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Peek K, Ross A, Andersen TE, Meyer T, Dahlen S, Georgieva J, Williamson PR, Clarke M, Serner A. Heading in football: a systematic review of descriptors, definitions, and reporting methods used in heading incidence studies. SCI MED FOOTBALL 2024:1-18. [PMID: 38855969 DOI: 10.1080/24733938.2024.2362191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
The primary objective of this systematic review was to describe the number and type of heading descriptors used in all published studies which report on heading incidence in football. The secondary objective was to detail the data collection and reporting methods used in the included studies to present heading incidence data. Eligible studies were identified through searches of five electronic databases: Ovid MEDLINE, CINAHL, EMBASE, SPORTDiscus, and Web of Science, using a combination of free-text keywords (inception to 12th September 2023). Manual searching of reference lists and retrieved systematic reviews was also performed. A descriptive overview and synthesis of the results is presented. From 1620 potentially eligible studies, 71 studies were included, with the following key findings: 1) only 61% of studies defined a header with even fewer (23%) providing an operational definition of a header within the methods; 2) important study and player demographic data including year and country were often not reported; 3) reported heading descriptors and their coding options varied greatly; 4) visual identification of headers was essential when inertial measurement units were used to collect heading incidence data; and 5) there was a lack of standardisation in the reporting methods used in heading incidence studies making comparison between studies challenging. To address these findings, the development of a standardised, internationally supported, operational definition of a header and related heading descriptors should be prioritised. Further recommendations include the development of minimum reporting criteria for heading incidence research.
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Affiliation(s)
- Kerry Peek
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Andrew Ross
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Physiotherapy Department, College of Sport, Health and Engineering, Victoria University, Melbourne, Australia
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, The Norwegian School of Sport Sciences, Oslo, Norway
- The Norwegian Football Association's Sports Medical Centre, Oslo, Norway
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrucken, Germany
| | - Sara Dahlen
- Oslo Sports Trauma Research Center, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Julia Georgieva
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Paula R Williamson
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
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Kern J, Gulde P, Hermsdörfer J. A prospective investigation of the effects of soccer heading on cognitive and sensorimotor performances in semi-professional female players. Front Hum Neurosci 2024; 18:1345868. [PMID: 38404611 PMCID: PMC10884128 DOI: 10.3389/fnhum.2024.1345868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/15/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Repetitive head impacts (RHI) from routine soccer (football) heading have been suggested to contribute to the long-term development of neurodegenerative disorders. However, scientific evidence concerning the actual risk of these RHI on brain health remains inconclusive. Moreover, female athletes-despite a presumably increased vulnerability toward the effects of RHI-are largely underrepresented in previous approaches. Therefore, our aim was to prospectively investigate the effects of heading on cognitive and sensorimotor performances, health perception, and concussion symptoms in semi-professional female soccer players. Methods An extensive test battery was used to assess cognitive and sensorimotor performances as well as health status (SF-36) and concussion symptoms (SCAT3) of a total of 27 female soccer players (22.2 ± 4.2 years) and 15 control subjects (23.2 ± 3.0 years) before and after one-and-a-half years. Throughout this period, soccer players' heading exposure was determined using video analysis. Results Subgroup comparisons (control [n = 12], low exposure [n = 7], high exposure [n = 8]) showed no time-dependent differences in SF-36 or SCAT3 scores. Similarly, across most behavioral tests, soccer players' performances evolved equally or more favorably as compared to the control subjects. However, there were significant effects pointing toward slightly negative consequences of heading on aspects of fine motor control (p = 0.001), which were confirmed by correlation and multiple regression analyses. The latter, further, yielded indications for a relationship between heading exposure and negative alterations in postural control (p = 0.002). Discussion Our findings do not provide evidence for negative effects of soccer heading on female players' health perception, concussion symptoms, and cognitive performances over the course of one-and-a-half years. However, we found subtle negative alterations in fine motor and postural control that could be attributed to heading exposure. Other factors, like the number of previous head injuries, were not linked to the observed changes. Given the reduction of our initial sample size due to player fluctuation, the results need to be interpreted with caution and validated in larger-scale studies. These should not only focus on cognitive outcomes but also consider sensorimotor changes as a result of RHI from soccer heading.
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Affiliation(s)
- Jan Kern
- Chair of Human Movement Science, Department Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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Georgieva J, Arnold EJ, Peek K, Smith A, Lavender AP, Serner A, Fitzgerald M, Ma'ayah F, Campbell A. The incidence and characteristics of heading in the 2019 FIFA Women's World Cup™. SCI MED FOOTBALL 2024:1-8. [PMID: 38293754 DOI: 10.1080/24733938.2024.2305396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION To quantify the incidence and characteristics of purposeful heading and other head impacts in professional women's football at the 2019 FIFA Women's World Cup™. METHODS This cross-sectional cohort study analysed purposeful headers (uncontested and contested) and their characteristics (e.g. playing position, match situation, field location, and distance ball travelled), and other head impact events using video analysis. Total headers and head impact events, and incidence rate (IR) per 1000 match-hours were calculated for countries, positions, and other characteristics, such as location on the pitch. RESULTS Purposeful headers accounted for 76% of all coded events (uncontested: 71%; contested: 29%), followed by attempted headers (21%), unintentional ball-head impacts (2%), and other head impacts (1%). Headers ranged from 0 to 22 per player, per match with a mean of 4.8 [±1.2]. Of all field positions, centrebacks had the highest heading rates and wingers the lowest. Strikers performed significantly more contested headers than any other position, and significantly less uncontested headers. Most headers occurred in the middle third (48%), from free game play (72%) and from long balls (>20 m) (68%). CONCLUSION The findings of this study could assist the development of player heading risk profiles, sex-specific heading guidelines, and coaching practices.
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Affiliation(s)
- Julia Georgieva
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Eloise J Arnold
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Kerry Peek
- Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Anne Smith
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- enAble Institute for Health Science, Curtin University, Perth, WA, Australia
| | - Andrew P Lavender
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC, Australia
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Melinda Fitzgerald
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
| | - Fadi Ma'ayah
- School of Education, Curtin University, Perth, WA, Australia
| | - Amity Campbell
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- enAble Institute for Health Science, Curtin University, Perth, WA, Australia
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Kenny R, Elez M, Clansey A, Virji-Babul N, Wu LC. Individualized monitoring of longitudinal heading exposure in soccer. Sci Rep 2024; 14:1796. [PMID: 38245604 PMCID: PMC10799858 DOI: 10.1038/s41598-024-52163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/15/2024] [Indexed: 01/22/2024] Open
Abstract
There is growing concern that repetitive soccer headers may have negative long-term consequences on brain health. However, inconsistent and low-quality heading exposure measurements limit past investigations of this effect. Here we conducted a comprehensive heading exposure analysis across all players on a university women's soccer team for over two calendar years (36 unique athletes), quantifying both game and practice exposure during all in-season and off-season periods, with over ten thousand video-confirmed headers. Despite an average of approximately 2 headers per day, players' daily exposures ranged from 0 to 45 headers, accumulating to highly variable total exposure of 2-223 headers over each in-season/off-season period. Overall, practices and off-season periods accounted for 70% and 45% of headers, respectively. Impact sensor data showed that heading kinematics fell within a tight distribution, but sensors could not capture full heading exposure due to factors such as compliance. With first-of-its-kind complete heading exposure data, we recommend exposure assessments be made on an individual level and include practice/off-season collection in addition to games and competitive seasons. Commonly used group statistics do not capture highly variable exposures, and individualized complete heading exposure tracking needs to be incorporated in future study designs for confirming the potential brain injury risk associated with soccer heading.
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Affiliation(s)
- Rebecca Kenny
- Department of Mechanical Engineering, University of British Columbia, 6250 Applied Science Ln Room 2054, Vancouver, BC, V6T 1Z4, Canada
| | - Marko Elez
- Department of Integrated Sciences, University of British Columbia, 6356 Agricultural Rd Room 464, Vancouver, BC, V6T 1Z2, Canada
| | - Adam Clansey
- Department of Mechanical Engineering, University of British Columbia, 6250 Applied Science Ln Room 2054, Vancouver, BC, V6T 1Z4, Canada
| | - Naznin Virji-Babul
- Department of Physical Therapy, The University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Lyndia C Wu
- Department of Mechanical Engineering, University of British Columbia, 6250 Applied Science Ln Room 2054, Vancouver, BC, V6T 1Z4, Canada.
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Wahlquist VE, Glutting JJ, Kaminski TW. Examining the influence of the Get aHEAD Safely in Soccer™ program on head impact kinematics and neck strength in female youth soccer players. Res Sports Med 2024; 32:17-27. [PMID: 35611394 DOI: 10.1080/15438627.2022.2079982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
The objective was to examine the efficacy of the Get aHEAD Safely in Soccer™ intervention on head impact kinematics and neck strength in female youth soccer players. The control group (CG) consisted of 13 players (age: 11.0 ± 0.4 yrs), while the experimental group (EG) consisted of 14 players (age: 10.6 ± 0.5 yrs). Head impact kinematics included peak linear acceleration (PLA), peak rotational acceleration (PRA), and peak rotational velocity (PRV). Pre- and post-season measures included strength measures of neck/torso flexion (NF/TF) and extension (NE/TE). Data were analysed using a multilevel linear model and ANOVA techniques. No differences in PLA, PRA, or PRV were observed between groups. The EG showed significant improvement in NF strength while the CG showed significant improvement in NE strength. Both groups significantly improved in TF pre- to post-season. The foundational strength components of the Get aHEAD Safely in Soccer program appear to show a benefit in youth soccer players beginning to learn the skill of purposeful heading.
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Affiliation(s)
| | | | - Thomas W Kaminski
- Athletic Training Research Laboratory, University of Delaware, Newark, DE, USA
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Urban JE, Filben TM, Zoch SR, Stewart Pritchard N, Mason DR, Miles CM, Stitzel JD. Integrating biomechanics with stakeholder perspectives to inform safety in grassroots dirt track racing. ACCIDENT; ANALYSIS AND PREVENTION 2023; 192:107254. [PMID: 37557000 DOI: 10.1016/j.aap.2023.107254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023]
Abstract
Grassroots dirt track racing is a foundational part of motorsports with a high risk of severe injury. This study aimed to gather perspectives and experiences of motorsports drivers surrounding safety and head acceleration events experienced during grassroots dirt track racing to inform strategies to improve driver safety. Thirteen drivers (n=9 who primarily race on dirt tracks; n=4 who primarily race on pavement tracks) with prior dirt track racing experience participated in separate, group-specific focus groups and/or one-on-one interviews where video, simulations of head motion, and head acceleration data were shared. Peak kinematics of laps and crash contact scenarios were recorded, and head perturbations (i.e., deviations in head motion relative to its moving-average trajectory) were quantified for each lap and presented through guided discussion. Responses were summarized using Rapid Assessment Process. Audio recordings and field notes were collected from focus groups and interviews and analyzed across 25 domains. Drivers described dirt track racing as short, fast bursts of racing. Benefits of dirt track racing for driver development were described, including learning car control. Drivers acknowledged risks of racing and expressed confidence in safety equipment but identified areas for improvement. Drivers observed lateral bouncing of the head in video and simulations but recognized that such motions were not noticed while racing. Track conditions and track type were identified as factors influencing head perturbations. Mean PLA (5.5 g) and PRV (3.07 rad/s) of perturbations experienced during racing laps and perturbation frequencies of 5 and 7 perturbations per second were reported. Generally, drivers accurately estimated the head acceleration magnitudes but were surprised by the frequency and maximum magnitude of perturbations. Maximum perturbation magnitudes (26.8 g and 19.0 rad/s) were attributed to hitting a "rut" in the dirt. Drivers described sudden stops, vertical loads due to landing from a large height, and impacts to the vehicle frame as crash events they physically feel the most. Summary statistics for crashes (medians = 7.30 g, 6.94 rad/s) were reported. Typical impact magnitudes measured in other sports (e.g., football) were provided for context. Upon reviewing the biomechanics, drivers were surprised that crash accelerations were relatively low compared to other contact/collision sports. Pavement drivers noted limited safety features in dirt track racing compared to pavement, including rigidity of vehicle frames, seat structure, seatbelt integration, and lack of oversight from sanctioning bodies. Most drivers felt seat inserts and head and neck restraints are important for injury prevention; however, usage of seat inserts and preferred head and neck restraint system differed among drivers. Drivers described their perspectives and experiences related to safety and identified strategies to improve safety in grassroots dirt track racing. Drivers expressed support for future safety research.
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Affiliation(s)
- Jillian E Urban
- Department of Biomedical Engineering, Wake Forest School of Medicine, United States; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, United States.
| | - Tanner M Filben
- Department of Biomedical Engineering, Wake Forest School of Medicine, United States; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, United States
| | - Sophia R Zoch
- Department of Biomedical Engineering, Wake Forest School of Medicine, United States; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, United States
| | - N Stewart Pritchard
- Department of Biomedical Engineering, Wake Forest School of Medicine, United States; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, United States
| | - Destiny R Mason
- Department of Biomedical Engineering, Wake Forest School of Medicine, United States; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, United States
| | - Christopher M Miles
- Department of Biomedical Engineering, Wake Forest School of Medicine, United States; Department of Family and Community Medicine, Wake Forest School of Medicine, United States
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, United States; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, United States
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Reeschke R, Haase FK, Dautzenberg L, Krutsch W, Reinsberger C. Training matters: Heading incidence and characteristics in children's and youth football (soccer) players. Scand J Med Sci Sports 2023; 33:1821-1830. [PMID: 37259619 DOI: 10.1111/sms.14408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/03/2023] [Accepted: 05/15/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Concerns about short- and long-term consequences of repetitive heading contributed to heading restrictions in youth football in some countries. This prospective longitudinal cohort study aims to describe heading exposure in children's and youth football over two seasons using standardized video analysis. METHODS All matches and training sessions of a male Under-11 (n = 29), Under-15 (n = 28), Under-19 (n = 38), and female Under-17 (n = 39) team were videotaped during the seasons 2019-2020 and 2020-2021. Heading frequencies and characteristics were analyzed. Individual heading exposure is presented as average incidence rates (IR) per 1000 match/training hours. RESULTS In 275 matches and 673 training sessions, 22 921 headers were observed. Heading IR per player in matches was 1256 (Under-11 m), 1608 (Under-15 m), 1050 (Under-17 f), and 1966 (Under-19 m). In training sessions, IR per player was 739 (Under-11 m), 2206 (Under-15 m), 1661 (Under-17 f), and 1419 (Under-19 m). Five Under-15 males headed the ball five to eight times per training on average. Most headers were performed without heading duels. Flight distance was predominantly 5-20 m (54%) in matches and <5 m (65%) in training. While head impact location most frequently was at frontal areas, one-third of all headers in Under-11 in matches hit temporal, parietal, and occipital parts of the head. CONCLUSION Heading incidence was low in the youngest age group, whereas (predominantly five) Under-15 males showed very high heading exposures in training. In assessment and regulation of heading burden, training sessions and individual heading behavior should specifically be addressed. Recommendations for heading the ball in practice should account for individual and age-related differences.
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Affiliation(s)
- Rebecca Reeschke
- Institute of Sports Medicine, Paderborn University, Paderborn, Germany
| | | | - Lena Dautzenberg
- Institute of Sports Medicine, Paderborn University, Paderborn, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Claus Reinsberger
- Institute of Sports Medicine, Paderborn University, Paderborn, Germany
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Wahlquist VE, Buckley TA, Caccese JB, Glutting JJ, Royer TD, Kaminski TW. Quantitative Analysis of Ball-Head Impact Exposure in Youth Soccer Players. J Sports Sci Med 2023; 22:591-596. [PMID: 37711709 PMCID: PMC10499164 DOI: 10.52082/jssm.2023.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/24/2023] [Indexed: 09/16/2023]
Abstract
Since the implementation of the US Soccer heading guidelines released in 2015, little to no research on ball-head impact exposure in the United States youth soccer population has been conducted. The purpose was to compare ball-head impact exposure across sex and age in youth soccer players over a weekend tournament. Ten male and female games for each age group (Under-12 [U12], U13, and U14) were video recorded at a weekend tournament for a total of 60 games. Ball-head impact exposure for each game was then coded following a review of each recording. Male players were 2.8 times more likely to have ball-head impacts than female players, (p < 0.001) particularly in the U14 age group when compared to the U12 age group (p = 0.012). Overall 92.4% of players experienced 0-1 ball-head impacts per game with the remaining players experiencing 2+ ball-head impacts per game. Ball-head impact exposure levels are low in the youth players. Most youth soccer players do not head the soccer ball during match play and those that did, only headed the ball on average once per game. Overall, the difference in ball-head impact exposure per player was less than 1 between all the groups, which may have no clinical meaning.
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Affiliation(s)
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, USA
| | - Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, USA
| | | | - Todd D Royer
- Department of Kinesiology and Applied Physiology, University of Delaware, USA
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, USA
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Jack J, Woodgates A, Smail O, Brown F, Lynam K, Lester A, Williams G, Bond B. Cerebral blood flow regulation is not acutely altered after a typical number of headers in women footballers. Front Neurol 2022; 13:1021536. [PMID: 36479047 PMCID: PMC9719992 DOI: 10.3389/fneur.2022.1021536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/31/2022] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The repeated act of heading has been implicated in the link between football participation and risk of neurodegenerative disease, and acutely alters cerebrovascular outcomes in men. This study assessed whether exposure to a realistic number of headers acutely influences indices of cerebral blood flow regulation in female footballers. METHODS Nineteen female players completed a heading trial and seated control trial on two separate days. The heading trial involved six headers in 1 h (one every 10 min), with the ball traveling at 40 ± 5 km/h. Cerebrovascular reactivity to hypercapnia and hypocapnia was determined using serial breath holding and hyperventilation attempts. Dynamic cerebral autoregulation (dCA) was assessed by scrutinizing the relationship between cerebral blood flow and mean arterial blood pressure during 5 min of squat stand maneuvers at 0.05 Hz. Neurovascular coupling (NVC) was quantified as the posterior cerebral artery blood velocity response to a visual search task. These outcomes were assessed before and 1 h after the heading or control trial. RESULTS No significant time by trial interaction was present for the hypercapnic (P = 0.48,η p 2 = 0.05) and hypocapnic (P = 0.47,η p 2 = 0.06) challenge. Similarly, no significant interaction effect was present for any metric of dCA (P > 0.12,η p 2 < 0.16 for all) or NVC (P > 0.14,η p 2 < 0.15 for all). CONCLUSION The cerebral blood flow response to changes in carbon dioxide, blood pressure and a visual search task were not altered following six headers in female footballers. Further study is needed to observe whether changes are apparent after more prolonged exposure.
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Affiliation(s)
| | | | | | | | | | | | | | - Bert Bond
- Exeter Head Impacts, Brain Injury and Trauma (ExHIBIT) Research Group, Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
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Sports-Related Concussion Is a Personalized Issue—Evaluation of Medical Assessment and Subjective Feeling of the Athlete in a German Level 1 Trauma Center. J Pers Med 2022; 12:jpm12101596. [PMID: 36294735 PMCID: PMC9605563 DOI: 10.3390/jpm12101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022] Open
Abstract
Sports-related concussions (SRC) have developed into a highly discussed topic in sports medicine over the last few years and demonstrate a severe issue in the personalized treatment of patients. This retrospective cohort study investigated 86 patients with sports-related concussions in a level 1 trauma center, relating to the mechanism, symptoms, medical history, acute therapy including first assessment and the return to sport. The research is based on medical records as well as questionnaires six months after hospitalization. Loss of consciousness for under 30 min (41.2%), headache (36.5%) and amnesia (29.4%) were the most frequent symptoms when presenting in the emergency room. During the hospitalization, mainly headache and vertigo were documented. Most concussions occurred after incidents in equitation and cycling sports; the most common mechanism was falling to the ground with a subsequent impact (59.3%). At the time of discharge from hospital, in 13.4% of all cases, concussion symptoms were still documented in medical records, in contrast to 39.5% of the concerned athletes who reported symptoms for longer than 24 h, and 41.0% who reported ongoing post-concussion symptoms after six months. Concussions are difficult-to-treat disorders with a challenging diagnostic process and many symptoms in various values and levels of persistence. Therefore, a patient-involving treatment with a complaint-dependent return to sport process should be applied to concerned athletes.
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LANGDON SHARI, GOEDHART EDWIN, OOSTERLAAN JAAP, KÖNIGS MARSH. Heading Exposure in Elite Football (Soccer): A Study in Adolescent, Young Adult, and Adult Male and Female Players. Med Sci Sports Exerc 2022; 54:1459-1465. [PMID: 35482757 PMCID: PMC9390232 DOI: 10.1249/mss.0000000000002945] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aims to quantify heading exposure in real-life elite football at the level of individual male and female adolescents, young adults, and adults. METHODS Heading exposure was determined by video analysis in combination with a structured electronic registration tool and observation training, to comprehensively register heading characteristics. Characteristics of heading events were registered in 116 official matches (96 male, 20 female) of Dutch national teams. RESULTS Mean exposure for male players based on full match participation was 4.2 headers, with maximum heading exposure at 10.6 headers. Mean heading exposure was higher in adult than adolescent players ( P = 0.049), whereas maximum heading exposure was higher for adult than for young adult players ( P = 0.045). Maximum heading exposure was higher in male than in female players ( P = 0.015). Defenders had the greatest mean and maximum heading exposure ( P < 0.001). Longer flight courses of the ball had greater contribution to mean and maximum heading exposure than shorter courses ( P < 0.01). Frontal headers had greater contribution to exposure than other points of contact on player's head ( P < 0.001), whereas linear headers had greater contribution than rotational headers ( P = 0.016). Defensive headers had greater contribution to exposure than other heading types ( P < 0.014). Unintentional head contacts in elite football players were, in most cases (80%), not related to heading situations. CONCLUSIONS This study provides real-life quantifications of mean and maximum heading exposure in elite football, with strong relevance for policy makers and researchers. The results highlight the roles of player and heading characteristics in heading exposure, informing current discussions on the role of heading in football.
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Affiliation(s)
- SHARI LANGDON
- Emma Neuroscience Group, Department of Pediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, THE NETHERLANDS
- Football Medical Centre, Royal Netherlands Football Association (KNVB), Zeist, THE NETHERLANDS
- Amsterdam Reproduction and Development Research Institute, Amsterdam, THE NETHERLANDS
| | - EDWIN GOEDHART
- Football Medical Centre, Royal Netherlands Football Association (KNVB), Zeist, THE NETHERLANDS
| | - JAAP OOSTERLAAN
- Emma Neuroscience Group, Department of Pediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, THE NETHERLANDS
- Amsterdam Reproduction and Development Research Institute, Amsterdam, THE NETHERLANDS
| | - MARSH KÖNIGS
- Emma Neuroscience Group, Department of Pediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, THE NETHERLANDS
- Amsterdam Reproduction and Development Research Institute, Amsterdam, THE NETHERLANDS
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Sandmo SB, Matyasova K, Filipcik P, Cente M, Koerte IK, Pasternak O, Andersen TE, Straume-Næsheim TM, Bahr R, Jurisica I. Changes in circulating microRNAs following head impacts in soccer. Brain Inj 2022; 36:560-571. [PMID: 35172120 DOI: 10.1080/02699052.2022.2034042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
AIM To explore the short-term effects of accidental head impacts and repetitive headers on circulating microRNAs, accounting for the effects of high-intensity exercise alone. METHODS Blood samples were collected from professional soccer players at rest. Repeat samples were drawn 1 h and 12 h after three conditions: (1) accidental head impacts in a match, (2) repetitive headers during training, and (3) high-intensity exercise. 89 samples were screened to detect microRNAs expressed after each exposure. Identified microRNAs were then validated in 98 samples to determine consistently deregulated microRNAs. Deregulated microRNAs were further explored using bioinformatics to identify target genes and characterize their involvement in biological pathways. RESULTS Accidental head impacts led to deregulation of eight microRNAs that were unaffected by high-intensity exercise; target genes were linked to 12 specific signaling pathways, primarily regulating chromatin organization, Hedgehog and Wnt signaling. Repetitive headers led to deregulation of six microRNAs that were unaffected by high-intensity exercise; target genes were linked to one specific signaling pathway (TGF-β). High-intensity exercise led to deregulation of seven microRNAs; target genes were linked to 31 specific signaling pathways. CONCLUSION We identified microRNAs specific to accidental head impacts and repetitive headers in soccer, potentially being useful as brain injury biomarkers.
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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.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Katarina Matyasova
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Peter Filipcik
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Martin Cente
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Inga Katharina Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.,Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ofer Pasternak
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Truls Martin Straume-Næsheim
- 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
| | - Igor Jurisica
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia.,Osteoarthritis Research Program, Division of Orthopedic Surgery, Schroeder Arthritis Institute and Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Department of Computer Science, University of Toronto, Toronto, ON, Canada
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13
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Ashton J, Coyles G, Malone JJ, Roberts JW. Immediate effects of an acute bout of repeated soccer heading on cognitive performance. SCI MED FOOTBALL 2022; 5:181-187. [PMID: 35077295 DOI: 10.1080/24733938.2020.1846769] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose: There isgrowing concern surrounding the harmful effects of soccer heading on cognitive function. The present study aims to examine the immediate effects of heading.Methods: 30 recreational male soccer players were divided into three groups that undertook 20 consecutive headers with a soft (8.8 psi), hard (16.2 psi), or no (control) ball. A battery of neuropsychological tests was completed before and after heading: King-Devick, trail-making (TM) (A, B), digit span (DS) and spatial span (SS) (forward, backward).Results: Significant increase in the time (M = 4.44 s) and errors (M = 1.45) for the King-Devick test within the hard and soft groups, although there was no significant difference for TM-A and TM-B. Significant decline for SS forward within the hard and soft groups (M= -16%), although the declines for SS backward (M = -16%), DS forward (M= -23%) and DS backward (M = -25%) were present only for the hard group (ps <.05).Discussion: While outside of regular match-play, this study showed that heading negatively influenced one indicator of a suspected concussion (King-Devick), as well as working memory (DS, SS) that is essential for daily life. These findings contribute to the growing debate surrounding heading safety.
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Affiliation(s)
- Jake Ashton
- School of Health Sciences, Liverpool Hope University, Hope Park, Liverpool, UK, L16 9JD
| | - Ginny Coyles
- School of Health Sciences, Liverpool Hope University, Hope Park, Liverpool, UK, L16 9JD
| | - James J Malone
- School of Health Sciences, Liverpool Hope University, Hope Park, Liverpool, UK, L16 9JD
| | - James W Roberts
- School of Health Sciences, Liverpool Hope University, Hope Park, Liverpool, UK, L16 9JD
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14
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Brett BL, Walton S, Meier T, Nencka AS, Powell JR, Giovanello KS, Guskiewicz KK, McCrea M. Head impact exposure, grey matter volume, and moderating effects of estimated IQ and educational attainment in former athletes at midlife. J Neurotrauma 2022; 39:497-507. [PMID: 35044240 PMCID: PMC8978573 DOI: 10.1089/neu.2021.0449] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Repetitive head impact (RHI) exposure has been associated with differences in brain structure among younger active athletes, most often within the hippocampus. Studies of former athletes at early-midlife are limited. We investigated the association between RHI exposure and grey matter structure, as well as moderating factors, among former athletes in early-midlife. Former collegiate football players (N=55; age=37.9+1.5 years) completed magnetic resonance imaging to quantify grey matter morphometry and extensive structured interviews of RHI history (Head Impact Exposure Estimate). Linear regression models tested the association between RHI exposure and GM structures of interest. Interactions were tested for moderators: two estimates of IQ (single word reading and picture vocabulary) and education history. Greater RHI exposure was associated with smaller hippocampal volume, β=-.36, p=.004. Conversely, RHI exposure was not significantly associated with other GM outcomes ps>.05. Education history significantly moderated the association between RHI exposure and hippocampal volume, β=.69, p=.047. Among those with a bachelor's degree, greater RHI exposure was significantly associated with smaller hippocampal volumes, β=-.58, p<.001. For those with graduate/professional degrees, the association between RHI and hippocampal volume was not significant, β=-.33, p=.134. Consistent with studies involving younger, active athletes, smaller hippocampal volumes were selectively associated with greater RHI exposure among former collegiate football players at midlife. This relationship was moderated by higher levels of education. Future longitudinal studies are needed to investigate the course of possible changes that can occur between early-midlife to older ages, as well as the continued protective effect of education and other potential influential factors.
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Affiliation(s)
- Benjamin L Brett
- Medical College of Wisconsin, 5506, Neurosurgery and Neurology, 8701 W Watertown Plank Rd, Milwaukee, Wisconsin, United States, 53226;
| | - Samuel Walton
- University of North Carolina at Chapel Hill College of Arts and Sciences, 169101, Department of Exercise and Sport Science, Chapel Hill, North Carolina, United States;
| | - Timothy Meier
- Medical College of Wisconsin, Neurosurgery, 8701 Watertown Plank Road, Milwaukee, Wisconsin, United States, 53226;
| | - Andrew S Nencka
- Medical College of Wisconsin, Biophysics, Milwaukee, Wisconsin, United States;
| | - Jacob R Powell
- University of North Carolina at Chapel Hill College of Arts and Sciences, 169101, Department of Exercise and Sport Science, Chapel Hill, North Carolina, United States;
| | - Kelly S Giovanello
- University of North Carolina at Chapel Hill, Psychology, Chapel Hill, North Carolina, United States;
| | - Kevin K Guskiewicz
- University of North Carolina, Exercise and Sport Science, CB#8700, Chapel Hill, North Carolina, United States, 27599-8700;
| | - Michael McCrea
- Medical College of Wisconsin, Neurosurgery, Hub for Collaborative Medicine, 8701 Watertown Plank Road, Milwaukee, Wisconsin, United States, 53226;
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15
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Disparate Associations of Years of Football Participation and a Metric of Head Impact Exposure with Neurobehavioral Outcomes in Former Collegiate Football Players. J Int Neuropsychol Soc 2022; 28:22-34. [PMID: 33563361 PMCID: PMC8353007 DOI: 10.1017/s1355617721000047] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Years of sport participation (YoP) is conventionally used to estimate cumulative repetitive head impacts (RHI) experienced by contact sport athletes. The relationship of this measure to other estimates of head impact exposure and the potential associations of these measures with neurobehavioral functioning are unknown. We investigated the association between YoP and the Head Impact Exposure Estimate (HIEE), and whether associations between the two estimates of exposure and neurobehavioral functioning varied. METHODS Former American football players (N = 58; age = 37.9 ± 1.5 years) completed in-person evaluations approximately 15 years following sport discontinuation. Assessments consisted of neuropsychological assessment and structured interviews of head impact history (i.e., HIEE). General linear models were fit to test the association between YoP and the HIEE, and their associations with neurobehavioral outcomes. RESULTS YoP was weakly correlated with the HIEE, p = .005, R2 = .13. Higher YoP was associated with worse performance on the Symbol Digit Modalities Test, p = .004, R2 = .14, and Trail Making Test-B, p = .001, R2 = .18. The HIEE was associated with worse performance on the Delayed Recall trial of the Hopkins Verbal Learning Test-Revised, p = .020, R2 = .09, self-reported cognitive difficulties (Neuro-QoL Cognitive Function), p = .011, R2 = .10, psychological distress (Brief Symptom Inventory-18), p = .018, R2 = .10, and behavioral regulation (Behavior Rating Inventory of Executive Function for Adults), p = .017, R2 = .10. CONCLUSIONS YoP was marginally associated with the HIEE, a comprehensive estimate of head impacts sustained over a career. Associations between each exposure estimate and neurobehavioral functioning outcomes differed. Findings have meaningful implications for efforts to accurately quantify the risk of adverse long-term neurobehavioral outcomes potentially associated with RHI.
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16
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Müller C, Zentgraf K. Neck and Trunk Strength Training to Mitigate Head Acceleration in Youth Soccer Players. J Strength Cond Res 2021; 35:S81-S89. [PMID: 33065700 DOI: 10.1519/jsc.0000000000003822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carsten Müller
- Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany.,University Sports, University of Münster, Münster, Germany; and
| | - Karen Zentgraf
- Department of Movement Science and Training in Sports, Institute of Sport Sciences, Goethe-University Frankfurt, Frankfurt, Germany
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17
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Koerte IK, Bahr R, Filipcik P, Gooijers J, Leemans A, Lin AP, Tripodis Y, Shenton ME, Sochen N, Swinnen SP, Pasternak O. REPIMPACT - a prospective longitudinal multisite study on the effects of repetitive head impacts in youth soccer. Brain Imaging Behav 2021; 16:492-502. [PMID: 34505977 PMCID: PMC8825640 DOI: 10.1007/s11682-021-00484-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 12/31/2022]
Abstract
Repetitive head impacts (RHI) are common in youth athletes participating in contact sports. RHI differ from concussions; they are considered hits to the head that usually do not result in acute symptoms and are therefore also referred to as “subconcussive” head impacts. RHI occur e.g., when heading the ball or during contact with another player. Evidence suggests that exposure to RHI may have cumulative effects on brain structure and function. However, little is known about brain alterations associated with RHI, or about the risk factors that may lead to clinical or behavioral sequelae. REPIMPACT is a prospective longitudinal study of competitive youth soccer players and non-contact sport controls aged 14 to 16 years. The study aims to characterize consequences of exposure to RHI with regard to behavior (i.e., cognition, and motor function), clinical sequelae (i.e., psychiatric and neurological symptoms), brain structure, function, diffusion and biochemistry, as well as blood- and saliva-derived measures of molecular processes associated with exposure to RHI (e.g., circulating microRNAs, neuroproteins and cytokines). Here we present the structure of the REPIMPACT Consortium which consists of six teams of clinicians and scientists in six countries. We further provide detailed information on the specific aims and the design of the REPIMPACT study. The manuscript also describes the progress made in the study thus far. Finally, we discuss important challenges and approaches taken to overcome these challenges.
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Affiliation(s)
- Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, 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
| | - Peter Filipcik
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jolien Gooijers
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Goup Biomedical Sciences, KU Leuven, Leuven, Belgium.,KU Leuven Brain Institute (LBI), Leuven, Belgium
| | - Alexander Leemans
- PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alexander P Lin
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,Boston University Alzheimer's Disease Center and Boston University CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - Martha E Shenton
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nir Sochen
- Department of Applied Mathematics, School of Mathematical Sciences, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Stephan P Swinnen
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Goup Biomedical Sciences, KU Leuven, Leuven, Belgium.,KU Leuven Brain Institute (LBI), Leuven, Belgium
| | - Ofer Pasternak
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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18
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Gilbert AW, Bering JM, Anderson LC. Addressing head injury risk in youth football: are heading guidelines the answer? SCI MED FOOTBALL 2021; 6:340-346. [DOI: 10.1080/24733938.2021.1967435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Alexander W. Gilbert
- 133 Union Street East, Dunedin
- Centre for Science Communication, University of Otago, Dunedin, New Zealand
| | - Jesse M. Bering
- Centre for Science Communication, University of Otago, Dunedin, New Zealand
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19
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McCunn R, Beaudouin F, Stewart K, Meyer T, MacLean J. Heading in Football: Incidence, Biomechanical Characteristics and the Association with Acute Cognitive Function-A Three-Part Systematic Review. Sports Med 2021; 51:2147-2163. [PMID: 34129222 DOI: 10.1007/s40279-021-01492-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is growing concern surrounding the role of repetitive sub-concussive head impacts, such as football heading, on brain health. OBJECTIVES Three questions were addressed while only considering studies that observed heading exposure directly: (1) how frequently does heading occur within football training and matches, (2) what are the biomechanical characteristics of heading, and (3) is cognitive function affected by heading? METHODS This review followed the steps described in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Electronic databases including MEDLINE and SPORTDiscus were searched from the earliest entry to July 2020. Studies that reported independently quantified heading exposure, biomechanical characteristics of heading or the relationship between heading and cognitive function were included. Data were extracted and used to populate summary tables with reference to each research question. RESULTS Heading incidence ranged between one to nine headers per player per match. The number of headers observed in small-sided games during training varied depending on the exact format used but generally speaking ranged between zero to one per player per game. The three most commonly reported biomechanical variables were head acceleration, head rotational velocity and overall movement kinematics during the heading action. Average head acceleration ranged from approximately four to 50 g. Nine out of 12 included studies did not observe a negative impact on cognitive test performance following exposure to heading and while three did, these negative effects were limited to specific outcome measures: reaction time and memory function. CONCLUSION The current weight of evidence summarised herein does not support the notion that heading is deleterious to cognitive performance in the short term; however, this conclusion is tentative due to methodological shortcomings in the existing evidence base.
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Affiliation(s)
- Robert McCunn
- Heart of Midlothian Football Club, Tynecastle Park , Edinburgh, EH11 2NL, UK.
| | - Florian Beaudouin
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Katy Stewart
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Hampden Sports Clinic, Glasgow, UK
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - John MacLean
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Hampden Sports Clinic, Glasgow, UK
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20
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Huber CM, Patton DA, Jain D, Master CL, Margulies SS, McDonald CC, Arbogast KB. Variations in Head Impact Rates in Male and Female High School Soccer. Med Sci Sports Exerc 2021; 53:1245-1251. [PMID: 33986230 PMCID: PMC8122001 DOI: 10.1249/mss.0000000000002567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Repetitive head impacts in soccer have been linked to short-term neurophysiological deficits, and female soccer players have higher concussion rates than males. These findings have inspired investigation into gender differences in head impact exposure and how head impact rate contributes to the cumulative effect of head impact exposure on neurological outcomes. Various periods of exposure have been used to calculate head impact rates, including head impacts per season, game, and player-hour. PURPOSE The aim of this study was to apply different methodological approaches to quantify and compare head impact rates by gender for two seasons of high school varsity soccer. METHODS Video review was used to confirm all events recorded by a headband-mounted impact sensor and calculate playing time for all players. Impact rates were calculated per athlete exposure (presence and participation) and per player-hour (scheduled game time, individual play time, and absolute time). RESULTS Impact rates per athlete exposure ranged from 2.5 to 3.2 for males and from 1.4 to 1.6 for females, and impact rates per player-hour ranged from 2.7 to 3.8 for males and from 1.0 to 1.6 for females. The exposure calculation method significantly affected head impact rates; however, regardless of approach, the head impact rate for males was higher, up to threefold, than for females. Individual head impact exposure varied substantially within a team with one in five players experiencing no impacts. CONCLUSIONS Overall, the gender differences found in this study indicate that males experience higher head impact exposure compared with females. Future studies are needed to understand potential clinical implications of variability in head impact exposure and reconcile higher female concussion rates with the reduced head impact rates presented herein.
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Affiliation(s)
- Colin M Huber
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA,Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Declan A. Patton
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Divya Jain
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA,Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Christina L. Master
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA,Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, Philadelphia, PA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan S. Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Catherine C. McDonald
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA,School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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21
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Abstract
Recent public concern over the short- and long-term effects of repetitive head impacts (RHI) associated with purposeful heading in soccer has led researchers to study a multitude of variables related to this important aspect of the game. Of particular interests are the effects of soccer heading in the youth population (≤ 13 years old) whose brains are undergoing rapid development. We conducted a review on youth soccer heading that includes purposeful heading frequency, head impact biomechanics, head injuries, clinical outcomes, and modifying factors. We have concluded that youth soccer players head the ball at a low frequency that typically increases with age and with a finding that boys head the ball more often than girls do. Interestingly, although girls head the ball less frequently than boys do, they tend to sustain higher head impact magnitudes. Head injuries are more likely to occur in girls versus boys and during games because of contact with another player. Clinical outcome measures of concussion are often utilized to study the effects of soccer heading, in both field and laboratory environments. Immediately following soccer heading, youth often report having a headache and demonstrate some deficits in balance measures. Modifying factors that may benefit soccer players participating in purposeful heading activities include stronger neck musculature, wearing headgear, and the use of mouthguards. Research involving youth soccer players needs to be expanded and funded appropriately to better understand the consequences of RHI in both the short and long term.
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22
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Garnett D, Patricios J, Cobbing S. Physical Conditioning Strategies for the Prevention of Concussion in Sport: a Scoping Review. SPORTS MEDICINE-OPEN 2021; 7:31. [PMID: 33999301 PMCID: PMC8128965 DOI: 10.1186/s40798-021-00312-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Concussion in sports has received a great deal of media attention and may result in short and longer-lasting symptoms, especially in adolescents. Although significant strides have been made in the identification and management of concussion, less is known about the primary prevention of this condition. The aims of this scoping review are to (1) summarize the current research of physical conditioning strategies to reduce or prevent concussion incidence in individuals participating in sport, especially adolescents, and (2) to identify gaps in the knowledge base. Our research question was what is known from the existing literature about physical preparation strategies to reduce or prevent concussion in adult and adolescent sports? METHODS Three literature searches were conducted by information officers at two universities at six-month intervals, using five electronic databases (PubMed; WorldCat.org ; Mendeley; EBSCOHost and Ovid MEDLINE). To increase the search range, subject experts were consulted and articles and reference lists were hand searched. A scoping review methodology identified eligible studies that analyzed physical preparation techniques on modifiable physical risk factors in athletes to reduce the incidence of concussion. The PRISMA-ScR checklist guided the reporting of the findings. RESULTS A total of 1414 possible articles were identified, after duplicates removed, and articles analyzed against the inclusion and exclusion criteria, only 9 articles qualified for analysis. Two articles were found from studying reference lists. Thus, a total of 11 articles were included in the final evaluation for the purposes of this study. Data are reported from mostly adolescent subjects participating in nine different sports from three countries. Findings are presented with specific reference to previously recognized modifiable risk factors of concussion which include neck strength, neck size, cervical stiffness, type of sport, and pre-activity exercises. CONCLUSIONS There is limited research examining the physical preparation of athletes, especially in adolescents, to reduce or prevent concussion, and conflicting evidence in the few small sample studies that were identified. This scoping review identifies the research gap for a potentially vital modifiable risk factor, notably in the physical preparation of children and adolescents to reduce or prevent sports-related concussion.
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Affiliation(s)
- Daniel Garnett
- Physiotherapy Department, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa. .,Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Jon Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saul Cobbing
- Physiotherapy Department, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
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23
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Huber CM, Patton DA, McDonald CC, Jain D, Simms K, Lallo VA, Margulies SS, Master CL, Arbogast KB. Sport- and Gender-Based Differences in Head Impact Exposure and Mechanism in High School Sports. Orthop J Sports Med 2021; 9:2325967120984423. [PMID: 33738313 PMCID: PMC7933779 DOI: 10.1177/2325967120984423] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Repeated head impacts sustained by athletes have been linked to short-term neurophysiologic deficits; thus, there is growing concern about the number of head impacts sustained in sports. Accurate head impact exposure data obtained via head impact sensors may help identify appropriate strategies across sports and between genders to mitigate repetitive head impacts. Purpose: To quantify sport- and gender-based differences in head impact rate and mechanism for adolescents. Study Design: Cohort study; Level of evidence, 2. Methods: High school female and male varsity soccer, basketball, lacrosse, and field hockey (female only) teams were instrumented with headband-mounted impact sensors during games over 2 seasons of soccer and 1 season of basketball, lacrosse, and field hockey. Video review was used to remove false-positive sensor-recorded events, and the head impact rate per athlete-exposure (AE) was calculated. Impact mechanism was categorized as equipment to head, fall, player to head, or head to ball (soccer only). Results: Male players had significantly higher head impact rates as compared with female players in soccer (3.08 vs 1.41 impacts/AE; rate ratio, 2.2 [95% CI, 1.8-2.6]), basketball (0.90 vs 0.25; 3.6 [2.6-4.6]), and lacrosse (0.83 vs 0.06; 12.9 [10.1-15.8]). Impact mechanism distributions were similar within sports between boys and girls. In soccer, head to ball represented 78% of impacts, whereas at least 88% in basketball were player-to-player contact. Conclusion: Across sports for boys and girls, soccer had the highest impact rate. Male high school soccer, basketball, and lacrosse teams had significantly higher head impact rates than did female teams of the same sport. For girls, basketball had a higher head impact rate than did lacrosse and field hockey, and for boys, basketball had a similar impact rate to lacrosse, a collision sport. Sport differences in the distribution of impact mechanisms create sport-specific targets for reducing head impact exposure.
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Affiliation(s)
- Colin M Huber
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Catherine C McDonald
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Divya Jain
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katherine Simms
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Valerie A Lallo
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Biomedical Engineering Department, Widener University, Chester, Pennsylvania, USA
| | - Susan S Margulies
- Walter H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Tierney GJ, Higgins B. The incidence and mechanism of heading in European professional football players over three seasons. Scand J Med Sci Sports 2021; 31:875-883. [PMID: 33280186 DOI: 10.1111/sms.13900] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
There are concerns surrounding the risk of neurodegenerative diseases associated with football (soccer) heading. The aim of this study was to conduct analysis on the incidence and mechanism of heading in the "Big 5" professional European football leagues (Bundesliga, Ligue 1, Premier League, La Liga and Serie A) and one lower tier professional league (English Championship) from 2016/17 to 2018/19. Match event data from 7147 matches were obtained from Opta Sports data feed. The data were parsed to extract header event details including player position, coordinates on the field, header type and preceding match event (including distance football travelled). Incidence data were reported as headers per match or match headers per player. Medians and interquartile ranges (IQR) were reported and either the Mann-Whitney U test or Kruskal-Wallis test were conducted for comparisons between positions and leagues. In the "Big 5" leagues, the most headers per match occurred during the Premier League (111.2 headers per match). However, the lower tier English Championship had the highest number of headers per match overall (139.0 headers per match). In all leagues, defenders had the greatest median number of match headers per player (P < .001). The highest median distance travelled by the football during a preceding match event was for goal kicks (57.5 m; IQR 53.7-61.1). The findings add necessary information for current longitudinal studies aiming to understand the potential link between football heading and neurodegenerative diseases. These studies should account for league, playing position, and level of play.
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Peek K, Vella T, Meyer T, Beaudouin F, McKay M. The incidence and characteristics of purposeful heading in male and female youth football (soccer) within Australia. J Sci Med Sport 2021; 24:603-608. [PMID: 33414022 DOI: 10.1016/j.jsams.2020.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/25/2020] [Accepted: 12/14/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To quantify the incidence and characteristics of purposeful headers and unintentional head impacts during male and female youth football (soccer) games in Australia. DESIGN Cross-sectional observational study. METHODS Ten match-videos (total n=110) per playing age (under 13-20 males; under 13-17 females) from the 2019 National Premier League season were coded for purposeful headers and unintentional head impacts. Total headers and head impacts as well as incidence rate (IR) per 1000 match-hours for different match characteristics were calculated. RESULTS Purposeful headers accounted for 99% (n=4615, IR:1618) of total head impacts. The IR of purposeful headers per 1000 match-hours was highest for under-15 males (IR:2117) and under-17 females (IR:2090) followed by under-20 males (IR:1761). Midfielders completed the most headers in all female age groups (mean IR:713) and under 13-14 males (mean IR:891), with defenders completing the most headers in under 15-20 males (mean IR:760). Heading duels accounted for 16% of total headers with most headers performed during free play (68%), throw-ins (15%), free kicks (12%) and corner kicks (5%). Only 57 head impacts (IR:20) were coded as unintentional head impacts resulting from being struck by the ball or opponent body part with 4 (IR:1.4) requiring medical attention. CONCLUSIONS Heading is a complex skill. Given the propensity of youth players of all ages to purposefully head the ball, consideration should be given to coaching heading technique based on specific game scenarios for their playing position and age group. The findings of this study can be used to inform heading guidelines.
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia.
| | - Teale Vella
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Medical Faculty, Saarland University, Germany
| | - Florian Beaudouin
- Institute of Sports and Preventive Medicine, Medical Faculty, Saarland University, Germany
| | - Marnee McKay
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia
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26
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Moyron RB, Vallejos PA, Fuller RN, Dean N, Wall NR. Neuroimaging and advanced research techniques may lead to improved outcomes in military members suffering from traumatic brain injury. Trauma Surg Acute Care Open 2021; 6:e000608. [PMID: 33490604 PMCID: PMC7797256 DOI: 10.1136/tsaco-2020-000608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 12/17/2022] Open
Abstract
Recent military conflicts in Iraq and Afghanistan have resulted in the significant increase in blast-related traumatic brain injury (TBI), leading to increased Department of Defense interest in its potential long-term effects ranging from the mildest head injuries termed subconcussive trauma to the most debilitating termed chronic traumatic encephalopathy (CTE). Most patients with mild TBI will recover quickly while others report persistent symptoms called postconcussive syndrome. Repeated concussive and subconcussive head injuries result in neurodegenerative conditions that may hinder the injured for years. Fundamental questions about the nature of these injuries and recovery remain unanswered. Clinically, patients with CTE present with either affective changes or cognitive impairment. Genetically, there have been no clear risk factors identified. The discovery that microglia of the cerebral cortex discharged small extracellular vesicles in the injured and adjacent regions to a TBI may soon shed light on the immediate impact injury mechanisms. The combination of neuroimaging and advanced research techniques may, one day, fill critical knowledge gaps and lead to significant TBI research and treatment advancements.
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Affiliation(s)
- Ron B Moyron
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
| | - Paul A Vallejos
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
| | - Ryan N Fuller
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
| | - Natasha Dean
- Department of Biology, La Sierra University, Riverside, California, USA
| | - Nathan R Wall
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
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27
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Smith AE, Krejany C, Jiwa M. Epidemiology of soccer-related head injury in children 5-14 years in Victoria, Australia. J Paediatr Child Health 2021; 57:46-51. [PMID: 32815628 DOI: 10.1111/jpc.15114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/16/2020] [Accepted: 07/22/2020] [Indexed: 11/28/2022]
Abstract
AIM Our aim was to use epidemiological data to determine the incidence of soccer-related head injuries in children aged 5-14 years who presented at emergency departments (EDs) or were admitted in hospitals in Victoria, Australia. METHODS ED presentation and hospital admission de-identified aggregate data were from the Victorian Injury Surveillance Unit. Soccer participation data were compared with the soccer-related head injury data to determine the incidence of this injury among these children. RESULTS The incidence of ED presentations was 0.17% of children participating in soccer during the study period (financial years 2011-2012 to 2015-2016). The 10-14-years age group presented with more head injuries than the 5-9-years age group. For the admissions data, soccer had a significantly lower (P = 0.0379) incidence of head injury when compared with 'sport as a whole'. CONCLUSIONS The low incidence of soccer-related head injuries presenting to an ED or admission to hospital is consistent with international findings.
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Affiliation(s)
- Amy E Smith
- Melbourne Clinical School, The University of Notre Dame Australia, Melbourne, Victoria, Australia
| | - Catherine Krejany
- Melbourne Clinical School, The University of Notre Dame Australia, Melbourne, Victoria, Australia
| | - Moyez Jiwa
- Melbourne Clinical School, The University of Notre Dame Australia, Melbourne, Victoria, Australia
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28
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Sandmo SB, Gooijers J, Seer C, Kaufmann D, Bahr R, Pasternak O, Lipton ML, Tripodis Y, Koerte IK. Evaluating the validity of self-report as a method for quantifying heading exposure in male youth soccer. Res Sports Med 2020; 29:427-439. [PMID: 33283535 DOI: 10.1080/15438627.2020.1853541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Assessing heading exposure in football is important when exploring the association between heading and brain alterations. To this end, questionnaires have been developed for use in adult populations. However, the validity of self-report in adolescents remains to be elucidated. Male youth soccer players (n = 34) completed a questionnaire on heading exposure after a two-week period, which included matches and training sessions. Self-reported numbers were compared to observation (considered reference). In total, we observed 157 training sessions and 64 matches. Self-reported heading exposure correlated with observed heading exposure (Spearman's rho 0.68; p < 0.001). Players systematically overestimated their heading exposure by a factor of 3 with the random error of 46%. Area under the curve was 0.87 (95% CI 0.67-1) utilizing self-report for identifying players from high- and low-exposure groups. Thus, in this study, self-reported data could be used to group youth players into high and low heading exposure groups, but not to quantify individual heading exposure.
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Affiliation(s)
- Stian B 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.,Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Jolien Gooijers
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Biomedical Sciences, KU Leuven, Leuven, Belgium.,LBI - KU Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Caroline Seer
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Biomedical Sciences, KU Leuven, Leuven, Belgium.,LBI - KU Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - David Kaufmann
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Radiology, Charité Universitätsmedizin, Berlin, Germany
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Ofer Pasternak
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael L Lipton
- Departments of Radiology, Psychiatry and Behavioral Sciences and the Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Inga K Koerte
- cBRAIN, 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
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29
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Structure, Intensity and Player Duels in Under-13 Football Training in Switzerland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228351. [PMID: 33187381 PMCID: PMC7696662 DOI: 10.3390/ijerph17228351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/24/2022]
Abstract
We evaluated the structure (i.e., the different training parts), contents (i.e., the various activities used), intensity and occurrence of contact situations and headers during training sessions in under-13 football in Switzerland. A total of 242 players from 20 different teams on average aged 11.4 (SD 0.7) years participated. The participants were filmed during a typical training session while they were equipped with a heart rate sensor. The sessions were systematically recorded to allow for detailed analyses. Furthermore, a preliminary and explorative analysis of the influence of the level of play on these results was conducted. The overall findings indicated that training included 33.4% playing forms, 29.5% training forms, 28.4% inactivity time and 8.7% athletics. The highest heart rates were achieved in the playing forms (166 min−1, 83% HRmax) compared to the other two activities (training forms 154 min−1, 77% HRmax; athletics 150 min−1, 75% HRmax). Each player had 12.8 duels and 0.6 headers per training. Overall, most duels were conducted from the anterior direction. Playing forms induce higher cardio-circulatory load as well as a better learning environment. Potentially dangerous situations like contact with other players or headers occurred in a single player on average every six min during a training session.
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Abstract
Repeated purposeful heading in soccer has come under increased scrutiny as concerns surrounding the association with long-term neurodegenerative disorders in retired players continue to grow. Although a causal link between heading and brain health has not been established, the "precautionary principle" supports the notion that soccer governing bodies and associations should consider implementing pragmatic strategies that can reduce head impact during purposeful heading in youth soccer while this relationship is being investigated. This Viewpoint discusses the current evidence to support low-risk head impact reduction strategies during purposeful heading to protect young, developing players, and how such strategies could be implemented now while research and debate continue on this topic. J Orthop Sports Phys Ther 2020;50(8):415-417. doi:10.2519/jospt.2020.0608.
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31
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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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32
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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: 31] [Impact Index Per Article: 6.2] [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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