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Comparison of Preseason and Postseason ImPACT Scores in NCAA
College Soccer Players
Demetri Menegos, D.O. April 16, 2010 Sports Medicine Fellow Atlantic Health--Overlook Mount Sinai School of Medicine
Background
College Soccer players suffer repetitive impact to the head throughout their season through heading of a soccer ball
Both in practice and in games they must strike the ball with their head from defensive and offensive positions
This exposes them to multiple impacts to the head throughout their season
Depending on position some players will head the ball more than others
Background
How repetitive heading of a ball throughout a season may affect a player's performance on Neuropsychological testing is unclear
There is much ongoing debate as to the effect of heading a ball on a soccer player's long term health
It has been suggested that soccer players should wear protective head gear, especially at the youth level to protect a player from developing Neurocognitive dysfunction secondary to heading
Headgear in Soccer
Mainly marketed to Youth Soccer players under the age of 12, where the occurrence of heading is significantly decreased, as compared to higher levels of play
Many of the headers at this level occur off the bounce
Studies have shown that the peak force of impact from a soccer ball was reduced by 112% or 400 N
Clinical Efficacy remains to be seen
Specifications of the Ball
Law 2 of the game, as per FIFA's Laws of the Game, states :
Circumference : 27-28 in. (68-70 cm) Weight : 14-16 oz. (410-450 grams) Pressure : 8.5-15.6 psi (59-108 kPa)
Mechanics of Impact
The highest velocity balls a player might head voluntarily are as follows :
Goalkeeper's Punt : 70km/h or 43 mph Goalkeeper's Dropkick : 85 km/h or 53 mph Goal Kick : 85 km/h or 53 mph Shot towards goal from a striking position : 119
km/h or 74 mph
Mechanics of Impact
A ball traveling at between 65 km/h and 120 km/h :
Hits a solid object for 10.23 milliseconds Force of 850N to 1200 N Acceleration of 30 to 55 g forces
Mechanics of Impact
Head can withstand greater linear forces than those created by properly heading a soccer ball
Purposeful heading is largely linear Most head injury occurs from rotational forces,
as in boxing A blow of the ball to the side of the head in an
unprepared player, or via improper or bad heading technique, can lead to rotational impact
Can be coupled with Transverse Rotation in an unprepared player
Mechanics of Impact : In Comparison
Football : Impacts last for 250 to 300 milliseconds at g forces ranging from 150 to 450 g
Boxing : Impact duration lasts from 14 to 18 milliseconds
6000 N G forces of 100 g
Mechanics of Heading
Heading the ball appropriately is a difficult technique and certainly tough to master as an effective threat at the college or professional level
Most coaching books that describe teaching progression don't even mention heading until 12 years of age or older
Active technique Ball is to be contacted on the forehead at or
near the hairline
Mechanics of Heading
The trunk is hyperextended and the chin tucked in slightly to the chest
The more trunk extension, the faster the forward velocity of the trunk and the greater the impact on the ball
Arms are usually extended for balance and protection
Exercise in precision timing
Mechanics of Heading
Flexing the hips, brings the trunk and head towards the ball
Arms are pulled back Contracting the neck muscles fixes the head,
making a firm surface for contact Effectively increasing the mass of the contact
surface, F=ma To contact the ball at the top of a jump, the
trunk must be flexed to transfer force to the ball
Mechanics of Heading
Proper heading technique is the athlete's best defense against injury from heading a soccer ball
Younger athlete may be at risk because of smaller size, less muscular development and less skillful heading technique
Mechanics of Heading
Coaches should instruct players to head the ball just below the hairline on the frontal bone
The thickest part of the cranium Simultaneously isometrically contracting the
neck musculature To counteract the force of the ball, the player
should apply a counterforce, generated by moving the trunk into flexion
Mechanics of Heading
The athlete becomes a single rigid unit that lowers the risk of injury, by decreasing the linear and rotational accelerations on the head
Forces generated by the ball are dispersed across the player's body
Mechanics of Heading
Frequency of Heading
Not a lot of data to document the frequency of heading
The average amount of headers per game in the English Premier League is stated to be six to seven per game
Incidence of Concussion in Soccer
According to a study of concussions in soccer players by Dick, Putukian, Agel, Evans, and Marshall (2007)
67.7% of reported concussions were due to player contact
18.3% were associated with contacting the ball 13.4% with contacting the playing surface
Incidence of Concussion in Soccer
In a Canadian study on concussions in University Football and Soccer players by Delaney, Lacroix, Leclerc and Johnston (2002)
70.4% of Football players had suffered concussion symptoms within the previous year
62.7% of Soccer players had suffered concussion symptoms
23.4% of Football players and 19.8% of concussed soccer players realized they had suffered a concussion
Incidence of Concussion in Soccer
Goalkeepers were the most commonly affected position
Concerns : Soccer and Head Injury
Head injuries account for 4 to 20% of all injuries in soccer
In a study involving US National Team players, the findings suggested that any evidence of encephalopathy in soccer players relates more to acute head injuries received playing soccer than from repetitive heading (Jordan, 1996)
In an Italian retrospective study involving professional players from the top three Italian divisions, there was a 20-fold increased incidence of ALS as compared to the general population (Vanacore and Belli, 2005)
Hypothesis
No difference exists between Preseason and Postseason Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores when NCAA College Soccer players sustain subconcussive microtrauma from forceful, repetitive contact activity through heading a ball from defensive and offensive positions
Purpose
The purpose of this study is to evaluate the effect of heading on performance in Neuropsychological testing
To this effect Preseason and Postseason ImPACT testing would be used to evaluate for Neuropsychological dysfunction in NCAA Division III US College Soccer players
Methods
Men's Soccer players from a large Division III University were recruited to participate in the study
Athletes were ImPACT tested at the beginning of their NCAA Division III Soccer season
They were ImPACT tested again at the very end of their NCAA Division III Soccer Season
The season had a length of twenty games The regular season lasted for two months
Methods
Players suffering a concussion at any point during the season were excluded from the study
13 Soccer players completed Preseason and Postseason ImPACT testing without having suffered a Concussion during the season
Four players suffered a concussion over the course of the season
Five players didn't complete the Postseason ImPACT
Methods
A Statistician was employed as part of the study to run the study data
A repeated measures analysis of variance was used to compare the scores at the two time intervals
Preseason and Postseason ImPACT scores were evaluated for statistical significance
Results
No statistically significant decreases were found in overall ImPACT scores when comparison was made between Preseason and Postseason ImPACT scores
Symptom scores, Visual and Verbal Memory Composite Scores were compared for statistical significance
No significant decrease was noted between Preseason and Postseason scores (p<0.05)
Results
There was no significant decrease in Visual or Verbal Memory Composite scores (p<0.05)
P values were calculated to be : Visual Memory Composite : p=0.01 Verbal Memory Composite : p=0.04
Results
Total Symptom Score remained stable between Preseason and Postseason (p<0.05)
Total Symptom Score : p=0.04 Reaction Time Composite scores showed a
wide spectrum of scores with a p=0.389
Discussion
Total Symptom Scores, Memory Composite Verbal Scores and Memory Composite Visual Scores on ImPACT testing were unchanged (p<0.05) between Preseason and Postseason
These findings fall in line with a College Football study evaluating ImPACT scores in athletes at similar intervals by Adamson, Pink and Sweet, 2007
ImPACT scores were not significantly altered in non-concussed football players
Discussion
No statistically significant decreases were found in overall ImPACT scores in any of the domains or composites of the tests
Conclusions
ImPACT scores are not significantly altered by a season of repetitive microtrauma due to heading of a soccer ball in collegiate athletes who did not sustain a concussion
Conclusion
This is a small scale Pilot study evaluating the effects of repetitive subconcussive microtrauma due to heading of a ball in NCAA College Soccer players on Neuropsychological ImPACT testing
The study should be performed on a larger scale to evaluate the effects of heading on an athlete's Neurocognitive functioning
This includes a larger sample size in terms of participating athletes
Conclusion
More Importantly : It must be considered that the NCAA College
Soccer season in the respective study had a duration of two months and twenty official competitive matches
Conclusion
The College Soccer season is significantly shorter than the International Soccer Season
The Professional Soccer Season in the majority of professional leagues around the world can last up to eleven months when including Preseason and Postseason matches
Professional Soccer players may play upwards of 75 matches a year when Club and International commitments are taken into account
Conclusion
It would be prudent to extrapolate the study on a professional level
Testing professional soccer players via ImPACT testing Preseason, Midseason and Postseason
Ideally, Soccer players would be ImPACT tested at the beginning of the traditional Preseason at the beginning of July, Midseason and at the end of the traditional season at the end of May
Clinical Significance
ImPACT scores should be correlated with clinical findings to evaluate an athlete for the occurrence of a Post-concussive event
Bibliography
Jordan BD. Acute and chronic brain injury in United States national team soccer players. Am J Sports Med 1996;24:704-5.
Belli S, Vanacore N. Proportionate mortality of Italian soccer players: Is Amyotrophic Lateral Sclerosis an occupational disease. European Journal of Epidemiology 2005;20,3:237-242.
Dick, R., Putukian, M., Agel, J., Evans, T. A., & Marshall, S. W. (2007). Descriptive epidemiology of collegiate women’s soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 through 2002–2003. Journal of Athletic Training, 42(2), 278–285.
Broglio, S. P., Ju, Y., Broglio, M. D., & Sell, T. C. (2003). The efficacy of soccer headgear. Journal of Athletic Training, 38(3), 220–224.
Bibliography
Kirkendall, D. T., & Garrett, E., Jr. (2001). Heading in soccer: Integral skill or grounds for cognitive dysfunction? Journal of Athletic Training, 36(3), 328–333.
Delaney JS, Lacroix VJ, Leclerc S, Johnston KM (2002). Concussions among university football and soccer players. Clin J Sport Med. 2002 Nov;12(6):331-8.
Putukian M, Echemendia R, Mackin S. The acute neuropsychological effects of heading in soccer. Clin J Sports Med 2000;10:104-9.
Miller JR, Adamson GJ, Pink MM, Sweet JC (2007). Comparison of preseason, midseason, and postseason neurocognitive scores in uninjured collegiate football players. Am J Sports Med. 2007 Aug;35(8):1284-8.
Thank You!
Michele Gilsenan, D.O. Peter Barry, D.O. Michael Beams, D.O. Nick Belasco, D.O Tim Sensor, ATC Kean University Soccer