impact, there were no significant pre–post heading differences in either fractional anisotropy or mean diffusivity. Additionally, aside from minimal practice effects, there were no significant differences in Sport Concussion Assessment Tool scores and no significant differences in the performance of the three executive function tasks pre–post heading. Conclusions The results provide initial evidence that repetitive heading in soccer practice, at a g force of 10, does not cause changes in brain structure or executive function. Future research should investigate heading in the context of games and with a greater sample size that would allow for sex-based comparisons.
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Affiliation(s)
- Rebecca A Kenny
- Department of Psychology, University of Victoria, Victoria, BC, Canada
- Department of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Chantel D Mayo
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Samantha Kennedy
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Island Medical Program, University of British Columbia, Victoria, BC, Canada
| | - Aaron A Varga
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Island Medical Program, University of British Columbia, Victoria, BC, Canada
| | - Lynneth Stuart-Hill
- Department of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | | | - Amanda McQuarrie
- Department of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Brian R Christie
- Department of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Island Medical Program, University of British Columbia, Victoria, BC, Canada
| | - Jodie R Gawryluk
- Department of Psychology, University of Victoria, Victoria, BC, Canada
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61
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Sandmo SB, Andersen TE, Koerte IK, Bahr R. Head impact exposure in youth football-Are current interventions hitting the target? Scand J Med Sci Sports 2019; 30:193-198. [PMID: 31584703 PMCID: PMC6916205 DOI: 10.1111/sms.13562] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/27/2019] [Accepted: 10/01/2019] [Indexed: 12/20/2022]
Abstract
Restrictions on heading in youth football have been implemented in some countries to limit head impact exposure. However, current interventions remain poorly guided by evidence. Our objective was to quantify heading exposure in youth football, assessing the effects of sex and age. Football matches played during an international youth football tournament with no heading restrictions were directly observed, including players from both sexes (11-19 years). The elite senior level was included for comparison, using video analysis. All heading events were registered, classified, and assigned to individual players. Heading rates were calculated for each sex and age group. We observed a total of 267 matches, corresponding to 4011 player hours (1927 player hours for females, 2083 player hours for males). Males headed more frequently than females (2.7 vs 1.8 headers/player hour; P < .001). Heading rates increased with age (ANOVA, P < .001), approaching the elite senior level for players 16 years and older. There was substantial variation within teams for all age and sex groups, with the widest range (1-18 headers) observed for girls aged 19. Girls younger than 12 years had the lowest exposure, with an average of <2 players per team heading the ball, each with 1-2 headers. In conclusion, age and sex influence head impact exposure in youth football, and warrants careful consideration when introducing injury prevention measures. Males are more frequently exposed than females, heading rates increase with age, and there is substantial variation between players. Heading is a rare event in the youngest age groups, especially among females.
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Affiliation(s)
- Stian Bahr Sandmo
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Inga Katharina Koerte
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Zuckerman SL, Brett BL, Jeckell A, Yengo-Kahn AM, Solomon GS. Chronic Traumatic Encephalopathy and Neurodegeneration in Contact Sports and American Football. J Alzheimers Dis 2019; 66:37-55. [PMID: 30223396 DOI: 10.3233/jad-180218] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease characterized by the presence of abnormally phosphorylated tau protein in the depths of one or more cortical sulci. Controversy over the risk of CTE and neurologic disorders later in life among contact sport athletes has taken hold in the public spotlight, most notably in American football. Players, parents, coaches, and legislators have taken action based on the commonly held notion that contact sports invariably lead to neurodegenerative disorders. However, to fully understand the science behind this assumed association, a critical appraisal of the evidence is warranted. With regards to CTE in sports, the objectives of the current report are to: 1) describe the history of CTE, 2) review current CTE definitions, 3) critically evaluate the empiric data, divided into all contact sports and exclusively American football, and 4) summarize notable themes for future research.
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Affiliation(s)
- Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin L Brett
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aaron Jeckell
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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63
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Kaminski TW, Thompson A, Wahlquist VE, Glutting J. Self-reported head injury symptoms exacerbated in those with previous concussions following an acute bout of purposeful soccer heading. Res Sports Med 2019; 28:217-230. [PMID: 31257930 DOI: 10.1080/15438627.2019.1635130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Rates of concussion in soccer are high, especially in female players. The primary aim of this study was to examine differences in self-reported concussion-related symptoms (CRS), balance (BESS), and neurocognitive performance (ImPACT) following an acute bout of soccer heading in a group of female collegiate players with and without a history of concussion. Eighty-seven players with 0 to 3+ previous concussions participated. The measurement variables were assessed before and after heading sessions; including one linear and one rotational bout. Players with concussion histories reported more CRS than their non-concussed teammates both before and after the heading sessions. Balance and neurocognitive scores were generally unaffected. This finding should heighten our awareness to carefully monitor soccer players who have experienced concussions and be aware that they may develop concussion-like symptoms, especially after acute bouts of heading either during practice or in matches. The long-term implications of this finding remain unknown.
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Affiliation(s)
- Thomas W Kaminski
- Department of Kinesiology & Applied Physiology, Athletic Training Research Laboratory, University of Delaware, Newark, DE, USA
| | - Adam Thompson
- Family Medicine, Crozer Chester Medical Center, Springfield, PA, USA
| | - Victoria E Wahlquist
- Department of Kinesiology & Applied Physiology, Athletic Training Research Laboratory, University of Delaware, Newark, DE, USA
| | - Joseph Glutting
- School of Education, University of Delaware, Newark, DE, USA
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64
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Prien A, Junge A, Brugger P, Straumann D, Feddermann-Demont N. Neurocognitive Performance of 425 Top-Level Football Players: Sport-specific Norm Values and Implications. Arch Clin Neuropsychol 2019; 34:575-584. [PMID: 30165564 DOI: 10.1093/arclin/acy056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/07/2018] [Accepted: 07/04/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Concussion diagnosis and management in sports largely relies on neurocognitive testing. In the absence of baseline assessment, only norm values of the general population are available for comparison with scores of concussed athletes. To evaluate whether (elite) sport specific norm values are needed, cognitive performance was compared between top-level football players and the general population. METHODS Cognitive performance of 425 top-level football players was evaluated using the computerized test battery CNS Vital Signs. Players were split into two age groups (15-19 and 20-29 years) and test results were compared with a norm sample (n = 268) by means of age-standardized scores using Cohen's d effect size statistics. RESULTS The younger age group outperformed the norm sample in all domains, with small to moderate effects on tests of processing speed (d = 0.58, 95% CI = 0.31,0.85), cognitive flexibility (d = 0.27, 95% CI = 0.01,0.53) and psychomotor speed (d = 0.97, 95% CI = 0.69,1.24). In the older age group, no differences were found on four out of six domains; a moderate positive effect was found for psychomotor speed (d = 0.74, 95% CI = 0.54,0.93), a small negative effect for reaction time (d = -0.47, 95% CI = -0.66,-0.28). Relative to the norm, older football players scored lower than younger football players on all test domains. CONCLUSION Cognitive performance of elite football players may be different from the general population. It is recommended to use football-specific norm scores for comparison with test results of concussed players, and to choose an adequate control group when investigating effects of contact sport on cognition. Studies with older/retired football players are needed to further analyze potential sport-specific age effects.
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Affiliation(s)
- Annika Prien
- Department of Prevention, Health Promotion and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Astrid Junge
- Department of Prevention, Health Promotion and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
- Schulthess Clinic, Zurich, Switzerland
- Swiss Concussion Centre (SCC), Zurich, Switzerland
| | - Peter Brugger
- Swiss Concussion Centre (SCC), Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, ZIHP, University of Zurich, Switzerland
| | - Dominik Straumann
- Swiss Concussion Centre (SCC), Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Nina Feddermann-Demont
- Schulthess Clinic, Zurich, Switzerland
- Swiss Concussion Centre (SCC), Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
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65
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Gasquoine PG. Historical perspectives on evolving operational definitions of concussive brain injury: From railway spine to sport-related concussion. Clin Neuropsychol 2019; 34:278-295. [PMID: 31146639 DOI: 10.1080/13854046.2019.1621383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: Concussion is a clinical syndrome of biomechanically induced alteration in brain function. The historical derivation of current operational definitions of uncomplicated concussive brain injury based on acute injury variables especially posttraumatic amnesia (PTA) vs. symptom presence (no PTA) are reviewed.Methods: Major milestones from 150 plus years of concussion research include (a) railway spine; (b) traumatic neurosis; (c) duration of loss of consciousness predicting severity of brain injury; (d) early neuropsychological studies; (e) sport related concussion; and (f) chronic traumatic encephalopathy.Results: After initial organic explanations proved untenable, 19th century conceptions of concussion were operationally defined from symptom presence, attributed primarily to psychogenic (emotional, motivational, and/or predispositional) causes. In the 1930s, duration of PTA was linked to brain injury severity via outcome studies. Concussion (as defined by PTA < 1 h) was later found to cause a transient lowering of neuropsychological test scores in memory and executive function. In the 1990s, organizational definitions of sport-related concussion began to include biomechanical events without PTA that produced symptoms. Such events have not been linked to neuropsychological impairment.Conclusions: Two differing operational definitions of concussion are in the current use, involving the presence vs. absence of PTA. These two groupings are not clinically similar, although they are currently being widely treated as such. Operational definitions of concussion should address both minimum and maximums for duration of PTA, initial Glasgow Coma Scale score, complications, and symptom presence.
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Affiliation(s)
- Philip Gerard Gasquoine
- Department of Psychological Science, University of Texas Rio Grande Valley, Edinburg, Texas, USA
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66
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Long-Term Neuroimaging Findings in American Football Players: Systematic Review. World Neurosurg 2018; 120:e365-e379. [DOI: 10.1016/j.wneu.2018.08.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/11/2018] [Indexed: 01/08/2023]
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67
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Monk SH, Legarreta AD, Kirby P, Brett BL, Yengo-Kahn AM, Bhatia A, Solomon GS, Zuckerman SL. Imaging findings after acute sport-related concussion in American football players: A systematic review. J Clin Neurosci 2018; 61:28-35. [PMID: 30487055 DOI: 10.1016/j.jocn.2018.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/05/2018] [Indexed: 12/21/2022]
Abstract
Sport-related concussion (SRC) has emerged as a major public health problem. The results of brain imaging studies following SRC have raised questions about long-term neurologic health, but the clinical implications of these findings remain unknown. A systematic review of brain imaging findings after SRC was performed utilizing the following inclusion criteria: football players, brain imaging within 6 months of SRC, and sample size >5. Studies were assessed for: 1) methodology, 2) imaging outcomes, and 3) number of positive statistical comparisons. Imaging was classified as immediate (≤1 week post-injury) or subacute (>1 week to 6 months post-injury). Eleven studies met inclusion criteria. Eight of the 11 studies conducted a total of 809 comparisons of brain function, of which 149 (18%) were statistically significant. Nine of the 11 studies (82%) reported positive immediate findings, but were more likely to be subject to recall bias (86% vs. 0%) and to lack baseline advanced brain imaging (78% vs. 50%) than negative studies. Only 3 of 9 studies that reported subacute findings (33%) reported positive results, and these positive studies were also more likely to be subject to recall bias (100% vs. 40%) and to lack baseline advanced brain imaging (100% vs. 67%) than negative studies. The results of the study demonstrate the transitory nature of positive imaging findings and methodological limitations that complicate study interpretation. Further research is required to correlate imaging findings with clinical outcomes.
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Affiliation(s)
- Steve H Monk
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Andrew D Legarreta
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Paul Kirby
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Benjamin L Brett
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aashim Bhatia
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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68
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Wahlquist VE, Glutting JJ, Kaminski TW. Examining neurocognitive performance and heading in interscholastic female football players over their playing careers. SCI MED FOOTBALL 2018. [DOI: 10.1080/24733938.2018.1532104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Victoria E. Wahlquist
- Department of Kinesiology and Applied Physiology, Athletic Training Research Lab, University of Delaware, Newark, DE, USA
| | | | - Thomas W. Kaminski
- Department of Kinesiology and Applied Physiology, Athletic Training Research Lab, University of Delaware, Newark, DE, USA
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69
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Mayer AR, Kaushal M, Dodd AB, Hanlon FM, Shaff NA, Mannix R, Master CL, Leddy JJ, Stephenson D, Wertz CJ, Suelzer EM, Arbogast KB, Meier TB. Advanced biomarkers of pediatric mild traumatic brain injury: Progress and perils. Neurosci Biobehav Rev 2018; 94:149-165. [PMID: 30098989 DOI: 10.1016/j.neubiorev.2018.08.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/27/2018] [Accepted: 08/03/2018] [Indexed: 12/20/2022]
Abstract
There is growing public concern about neurodegenerative changes (e.g., Chronic Traumatic Encephalopathy) that may occur chronically following clinically apparent and clinically silent (i.e., sub-concussive blows) pediatric mild traumatic brain injury (pmTBI). However, there are currently no biomarkers that clinicians can use to objectively diagnose patients or predict those who may struggle to recover. Non-invasive neuroimaging, electrophysiological and neuromodulation biomarkers have promise for providing evidence of the so-called "invisible wounds" of pmTBI. Our systematic review, however, belies that notion, identifying a relative paucity of high-quality, clinically impactful, diagnostic or prognostic biomarker studies in the sub-acute injury phase (36 studies on unique samples in 28 years), with the majority focusing on adolescent pmTBI. Ultimately, well-powered longitudinal studies with appropriate control groups, as well as standardized and clearly-defined inclusion criteria (time post-injury, injury severity and past history) are needed to truly understand the complex pathophysiology that is hypothesized (i.e., still needs to be determined) to exist during the acute and sub-acute stages of pmTBI and may underlie post-concussive symptoms.
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Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States; Neurology Department, University of New Mexico School of Medicine, Albuquerque, NM, 87131, United States; Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM, 87131, United States; Psychology Department, University of New Mexico, Albuquerque, NM, 87131, United States.
| | - Mayank Kaushal
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Faith M Hanlon
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Nicholas A Shaff
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, 02115, United States
| | - Christina L Master
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, PA, 19104, United States; Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - John J Leddy
- UBMD Department of Orthopaedics and Sports Medicine, University at Buffalo, Buffalo, NY, 14214, United States
| | - David Stephenson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Christopher J Wertz
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Elizabeth M Suelzer
- Medical College of Wisconsin Libraries, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, PA, 19104, United States
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, United States; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
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70
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Becker S, Fröhlich M, Kelm J, Ludwig O. The Influence of Fatigued Core Muscles on Head Acceleration during Headers in Soccer. Sports (Basel) 2018; 6:E33. [PMID: 29910337 PMCID: PMC6027546 DOI: 10.3390/sports6020033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 11/16/2022] Open
Abstract
The core muscles play a central role in stabilizing the head during headers in soccer. The objective of this study was to examine the influence of a fatigued core musculature on the acceleration of the head during jump headers and run headers. Acceleration of the head was measured in a pre-post-design in 68 soccer players (age: 21.5 ± 3.8 years, height: 180.0 ± 13.9 cm, weight: 76.9 ± 8.1 kg). Data were recorded by means of a telemetric 3D acceleration sensor and with a pendulum header. The treatment encompassed two exercises each for the ventral, lateral, and dorsal muscle chains. The acceleration of the head between pre- and post-test was reduced by 0.3 G (p = 0.011) in jump headers and by 0.2 G (p = 0.067) in run headers. An additional analysis of all pretests showed an increased acceleration in run headers when compared to stand headers (p < 0.001) and jump headers (p < 0.001). No differences were found in the sub-group comparisons: semi-professional vs. recreational players, offensive vs. defensive players. Based on the results, we conclude that the acceleration of the head after fatiguing the core muscles does not increase, which stands in contrast to postulated expectations. More tests with accelerated soccer balls are required for a conclusive statement.
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Affiliation(s)
- Stephan Becker
- Department of Sport Science, Technische Universität Kaiserslautern, 67663 Kaiserslautern, Germany.
| | - Michael Fröhlich
- Department of Sport Science, Technische Universität Kaiserslautern, 67663 Kaiserslautern, Germany.
| | - Jens Kelm
- Chirurgisch-Orthopädisches Zentrum, 66557 Illingen, Germany.
| | - Oliver Ludwig
- Department of Sport Science, Technische Universität Kaiserslautern, 67663 Kaiserslautern, Germany.
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71
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Abstract
My objectives are to review: 1) a brief history of sport-related concussion (SRC) and chronic traumatic encephalopathy (CTE), 2) the evolution of CTE in American professional football, 3) the data regarding SRC/CTE as they relate to depression and suicide, 4) the data on the neurocognitive effects of subconcussion/repetitive head trauma (with emphases on heading the ball in soccer and early exposure to football), 5) the evidence related to SRC and neurodegenerative diseases, 6) the published studies of CTE, 7) the NINDS neuropathological criteria for CTE, 8) public beliefs about SRC/CTE, and 9) the scientific questions regarding CTE.
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Affiliation(s)
- Gary Solomon
- a Department of Neurological Surgery, Vanderbilt Sports Concussion Center , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
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72
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Kellar D, Newman S, Pestilli F, Cheng H, Port NL. Comparing fMRI activation during smooth pursuit eye movements among contact sport athletes, non-contact sport athletes, and non-athletes. NEUROIMAGE-CLINICAL 2018. [PMID: 29541575 PMCID: PMC5849867 DOI: 10.1016/j.nicl.2018.01.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objectives Though sub-concussive impacts are common during contact sports, there is little consensus whether repeat blows affect brain function. Using a "lifetime exposure" rather than acute exposure approach, we examined oculomotor performance and brain activation among collegiate football players and two control groups. Our analysis examined whether there are group differences in eye movement behavioral performance and in brain activation during smooth pursuit. Methods Data from 21 off-season Division I football "starters" were compared with a) 19 collegiate cross-country runners, and b) 11 non-athlete college students who were SES matched to the football player group (total N = 51). Visual smooth pursuit was performed while undergoing fMRI imaging via a 3 Tesla scanner. Smooth pursuit eye movements to three stimulus difficulty levels were measured with regard to RMS error, gain, and lag. Results No meaningful differences were found for any of the standard analyses used to assess smooth pursuit eye movements. For fMRI, greater activation was seen in the oculomotor region of the cerebellar vermis and areas of the FEF for football players as compared to either control group, who did not differ on any measure. Conclusion Greater cerebellar activity among football players while performing an oculomotor task could indicate that they are working harder to compensate for some subtle, long-term subconcussive deficits. Alternatively, top athletes in a sport requiring high visual motor skill could have more of their cerebellum and FEF devoted to oculomotor task performance regardless of subconcussive history. Overall, these results provide little firm support for an effect of accumulated subconcussion exposure on brain function.
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Affiliation(s)
- Derek Kellar
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States
| | - Sharlene Newman
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States
| | - Franco Pestilli
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States
| | - Hu Cheng
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States
| | - Nicholas L Port
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States.
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73
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Lamond LC, Caccese JB, Buckley TA, Glutting J, Kaminski TW. Linear Acceleration in Direct Head Contact Across Impact Type, Player Position, and Playing Scenario in Collegiate Women's Soccer Players. J Athl Train 2018; 53:115-121. [PMID: 29373056 DOI: 10.4085/1062-6050-90-17] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Heading, an integral component of soccer, exposes athletes to a large number of head impacts over a career. The literature has begun to indicate that cumulative exposure may lead to long-term functional and psychological deficits. Quantifying an athlete's exposure over a season is a first step in understanding cumulative exposure. OBJECTIVE To measure the frequency and magnitude of direct head impacts in collegiate women's soccer players across impact type, player position, and game or practice scenario. DESIGN Cross-sectional study. SETTING National Collegiate Athletic Association Division I institution. PATIENTS OR OTHER PARTICIPANTS Twenty-three collegiate women's soccer athletes. MAIN OUTCOME MEASURE(S) Athletes wore Smart Impact Monitor accelerometers during all games and practices. Impacts were classified during visual, on-field monitoring of athletic events. All direct head impacts that exceeded the 10 g threshold were included in the final data analysis. The dependent variable was linear acceleration, and the fixed effects were (1) type of impact: clear, pass, shot, unintentional deflection, or head-to-head contact; (2) field position: goalkeeper, defense, forward, or midfielder; (3) playing scenario: game or practice. RESULTS Shots (32.94 g ± 12.91 g, n = 38; P = .02) and clears (31.09 g ± 13.43 g, n = 101; P = .008) resulted in higher mean linear accelerations than passes (26.11 g ± 15.48 g, n = 451). Head-to-head impacts (51.26 g ± 36.61 g, n = 13; P < .001) and unintentional deflections (37.40 g ± 34.41 g, n = 24; P = .002) resulted in higher mean linear accelerations than purposeful headers (ie, shots, clears, and passes). No differences were seen in linear acceleration across player position or playing scenario. CONCLUSIONS Nonheader impacts, including head-to-head impacts and unintentional deflections, resulted in higher mean linear accelerations than purposeful headers, including shots, clears, and passes, but occurred infrequently on the field. Therefore, these unanticipated impacts may not add substantially to an athlete's cumulative exposure, which is a function of both frequency and magnitude of impact.
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Affiliation(s)
- Lindsey C Lamond
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
| | - Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
| | | | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
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74
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Coffey N, Lawless M, Kelly S, Buggy C. Frequency of Self-Reported Concussion Amongst Professional and Semi-Professional Footballers in Ireland During the 2014 Season: a Cross-Sectional Study. SPORTS MEDICINE - OPEN 2018; 4:4. [PMID: 29313156 PMCID: PMC5758485 DOI: 10.1186/s40798-017-0118-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 12/20/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND This paper examines the occupational risk of concussion amongst professional and semi-professional footballers in Ireland during the 2014 League of Ireland season. As part of a broader nationally representative study examining occupational safety and health (OSH) awareness amongst professional footballers, this empirical quantitative study, utilising a convenience sample is the first and largest investigation of the frequency of, and attitudes towards, concussion and concussion reporting amongst Irish senior professional and semi-professional footballers. METHODS A census survey using an anonymous questionnaire was provided to available League of Ireland clubs between March and May 2015. Permission to access players was provided by the Professional Footballers Association of Ireland. This convenience sample was determined by club availability in relation to match fixtures. Participation by the footballers was voluntary. At the time, there were 250 professional and semi-professional players within the League available to participate. RESULTS A total of 149 footballers participated in the study. Sixty percent of the participants were employed on a semi-professional basis and the majority of all participants were aged between 18 and 30. 15.7% of the participants reported having received a concussion in the 2014 season with semi-professional players having a noticeably higher (though not significant) reporting rate. Analysis indicated that there was a significant association between playing position and concussion reporting with defenders having the greater odds of reporting a concussion than other playing positions. Professional and semi-professional footballers have a relatively equal risk of receiving a concussion. CONCLUSION This research is the first major investigation of the self-reported frequency of, and attitudes towards, concussion amongst Irish senior professional and semi-professional footballers. The results have important implications for coaches, clinicians, parents, players and national governing bodies. Further research is needed to ascertain whether professional footballers perceive concussion as an occupational risk, and whether they appreciate that accepting such risks can have long-term implications for health.
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Affiliation(s)
- Nicola Coffey
- UCD Centre for Safety and Health at Work, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Martin Lawless
- UCD Centre for Safety and Health at Work, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Seamus Kelly
- UCD Centre for Sports Studies, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Conor Buggy
- UCD Centre for Safety and Health at Work, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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75
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Caccese JB, Buckley TA, Tierney RT, Rose WC, Glutting JJ, Kaminski TW. Sex and age differences in head acceleration during purposeful soccer heading. Res Sports Med 2017; 26:64-74. [PMID: 29067816 DOI: 10.1080/15438627.2017.1393756] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Differences in head-neck segment mass, purposeful heading technique, and cervical strength and stiffness may contribute to differences in head accelerations across sex and age. The purpose of this study was to compare head acceleration across sex and age (youth [12-14 years old], high school and collegiate) during purposeful soccer heading. One-hundred soccer players (42 male, 58 female, 17.1 ± 3.5 years, 168.5 ± 20.3 cm, 61.5 ± 13.7 kg) completed 12 controlled soccer headers at an initial ball velocity of 11.2 m/s. Linear and rotational accelerations were measured using a triaxial accelerometer and gyroscope and were transformed to the head centre-of-mass. A MANOVA revealed a significant multivariate main effect for sex (Pillai's Trace = .165, F(2,91) = 11.868, p < .001), but not for age (Pillai's Trace = .033, F(4,182) = 0.646, p = .630). Peak linear and rotational accelerations were higher in females (40.9 ± 13.3 g; 3279 ± 1065 rad/s2) than males (27.6 ± 8.5 g, 2219 ± 823 rad/s2). These data suggest that under controlled soccer heading conditions, females may be exposed to higher head accelerations than males.
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Affiliation(s)
- Jaclyn B Caccese
- a Department of Kinesiology and Applied Physiology , University of Delaware , Newark , DE , USA.,b Biomechanics and Movement Science Interdisciplinary Program , University of Delaware , Newark , DE , USA
| | - Thomas A Buckley
- a Department of Kinesiology and Applied Physiology , University of Delaware , Newark , DE , USA.,b Biomechanics and Movement Science Interdisciplinary Program , University of Delaware , Newark , DE , USA
| | - Ryan T Tierney
- c Department of Kinesiology , Temple University , Philadelphia , PA , USA
| | - William C Rose
- a Department of Kinesiology and Applied Physiology , University of Delaware , Newark , DE , USA.,b Biomechanics and Movement Science Interdisciplinary Program , University of Delaware , Newark , DE , USA
| | | | - Thomas W Kaminski
- a Department of Kinesiology and Applied Physiology , University of Delaware , Newark , DE , USA.,b Biomechanics and Movement Science Interdisciplinary Program , University of Delaware , Newark , DE , USA
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76
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Rutherford A, Stewart W, Bruno D. Heading for trouble: is dementia a game changer for football? Br J Sports Med 2017; 53:321-322. [PMID: 28729242 PMCID: PMC6579495 DOI: 10.1136/bjsports-2017-097627] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 11/03/2022]
Affiliation(s)
- A Rutherford
- School of Psychology, Keele University, Keele, UK
| | - William Stewart
- Queen Elizabeth University Hospital and Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Davide Bruno
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK
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77
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Kelley ME, Urban JE, Miller LE, Jones DA, Espeland MA, Davenport EM, Whitlow CT, Maldjian JA, Stitzel JD. Head Impact Exposure in Youth Football: Comparing Age- and Weight-Based Levels of Play. J Neurotrauma 2017; 34:1939-1947. [PMID: 28274184 DOI: 10.1089/neu.2016.4812] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Approximately 5,000,000 athletes play organized football in the United States, and youth athletes constitute the largest proportion with ∼3,500,000 participants. Investigations of head impact exposure (HIE) in youth football have been limited in size and duration. The objective of this study was to evaluate HIE of athletes participating in three age- and weight-based levels of play within a single youth football organization over four seasons. Head impact data were collected using the Head Impact Telemetry (HIT) System. Mixed effects linear models were fitted, and Wald tests were used to assess differences in head accelerations and number of impacts among levels and session type (competitions vs. practices). The three levels studied were levels A (n = 39, age = 10.8 ± 0.7 years, weight = 97.5 ± 11.8 lb), B (n = 48, age = 11.9 ± 0.5 years, weight = 106.1 ± 13.8 lb), and C (n = 32, age = 13.0 ± 0.5 years, weight = 126.5 ± 18.6 lb). A total of 40,538 head impacts were measured. The median/95th percentile linear head acceleration for levels A, B, and C was 19.8/49.4g, 20.6/51.0g, and 22.0/57.9g, respectively. Level C had significantly greater mean linear acceleration than both levels A (p = 0.005) and B (p = 0.02). There were a significantly greater number of impacts per player in a competition than in a practice session for all levels (A, p = 0.0005, B, p = 0.0019, and C, p < 0.0001). Athletes at lower levels experienced a greater percentage of their high magnitude impacts (≥ 80g) in practice, whereas those at the highest level experienced a greater percentage of their high magnitude impacts in competition. These data improve our understanding of HIE within youth football and are an important step in making evidence-based decisions to reduce HIE.
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Affiliation(s)
- Mireille E Kelley
- 1 Department of Biomedical Engineering, Wake Forest School of Medicine , Winston-Salem, North Carolina.,2 Virginia Tech - Wake Forest School of Biomedical Engineering and Sciences , Winston-Salem, North Carolina
| | - Jillian E Urban
- 1 Department of Biomedical Engineering, Wake Forest School of Medicine , Winston-Salem, North Carolina.,2 Virginia Tech - Wake Forest School of Biomedical Engineering and Sciences , Winston-Salem, North Carolina
| | - Logan E Miller
- 1 Department of Biomedical Engineering, Wake Forest School of Medicine , Winston-Salem, North Carolina.,2 Virginia Tech - Wake Forest School of Biomedical Engineering and Sciences , Winston-Salem, North Carolina
| | - Derek A Jones
- 1 Department of Biomedical Engineering, Wake Forest School of Medicine , Winston-Salem, North Carolina.,2 Virginia Tech - Wake Forest School of Biomedical Engineering and Sciences , Winston-Salem, North Carolina
| | - Mark A Espeland
- 3 Department of Biostatistical Sciences, Wake Forest School of Medicine , Winston-Salem, North Carolina
| | | | - Christopher T Whitlow
- 2 Virginia Tech - Wake Forest School of Biomedical Engineering and Sciences , Winston-Salem, North Carolina.,5 Department of Radiology (Neuroradiology), Wake Forest School of Medicine , Winston-Salem, North Carolina.,6 Clinical and Translational Sciences Institute , Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joseph A Maldjian
- 4 Department of Radiology, University of Texas Southwestern , Dallas, Texas
| | - Joel D Stitzel
- 1 Department of Biomedical Engineering, Wake Forest School of Medicine , Winston-Salem, North Carolina.,2 Virginia Tech - Wake Forest School of Biomedical Engineering and Sciences , Winston-Salem, North Carolina
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78
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Faude O, Rössler R, Junge A, Aus der Fünten K, Chomiak J, Verhagen E, Beaudouin F, Dvorak J, Feddermann-Demont N. Head injuries in children's football-results from two prospective cohort studies in four European countries. Scand J Med Sci Sports 2017; 27:1986-1992. [PMID: 28054391 DOI: 10.1111/sms.12839] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 11/27/2022]
Abstract
Head injuries are considered harmful in children. We analyzed head and neck injuries in organized football in 7- to 12-year-old children. Data for this analysis were obtained from a prospective cohort study over two consecutive football seasons in two European countries, and a randomized intervention trial over one season in four European countries. Football exposure and injuries were documented through an online database. Detailed information regarding injury characteristics and medical follow-up was retrieved from coaches, children and parents by phone. Thirty-nine head injuries and one neck injury (5% of all 791 injuries) were documented during 9933 player-seasons (total football exposure 688 045 hours). The incidence was 0.25 [95%CI 0.15, 0.35] head/neck injuries per 1000 match hours (N=23 match injuries) and 0.03 [95%CI 0.02, 0.03] per 1000 training hours. Eleven concussions (27.5%), nine head contusions (22.5%), eight lacerations or abrasions (20%), two nose fractures (2.5%), and two dental injuries (2.5%) occurred. The remaining eight injuries were nose bleeding or other minor injuries. Thirty injuries (75%) resulted from contact with another player, and ten injuries were due to collision with an object, falling or a hit by the ball. Whereas 70% of all head injuries (N=28) were due to frontal impacts, 73% of concussions (N=8) resulted from an impact to the occiput. The incidence and severity of head injuries in children's football are low. Coaches and parents, however, should be sensitized regarding the potential of concussions, particularly after an impact to the occiput.
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Affiliation(s)
- O Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - R Rössler
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - A Junge
- Medical School Hamburg, Hamburg, Germany.,Swiss Concussion Center (SCC) and Schulthess Clinic, Zurich, Switzerland
| | - K Aus der Fünten
- Institute of Sports and Preventive Medicine, Saarland University, FIFA-Medical Centre of Excellence, Saarbrücken, Germany
| | - J Chomiak
- Department of Orthopaedics, 1st Faculty of Medicine of Charles University and Hospital Na Bulovce, FIFA-Medical Centre of Excellence, Prague, Czech Republic
| | - E Verhagen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - F Beaudouin
- Institute of Sports and Preventive Medicine, Saarland University, FIFA-Medical Centre of Excellence, Saarbrücken, Germany
| | - J Dvorak
- Swiss Concussion Center (SCC) and Schulthess Clinic, Zurich, Switzerland
| | - N Feddermann-Demont
- Swiss Concussion Center (SCC) and Schulthess Clinic, Zurich, Switzerland.,Department of Neurology, Interdisciplinary Center for Vertigo and Neurological Visual Disorders, University Hospital & University of Zurich, Zurich, Switzerland
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