Emotional abuse of youth players is more common than we realize

This is a complex topic, and one I believe we as coaches, parents, officials, and players don’t talk enough about. During my many years of officiating, coaching, and observing youth soccer across pretty much all levels of play, age groups, and both genders, I have unfortunately observed too many situations where boys and girls appear to be subjected to persistent negativity and emotional abuse by coaches and also parents.

For example, during a U17 girls game that I was officiating the coach for one of the teams kept putting his key midfielder down throughout the game. She was arguably the best player on the team, battling hard, and a team player, yet the coach kept blaming her. She was clearly emotionally affected by this.

At an opportune moment during the game I spoke some encouraging words to her, but I wish I could have done more, including talking to her parents. The challenge is that these situations are tricky. Accusing someone of abuse, even just speculatively, is quite the charge and I only had this one game to go on and no other context.

Unfortunately, coaches and parents too often don’t appreciate how quickly negative coaching can destroy a player, take away the excitement of playing a sport, and how destructive persistent emotional abuse can be for a child (and any person of any age for that matter). The effects often don’t show themselves immediately (which makes it more difficult to recognize cause and effect), but they can last a lifetime and manifest themselves in the form of mental and physical health issues.

Coaches and parents submitting the boys and girls to emotional abuse aren’t necessarily intentionally doing it or even aware of it – they often don’t realize that they are doing it because they are struggling with their own demons. Unfortunately, kids are an easy and vulnerable escape valve for those demons.

Parents, tolerating a negative coaching environment is equivalent to tolerating an activity that keeps given your son or daughter physical pain. The mental bruising from the former is far more damaging because it persists, deepens, and damages the core of who your son or daughter is and growing up to be.

Imagine your son or daughter returning home from a daily activity that gives them bruises all over their bodies, every single day. You’d never subject your child to this nor would you accept emotional abuse from a teacher at school.

So why should sports be any different? Probably because of some perverted view that this “toughens ’em up so they can cope better with life.” Exactly the opposite!

The Positive Coaching Alliance has been working for twenty years to improve this aspect of youth sports, but it starts with us parents. We need to know what to look for and proactively identify coaching environments that are negative and emotionally abusive and remove our boys and girls from that environment, and possibly call out the coach for his/her behavior. Some parents also need to take a hard look at their own behavior.

On February 14, 2018, a new law went into effect, S.534, the “Protecting Young Victims from Sexual Abuse and SafeSport Authorization Act of 2017”, which established the U.S. Center for Safesport and published a parent toolkit to educate parents about the various forms of abuse in sports. U.S. Soccer also launched its Safe Soccer initiative and a Safe Soccer Framework.

To take a closer look at what emotional abuse in a youth sports context can look like, I’m including here some key passages from the above referenced toolkit:

Child abuse is a complex issue. The term may evoke a strong emotional response and can create confusion as people try to agree on what is and is not abuse. Child abuse includes many forms, including physical, sexual and emotional harm.

The complexity is caused in part because individual families and communities have many different values about how to treat children. Further, child abuse is defined differently by the criminal justice system, the civil court system, and clinicians.

The clinical standard is the one of primary importance to this discussion, and it simply is ‘does a child feel as if they have been abused?’ Many acts rise neither to the level of civil nor criminal charges, but leave a child feeling awful.

Sharp observation by parents and coaches, and open communication between parents and children, can help identify when language or behavior has crossed a painful boundary for a specific child, and swift, compassionate intervention is called for.

Emotional abuse, also known as psychological maltreatment, is considered the most common type of maltreatment, but the least reported.

Psychological maltreatment is defined as “a repeated pattern or incident(s)…that thwart the child’s basic psychological needs…and convey that a child is worthless, defective, or damaged goods [whose value is] primarily…meeting another’s needs.”

Victims of emotional abuse are left to feel expendable, which is the exact opposite of the message a child needs to develop healthy self-esteem.

Forms of emotional abuse may include verbal acts, non-contact physical acts, and acts that deny attention or support. The following list describes major categories of emotional abuse, and examples of how they might play out in youth sports:

Verbal

  • Use of degrading or shaming nicknames
  • Repeatedly telling a child they are not good enough to be on the team
  • Repeatedly mocking a child for poor performance
  • Repeatedly calling out a child for their differences (e.g. race, ethnicity, disability)
  • Threats of frightening and inappropriate repercussions from a coach

Acts That Deny Attention & Support

  • Acts or words that reject and degrade a child
  • Consistently excluding a child from playing time, even in practice
  • Singling out a child to consistently have the least favorable position or assignment
  • Consistently having the same child sit alone
  • Consistently giving a child a job or chore that removes them from the rest of the team

An isolated incident of inappropriate behavior may occur when an adult is under stress and makes a reactive comment. Some parents become uncomfortable reading these definitions for the first time, remembering that they may have behaved or spoken like this to their child on occasion. A healthy adult recognizes their mistakes and offers the child a sincere apology. A key factor in the definition of emotional abuse is the ongoing and repeated exposure to these painful and negative behaviors.

The good news is that the negative effects of emotional abuse can be buffered by the ongoing support from a nurturing loving parent or caretaker, but a parent must become aware of the abuse to help.

Please, parents, take a closer look at the coaching environment your son or daughter is subjected to. There is no place for emotional abuse – ever. Even persistent negativity has a lasting mental health effect.

Pull your child out of that environment immediately and share your concerns with other parents to help them make informed decisions about their children too.

The first English soccer player dies of CTE. Kevin Moore was in his 40s when he showed signs of brain disease.

Mandy Moore still winces as she recalls how it often was for her late husband, Kevin, after so many of his 623 matches as a professional footballer. “He had stitches and scars around his eyes,” she recalls. “There were times when he could not even remember parts of a match after taking a kick or an elbow in the head.”

His friend and former team-mate Iain Dowie says that they would stay behind to practise heading. “Maybe 100 balls a day,” says Dowie.

And then there were the shuddering match incidents. “I don’t know how many times Kev – God bless him – got concussed,” says Dowie. “But I remember an incident as the ball dropped in the box. Kev slipped and the lad was about to smash it in. Kev put his head between the ball and him. The lad kicked his head and [the ball] went for a corner.”

Moore was 39 when he retired in 1996 after a 20-year career. This was not an elderly player struck down with a devastating form of dementia, but a defender from the Premier League era who had been a Southampton team-mate of Alan Shearer and Matthew Le Tissier.

He is the first known Premier League player to have died of dementia and was only in his mid-40s when his family noticed changes.

He unexpectedly lost his job as Fulham’s safety officer and training ground manager. He became forgetful, unsteady on his feet and had minor car accidents. He started making rash decisions.

A diagnosis of Pick’s Disease – a rare form of dementia affecting the front of the brain – was made in 2007 and his decline would be cruelly rapid.

For his daughter, Sophie, a gap of 10 months between visits when she was living in Australia was startling. “I was left shocked,” she says. “I felt like I didn’t recognise him as my dad.”

Moore eventually needed full-time care and died in April 2013 on what was both his wedding anniversary and 55th birthday.

“My abiding memory was him scoring at Wembley in the Zenith Data Systems final in 1992,” says Le Tissier. “It was the only time I’ve seen a guy head the ball downwards into the top corner.”

Although former England striker Jeff Astle died in 2002 from brain disease that both a coroner and neuropathologist attributed to playing football, the link was not then being widely made.

There was a sad irony in that Moore had been sufficiently concerned while he was still playing to have discussed it with Dowie and a doctor. They raised the issue with Gordon Taylor, the chief executive of the Professional Footballers’ Association.

Mandy Moore also wrote to Taylor following Kevin’s diagnosis and received a reply. There were no words of sympathy and, even though she says there had been no request to cover care costs, the letter stated that the organisation would be bankrupt within a year if it paid care home fees for members. Taylor estimated in the letter, written in 2008, that 1,000 of his members required such care and that the annual bill would be about £15 million.

The Moore family were taken aback by the letter’s tone and, while grateful for the wider help Kevin received from the PFA, felt a huge difference in how they were supported by the Royal Institute of Chartered Surveyors, where Moore was also a member.

Dementia caused by head trauma has since been identified as chronic traumatic encephalopathy and, while definitive diagnosis can be made only by examining the brain after death, Moore’s symptoms were consistent with the disease. “This is not about banning football or heading but getting research done so that players know where they stand and risks are mitigated,” says Mandy.

Dowie agrees. “I feel sure football did play a part – there is no doubt in my mind,” he says.

Brain injury from heading the ball – growing evidence from England

One pro player’s traumatic experiences with head injuries

My teammate and I were standing outside RFK Stadium in Washington, D.C. It was April 2003, our first home game of the season against the Chicago Fire. It was my first official appearance as a professional soccer player. It was a dream come true.

“Let’s take a picture,” he said. “I feel like this is a day we definitely want to remember.” He handed someone his digital camera, we posed together and smiled.

[Click here for the original article @ThePlayers’Tribune]

I was a 20-year-old rookie — picked No. 1 by D.C. United in the MLS SuperDraft just a few months prior. I hadn’t played against Kansas City in our season opener, so I had made sure to bust my ass in practice that week.

A few days before the game, Coach had even pulled me aside to let me know that he was going to try to get me some minutes. So I put the word out to family and friends.

My parents drove down from New Jersey, my cousin flew in from L.A., some friends came up from the University of Virginia.

But I don’t remember seeing anyone at the match. I don’t remember my name being announced over the loudspeaker. I don’t remember the roar of the crowd and the bright lights.

I don’t even remember stepping onto the field.

Shortly after I came off the bench in the 65th minute, I found myself on the wrong end of a major collision while jumping for a header. I got undercut, flipped over and landed on my head.

I didn’t know it at the time, but the first game of my rookie season was the beginning of the end of my professional soccer career.

The photo we took two hours before the match would be the last thing I remembered until I ended up at the hospital later that night.

I was told that after the game, my mom and dad were waiting outside the locker room for me, but I walked right by them. I didn’t even acknowledge their presence. My team doctor had to explain that I had suffered a head injury and would be heading to the hospital to make sure my brain was not bleeding.

You know when someone claps their hands in front of your face to snap you back into reality? Well, an hour or so later, out of the blue, that’s what I felt happen as I suddenly became aware of where I was. I looked around and noticed my family and friends beside me in the hospital waiting room.

“What are we doing here?” I asked.

“He is still pretty out of it,” I heard my mother tell my father in Armenian. Her voice, and then seeing my family and friends gathered around me, are the first things I can really remember since taking the photograph.

But I still had no idea what had happened.

“Alecko, you hit your head,” the doctors told me.

After a few hours of tests, all the scans on my brain had come back negative for any major brain injury. The only outward sign that anything had happened was the cast on my hand for the three fingers I had broken in the collision.

As for my head, I was told to go home and get some rest, and if there were any problems, to call my team doctor immediately.

I didn’t have any idea how bad the fall was until I got to practice two days later and my coach pulled me into his office.

“Have you seen the video?” he asked me, his voice cracking and eyes welling up with tears. “You’re lucky to be walking, son.”

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He showed me the tape. The slow-motion replay of my entire body weight crashing on top of my head and neck made me nauseous. It wasn’t until then that I also realized I had actually stayed in the game.

I didn’t remember any of it. I just thought, I never want to see that again. And I wouldn’t for the next 12 years.

The crazy thing is, I still didn’t really understand the damage it had done to my brain.

Besides the doctors in the hospital, nobody ever mentioned the word concussion. And after a week of rest, I was back out playing and training with the team. Bullet dodged.

That is how my nightmare began.

Soccer brought my family to this country. My dad, Andranik, grew up an Armenian Christian in Tehran and became one of the best defenders in the history of the Iranian national team.

After playing for Iran at the 1978 World Cup, he was selected to the World All-Star team that played an exhibition game at Giants Stadium against the New York Cosmos.

Immediately after the match, the Cosmos offered him a contract. Despite interest from other top European clubs, my dad decided moving to the U.S. would be the best thing for our family.

So my parents moved with my older brother to New York, and a few years later I was born, more or less with a soccer ball at my feet.

Not a single day went by in my childhood where I didn’t play soccer. Whether in our backyard, or in our basement, or at the park down the street from our house, or with my dad and his teammates — Giorgio Chinaglia, Carlos Alberto, Hubert Birkenmeier, even Pelé. To me, they were just friends who were always ready to kick the ball around with me.

Soccer was life for my family. In my elementary school yearbooks, my classmates and I had to write what we wanted to be when we grew up. Other kids wrote the usual: doctor, astronaut, police officer, and so on. Next to my name were three words, “Professional soccer player.”

Even off the pitch, soccer was an integral part of our lives. In 1982, Hubert had opened up Birkenmeier Sport Shop, one of the first and only soccer shops in the U.S. But in 1985, as the Cosmos roster went through a major upheaval, Hubert and my dad both got traded and had to relocate to continue their careers.

My father had a different idea – he would instead choose to retire from pro soccer, buy the shop from Hubert, and plant our family roots in New Jersey.

The shop became my second home — and the place where everyone came to talk soccer. Almost every serious soccer player from northern New Jersey — including men’s national team stars Tony Meola, Tab Ramos, John Harkes, Gregg Berhalter, and Giuseppe Rossi — grew up coming to the shop.

Sure, Dad’s store sold the newest cleats or kits, but mostly people would come by to talk soccer with my dad and Hubert, who had returned after finishing his playing career.

Meanwhile, I was busy following in my dad’s footsteps as a player. I was New Jersey’s high school player of the year in 2000 and won the Hermann Trophy as the top player in college soccer in ’02.

By that time, I had already represented the U.S. in the FIFA U-20 World Cup. In ’04, I led the U.S. in scoring during Olympic qualifying. Despite getting my own trials with several European clubs, I knew that I wanted to be close to my family. After my junior season at UVA, I decided to enter the MLS draft.

My first game in MLS was supposed to be one I would never forget. Instead it was one that I cannot remember.

I was fortunate that Carlos Bocanegra, a defender for the Fire in that game, was looking out for my well-being. After I stayed on the field following my injury, he and other players actually alerted the referee and medical staff to get me out of the game.

I’ve since been told that I was saying things that did not make any sense after the collision, cursing at guys, saying we were in San Francisco even as I was standing on the pitch in Washington, D.C.

Most people don’t really think of soccer as a contact sport, but that couldn’t be further from the truth. As the game has gotten more physical, and players have gotten faster and stronger, collisions have become more violent. The number of head injuries has been growing rapidly.

Still, most don’t realize the seriousness of head injuries, how to identify them and most importantly, how to treat them.

 

EARTHQUAKE DC UNTED

After getting knocked unconscious in my first game, I was back on the field in a week. All I needed to hear was that I had been cleared to play and that was enough for me.

It was the same story the following season when I was hit in the back of my head after a scuffle broke out during a match. “Just take a week off to get some rest,” our trainers told me.

Once again I thought, As long as I’m cleared then I should be fine, right? That certainly seemed to be the way it worked out. I scored 14 goals that season, made the All-Star team and was named MLS Cup MVP as we won the championship. I was called in to represent the U.S. Men’s National Team.

Everything was going according to plan. Or at least it seemed to be.

What I didn’t know, however, was that those two hits had done lasting damage to my brain. So when I suffered my third concussion less than a year later in 2005, it had an immediate and devastating effect.

With no more than a couple minutes left in a match against the New England Revolution, the knee of their goalkeeper slammed into the side of my head.

It felt like getting hit with a baseball bat.

And then everything went silent, except for the throbbing and pounding inside my head. It was as if my heart had replaced my brain and all I could feel was it beating inside my skull.

“Esky, are you alright?” I heard the referee ask as he stood over me.

“No,” I muttered. “This isn’t good.”

My trainer took me straight into the locker room and for the next few hours, it felt like I was drunk. Time seemed to slow down and my balance was unstable.

As I did after the first two concussions, I took some cognitive tests, and just like the first two times, I passed every one.

But something was different. This time, I felt a pressure in my skull that I had never felt before. Our team doctor noticed my concern and made sure a friend drove me home.

I thought that — again, just like with my first two head injuries — if I just laid low and got some sleep I would feel better in the morning.

But this time I didn’t.

When I woke up on Sunday morning, it felt like there was a cinder block in the back of my head, like blood had just pooled there overnight. The throbbing was still there, too.

I met with a neurologist on Monday. More tests, more passing, more reassurances that everything would be O.K. More instructions to just take it easy and to take some Tylenol if the headaches persisted.

And a week or so later? Cleared to play.

Alecko Eskandarian

But I still felt that something wasn’t right. The pain, the pressure, the weight in the back of my head — they just wouldn’t go away.

I returned to training, where all my coaches and trainers and teammates knew that doctors had cleared me to play. So the mental warfare began. Do I just suck it up? If I’ve been cleared I must be fine, right? No athlete ever wants to be “that guy” sitting out. Ever. Especially for “headaches.”

I felt like I had no choice. I began playing again. I had never before depended on painkillers, but suddenly I needed them badly. After training, my symptoms would get even worse. How many Tylenol am I supposed to take before the pain goes away?

The locker room was not a good place for me to vent my frustration. Every guy in there was playing through some sort of injury. Any mention of my discomfort and the ribbing would start.

Man, you’re sitting out for that?

Oh, trying to get another vacation day?

I wish I could get a day off every time I had a headache.

Nobody understood what I was going through. But I was determined to beat this thing. I focused all my energy on sucking it up, getting back on the field — for my livelihood, for my career. After missing games for three straight weeks, I was back training and finally set to return to the starting lineup.

But a few days before the game, as I was driving home to my Georgetown apartment after practice, I suddenly experienced a headache so sharp that I could actually hear it. You know that sound when a microphone screeches? That terrible, piercing ring that keeps rising?

I had to close my eyes. I swerved across three lanes of traffic. How I didn’t end up in a car accident I’ll never know.

I immediately called my trainer and asked to meet with a new neurologist in order to get a second opinion. The next day at the doctor’s office, I told him everything I had been through, starting with the collision in the first game of my rookie year. He just looked at me in disbelief.

“If you play soccer and you get hit in the head again, you might die,” he said.

He told me that I would have to be shut down for a minimum of two months, until I was completely symptom free. No physical activity — nothing that would raise my heart rate until the headaches went away.

For the next 10 months, I was a ghost.

20161031_sm_alecko_232b

I stopped answering the phone. I stopped going out with my friends. I used to be the happiest guy in the locker room, always ready to share a story or play a practical joke.

Now, I would sit in my apartment and watch the hours go by. I struggled to eat more than one meal a day. It was torture to go to games at the stadium to support my teammates. The atmosphere at RFK — which I had once thrived on — now triggered headaches.

The thing I loved most in this world had been taken away from me and I didn’t know what to do.

I just felt isolated and helpless. And honestly, I was terrified about not knowing what was going to happen. If I was going to recover, or if the depression was going to consume me.

The worst part about my recovery was that no one was able to see what I was going through. To the naked eye, you would have thought I was fine.

I wasn’t. I didn’t know if the headaches would ever go away. If I’d ever feel like myself again. I didn’t know if I’d ever return to the field.

Most people thought I was done. About a week before one of the last games of the season, I got Facebook messages from members of the Screaming Eagles and Barra Brava, two D.C. United supporters groups.

“At the next match just make sure you have a good view of our supporters’ section in the 11th minute.”

That weekend, I went to the match and looked to where the Screaming Eagles sit. At the 11th minute, they held up a huge banner.

 

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I got pretty emotional about it. I mean, of course it was an incredible gesture from the fans to let me know that they hadn’t forgotten about me —but it was also like, Holy shit, it’s as if I’ve died.

At that point, it actually felt like I already had. I was pretty much ready to risk my life for the game. I was only 22, and I might have been romanticizing things a bit, but more than once I had thought to myself, I’d rather die on the field than never play again.

It all sort of reached a boiling point when I went back home to New Jersey for the off-season. I’d always been close with my parents, but because of everything I’d been going through, I was not a pleasant person to be around. When I was living in D.C., I had grown increasingly frustrated any time they would call to ask if I was feeling any better.

“No, I still have headaches. Every day is the same. Please stop asking.”

Being back home, I had family support to lean on, but I rejected it. I started to feel sorry for myself, and with the holidays around the corner, I became annoyed about how cheery everyone was.

I thought, My life’s work is being taken away from me. I have no idea if I’ll ever get better, and you want me to buy presents, put up Christmas decorations and sing carols?

I knew that I had to start digging myself out the hole I was in — not just to play soccer again, but to have any sort of life period. I set up a treadmill that my brother and I had gotten for my parents and started running.

Two minutes without a headache. Next day, five minutes. The next, 10 minutes. I started doing crossword puzzles to keep my brain active. I made sure my brain was at full rest for a certain number of hours a day — no TV, no reading, no straining whatsoever. I basically re-calibrated my entire life.

Soon, the weight and the pressure in my head started to subside, and life felt more … normal. And when preseason rolled around in February, I had been symptom-free long enough to rejoin the team.

We took things easy at first, but eventually, I found myself back on the pitch at RFK Stadium for our season-opener — and scoring off a left-footed volley.

I knew there were still uncertainties with my head, but I made the All-Star team again that season, and was one of the league’s top goal scorers. I even scored in an exhibition game against Real Madrid in front of 70,000 fans. I was back. My teammate Josh Gros started calling me “the Truman Show.”

“Your life couldn’t be any more scripted,” he said.

I have to admit, everything felt so surreal. I thought, Am I still concussed and dreaming all of this? I played every game and celebrated every goal like it was my last, because I knew it could have been.

LA Galaxy v New York Red Bulls

And four years later, on July 19, 2009, I did play my last game. Call it piss-poor luck or a heartbreaking twist, but I suffered my fourth concussion while playing for the L.A. Galaxy when an opposing defender inadvertently cleared the ball into my face.

Once again, everything went black. I couldn’t breathe. It felt like I was swallowing my tongue. I had broken my nose and started spitting out blood. My old symptoms had returned. This time, worse than before.

I tried to convince myself that I could pull off another comeback. But this time, my doctors and coaches weren’t willing to take the risk. I wasn’t cleared to play.

“If you were my son, I’d tell you to stop,” my coach at the time told me.

I went from living in paradise in Hermosa Beach to once again being consumed by depression — steps away from the sand and the ocean, but confined to the darkness of my apartment.

I tried to fight it as best as I could. I kept myself busy and started doing some TV broadcasting work. I started taking business courses. I was making new friends. But none of it helped me escape my reality.

I could feel myself spiraling downward and I knew I needed change. So I moved back to Charlottesville, to finish up my degree at UVA and find an escape from soccer.

At school, new challenges awaited. The damage to my brain was worse than before. I struggled to focus and began experiencing vertigo.

One day in Charlottesville, after finishing a light workout my body suddenly went into shock. My head began pounding. I started shaking. I felt nauseous. I was fading.

Sitting in the passenger seat of my friend’s car while he rushed me to the hospital, I quickly ruled out any thought of a comeback.

“It’s over,” I said as we drove up Route 29. “I’ll never play again.”

“Dude, what?” my buddy said.

“I’ll never play soccer again.”

“Uh, yeah? I’m taking you to the hospital to make sure you don’t die and you’re worried about whether you’ll kick a ball again?”

The next day, I wrote it down. I’m never going to be a professional soccer player again.

When I look back on my career, I think about dribbling a ball around my dad’s soccer shop and dreaming about playing in front of thousands of people.

I think about the great teams and teammates I played with. I think about how I got to share the field with some of soccer’s biggest stars — Messi, Cristiano Ronaldo, Ronaldinho, Pirlo, David Beckham.

Yet something else also happened on those fields that changed my life. And it’s still happening.

It wasn’t until I went through head injuries myself that I realized how many people are struggling with the aftereffects of concussions.

Even over the course of my own recovery, I haven’t wanted to open up about what I have gone through. I didn’t want to talk about the dark places my concussions took me, the depression, the isolation, the helplessness. How could I help others if I couldn’t help myself?

It wasn’t until I went through head injuries myself that I realized how many people are struggling.

But, I’m finally at a point where I have learned to manage my brain injury, and it’s time I start sharing my story about concussions in soccer. It’s time that all soccer players do.

As I’ve started to be more open about my own struggles, dozens and dozens of players of all ages have reached out to me asking for guidance or advice.

I remember when I was recovering from my third concussion, I got a call from my agent. He told me that former MLS midfielder Ross Paule wanted to talk to me. A few days later, my phone rang.

“This isn’t the life you want,” Ross told me, and warned me not to rush to come back. He’d suffered concussions while playing for the Columbus Crew and had tried to play through them — until they eventually forced him to retire.

“I can’t drive after dark,” he said. “I can’t play with my little girl. You don’t want this.”

I remember I was sitting in the Galaxy dressing room after my fourth concussion when David Beckham approached me.

“Mate, I’m so sorry you’re going through this. Same thing happened to one of my teammates at Manchester United. He sat in a dark room for a month.”

As an assistant coach now for the NASL’s New York Cosmos, I sat down recently with one of our players who had suffered a concussion. I told him about my experiences and how he needed to be careful.

He just stared back at me. In his face, I saw the same 20-year-old I had been. I knew how much he wanted to be on the field and how all he wanted to hear was that he was cleared to play.

It hurt me that he couldn’t see what I had gone through. If only there was a scar to show….

For all the progress we’ve made in the last few years, education about head injuries still needs to be emphasized more by leagues, coaches and trainers. There is still no clear-cut diagnosis process or treatment method.

I still can’t sit in the back of a car without feeling nauseous. I can’t yell throughout practices or games. I can’t raise my heart rate too high without getting headaches.

But I decided a few years ago to focus on what I can do. And much of that is not taking things for granted anymore — like being able to go outside and run, which led to running in my first marathon this past month.

And another thing I can do is talk about a serious problem — one that is growing —in our sport. We all need to keep talking about it — so that no one has to experience what I did.

ALECKO ESKANDARIAN

alecko-sign

“I used to head 100 balls a day and I don’t remember good times so well.”

You are probably aware of ongoing discussions regarding head injuries in soccer (it’s much much worse for (American) football, of course, but it’s an issue for soccer too).

Full-blown concussions typically take center-stage, but medical professionals are now also worried about the many smaller sub-concussive blows to the head.

And there is increasing evidence that even just rapid head movements can cause long-term damage.

In response, U.S. Soccer recently introduced a powerful educational concussion video and the no-heading rule for players up to and including twelve years of age.

This caused some frustration, including concerns about our youngsters not being able to head the ball well when they are older. 

Some also felt that this was an overreaction and that heading the ball safely (with the front of the head instead of the top or sides) can be taught from a young age.

The risks associated with heading balls is not yet properly understood. Scientists and medical professionals are working to understand this much better, but it will take some time.

In the meantime, I would like to share the experiences of a family friend with you.

Chris Nicholl was a professional soccer player and manager in the English Premier League. He played as a central defender for Aston Villa (1972–1977) (210 league appearances) and then Southampton (1977-1983) (228 league appearances).

Chris also played internationally for Northern Ireland (51 caps). After he retired from his playing career, Chris managed Southampton amongst other clubs.

I’ve added a vintage clip at the end of this article showing Chris’ most famous goal, scored during the League Cup Final against Everton.

But arguably his most memorable feat was scoring all four goals in a 2:2 draw between Aston Villa and Leicester City. 😁
Chris was interviewed by the Daily Mail a couple of weeks ago and I’m pasting a key passage below. Click here for the full article.

“I know I’m brain damaged from heading footballs. I used to head 100 balls almost every day. When I was at Aston Villa I would watch all my team-mates going home in their cars and I would still be there on the training pitch with Ray Grayden who used to send them long. It’s definitely affected my memory. The balls were a lot heavier then.” Nicholl points to his nose which is unnaturally curved and crooked. “Maybe you can tell, I used to head more with my nose,” he adds. “It’s not recommended.”

To be clear, Chris’ example doesn’t prove that heading the ball causes brain damage nor how many headers per day/week/month are safe. His memory loss might simply be age related (he is 70).

However, the medical research community in England and now also the English FA is looking into pre-mature deaths and behavioral changes of former players.

Early evidence is showing that some died of chronic traumatic encephalopathy (CTE), the same condition as American football players.

And three members of England’s 1966 World Cup winning squad suffered from Alzheimer’s disease, believed to be caused by heading.

According to one health advocate in England, 75% to 80% of the players that contact her are centre-halves and centre-forwards.

“Obviously not all of them are, but the vast majority are. Although any player on the pitch can head the ball, centre halves and strikers head the ball more, especially in those days.”

Researchers at the University of Stirling, UK, found heading the ball just 20 times could make “small but significant changes in brain function” for the next 24 hours, when memory performance was reduced between 41 and 67 per cent.

I hope this serves as a cautionary tale. 

Unfortunately, as a referee I still see too many coaches who ignore or down-play players’ head injuries during games and practices.

Let’s err on the side of caution for our youngsters, folks. The brain is precious and damage to it often doesn’t become apparent until later in life.

That damage is irreversible and fundamentally changes who you are as a person well before your pre-mature death.

Powerful concussion video released by U.S. Soccer

As part of the ongoing efforts to educate the soccer community, U.S. Soccer recently released the below powerful video.

It follows a player through her journey on the road to recovery; from the initial impact, assessment, recovery, and finally back on the pitch.

The message in the video is simple, “Recognize the symptoms, take the appropriate action, and come back to the game 100%”.

This message is one that we cannot fail to share enough with the soccer community. Only with your diligence on the pitch during games and practices, can we make an impact on our players’ road to recovery.

Please share the below video with your players, parents, coaches, administrators and friends in soccer. Also share this U.S. Soccer webpage and this link to useful shareable resources, including impactful printable materials.

The above text is taken, in part, from Cal North’s website and edited for brevity.

Finally, please keep in mind that concussions are just the tip of the iceberg. There is growing scientific evidence that even repeated sub-concussive impacts on the brain can lead to severe lifetime brain damage. Click here for more information.

Clarifying rules for development academy players (boys and girls)

With the recent expansion of the US Soccer Development Academy (DA) to the younger U-12 age bracket (which will actually be the ‘old’ U-11 age bracket starting Fall 2017) for boys and the launch of the Girls’ Development Academy in the Fall next year, it might be helpful to clarify the rules for DA players doing non-DA activities.

The rules are more difficult to understand and interpret than I expected, and even emailed clarifications I received directly from the DA aren’t necessarily 100% clear, at least to me.

Please let me know in the comments below if you think there are inaccuracies and/or missing pieces of information.

With that in mind, here are the rules for all DA players, boys and girls, starting at U12:

DA clubs are responsible for developing an individual development plan for each player. This plan is meant to have each player’s best interest in mind to further his/her soccer development.

With that in mind, the DA is very focused on an appropriate train-to-play-to-rest ratio for the longer-term healthy development of players. This ratio is understood by all DA clubs and is taken into consideration when designing the individual player development plans.

Given that the DA-mandated activity load is already substantial, any additional outside activities are cause for concern.

Therefore:

DA players are not allowed to compete in *any* non-DA league or tourney. This includes activities such as high school soccer, beach soccer tourneys, and winter futsal leagues/tourneys. In fact, this applies to any *sport*.

DA clubs can apply for exemptions to compete in elite non-DA activities such as Dallas Cup, Surf Cup, and tournaments in Europe, but this is at the club/team level, not for individual players. Approval requires a written request by the club to academy staff for decision making.

And any non-DA *training* done outside the club’s training program such as additional strength conditioning sessions, private clinics, or weekly futsal practices are at the discretion of the player’s club and have to fit into the player’s overall development plan.

In other words, the player’s club can make a case-by-case decision to allow non-DA *training* if the DA club believes it to be beneficial for the player’s development.

However, my understanding is that any training exemptions are rare, so for all practical intents and purposes you should assume that non-DA training won’t be allowed.

During the DA off-season from mid-July (after Nationals) to the first week in September (about 6-8 weeks), players are permitted to get outside training and attend outside camps (ID camps, soccer, camps, college camps etc.).

But any consideration of outside training even during the off-season has to be brought to the attention of the club and discussed with them to make sure the training is in the best interest of the player.

I’m in two minds about this.

On the one hand, having flexibility to pursue soccer activities outside the regular DA structure could help youngsters enjoy the game more and for longer. For example, traveling to Spain during the Christmas/New Year break to train and play futsal at FC Barcelona (with a Bay Area non-DA futsal group) would surely help motivate a soccer-passionate youngster.

But on the other hand, the schedule for DA players truly is heavy already. The time commitment and physical exertion is considerable. And how many parents are in a position to make the right decisions regarding their youngster’s possible over-exertion? Many of us might think we can make the right decision “because we know our son or daughter best”, but I’m not sure about that, at least not at this elite level.

And then there are the resources that USSF and the DA clubs invest in the development of our elite players. Shouldn’t the DA and the clubs be able to protect that ‘investment’ for the longer-term?

Nevertheless, clubs need to do a much better job providing individualized holistic player development, not just focus on improving team-level play. And this is supposed to set the DA apart from non-DA programs – individual player development.

In contrast to non-DA players, who have a lot of flexibility to change teams/clubs/coaches and engage in a range of different soccer activities, DA players have to put a lot of trust into their DA club and coaches to truly take care of their entire player development needs and interests.

This isn’t easy – there are many points of view supporting both sides of this debate. Please let me know what you think in the comments section below. Keep in mind that we are talking about the most elite girls and boys players in our country when you consider the pros and cons of these DA rules.

Thank you!

Here are some relevant links and pasted information from those sources:

From http://www.ussoccerda.com/overview-program-benefits:

No Outside Activity/Competitions

To maintain a focus on club training environments, Academy players and teams do not play in any outside competitions without written permission from the U.S. Soccer Development Academy staff.

This includes any other leagues, tournaments, State Cup competitions, ODP or All-Star events. Development Academy players for all teams must choose to participate in the Academy full-time and forgo playing for their high school teams.

Full-time Academy players can only participate on their designated Academy team, with only two exceptions: U.S. Soccer Training Centers and Youth National Team duty.

The Development Academy upholds this rule because we believe elite players require world class environments. The Development Academy’s 10-month Program allows for a greater opportunity to institute style of play and implement a system according to U.S. Soccer’s Development Philosophy.

It also gives teams increased opportunities for younger kids in their club to “play up” against older players in both training and matches, thereby accelerating their development.

From http://www.ussoccerda.com/overview-academy-structure:

Outside Activity/Competition

Academy players and teams cannot play in any outside competitions without written permission from the Development Academy staff. This includes any other leagues, high school season, tournaments, State Cup competitions, ODP or All-Star events. There are two potential exceptions to this rule, provided they are approved by Development Academy staff:

  1. Domestic and international tournaments: Domestic & international tournaments may be permitted if they meet Academy’s technical standards of one game per day and elite competition. Examples of permitted events include the Dallas Cup, Surf Cup, Disney Showcase, and other International events
  2. Possibility for friendly games: Academy clubs can schedule friendly games to provide players with a heightened development experience. The games must not be part of an organized competition (i.e. tournament, league or camp) as defined in the non-participation regulations, and all competitions must adhere to all Academy standards and guidelines.

From http://www.ussoccerda.com/faq:

Can Academy players participate with non-Academy teams during the season? Full-time Academy players are only permitted to participate on their Academy team, and National Team duty.

Which teams participate in 10-month programming and do not allow high school participation? The entire Academy program does not participate in high school programming.

Even mild childhood concussion linked to lifelong health and social problems

The scientific evidence is mounting: even mild childhood head injuries can increase the risk of low educational attainment, psychiatric hospitalization and early death, according to a highly respected team of scientists from the US, UK, and Sweden.

“Even a single mild traumatic brain injury will predict poor adult functioning.”

-Amir Sariaslan, University of Oxford, UK

To be clear, ‘traumatic brain injury’ sounds like a major head injury to us non-medical parents, coaches, and players, but in the medical world ‘just’ a concussion is considered a traumatic brain injury.

Click here for the just-published scientific paper if you’re interested. And click here for an easier to digest article summarizing some of the findings.

And I also wanted to share the following recent comments published in the New York Times by Dr. Omalu, the forensic pathologist and neuropathologist who first discovered chronic traumatic encephalopathy in American football players. He is featured in the movie Concussion. The last sentence struck me as especially profound so I bolded it.

“Our children are minors who have not reached the age of consent. It is our moral duty as a society to protect the most vulnerable of us. The human brain becomes fully developed at about 18 to 25 years old.

We should at least wait for our children to grow up, be provided with the information and education on the risk of play [in American Football], and let them make their own decisions. No adult, not a parent or a coach, should be allowed to make this potentially life-altering decision for a child.

We have a legal age for drinking alcohol; for joining the military; for voting; for smoking; for driving; and for consenting to have sex. We must have the same when it comes to protecting the organ that defines who we are as human beings.

To be clear, there is a big difference in risks between American Football and soccer. Like probably in any team sport, there are brain injury risks playing soccer, but those are arguably manageable through smart and prudent preventive measures, including heading rules for youngsters and stricter enforcement of challenges on players that risk injury to the brain.

But let’s get ahead of this in soccer. Take the risks of head injuries seriously folks, even mild ones!

Sportsmanship message from NorCal Premier Soccer – unfortunately too easily forgotten as the season unfolds

As we head into the fall season, we would like to encourage players, coaches, family members, club officials, and referees to take a moment to consider how they will behave around their upcoming soccer games. All play an important role in our small piece of the “World’s Game”, all deserve to be treated respectfully.

While we absolutely encourage everyone to give their best effort, trying to win, we also believe a sense of soccer fellowship should be maintained at all times ­among opponents, opposing fans, and referees.

Treat each other with courtesy, remember your opponents are just like you, fans of the game, only in a different uniform, playing for a different club, supporting a different team, or in the case of referees, with a different role to play.

Whatever part you play, be a role model. Set an example. Your positive example is incredibly valuable to those who witness it!

The rules must be respected – they maintain a player’s health and safety, provide everyone a fair chance to win each match, and provide necessary checks and balances to govern a game full of emotions.

Referees must be respected and treated properly ­- without them the games cannot be played. Remember they are sons and daughters, fathers and mothers, grandmothers and grandfathers. They are our fellow soccer fans and they deserve our patience. Our praise, respect and admiration should be shown to them for taking on what is often a thankless task.

Finally, respect the game! Soccer, futebol, fussball, football, whatever you may call it, is the greatest sport in the world – for it to continue to grow and remain healthy in our country it absolutely needs us to respect… its fields, its players, its fans, its referees and its coaches.

Thank you very much,

Norcal Board of Directors

If you love your child read this

Please consider sharing this with family, friends, and coaches.

Brown University scientists have captured in real-time video (see below) what happens to a brain cell after experiencing a significant impact on the brain. And, crucially, it’s not just the hard concussion-causing blows that cause permanent brain damage.

When the brain was hit with a slower blow, “the cells gradually retract all their connections to the surrounding networks and sort of silently shut down. What is striking to us is that within the first four to five hours, the brain cells look healthy, and you think everything is OK.

Then you see the cells changing, and then they start to change rapidly and degenerate, and they’re dead within a few hours. [the below clip shows that clearly]

The reason why there is a delay is because it’s a chemical process that plays out inside the cell. There are certain enzymes that, once they become activated, start to chop down the cell from the inside out.” Christian Franck, Assistant Professor at Brown University

So what does this mean for soccer? Well, for one, I believe that we need to err on the side of caution and prevent youngsters from heading balls until they are, say, 14 or older. Coaches and referees also need to be much more vigilant about head injuries.

CYSA now bans heading for all U13 and below games and NorCal for all U11 and below. This is a very good step, of course, but my personal preference is to see this extended to U14 across the nation.

By the way, even medical professionals and scientists don’t yet know what an acceptable number and type of blows to the head should be. Research is underway, but it will take many years. But I just look at the fragile floating brain in our skull in the clip below and just can’t help but feel that we’re not cautious enough.

And what does this mean for American Football? Pull your child out immediately. You are causing lasting long-term brain damage to your child and there is no way to repair that damage. I simply can’t see how American Football can be modified to make it safe.

There is nothing more precious than our brains and especially a child’s developing brain. For some reason, as a society, we are prone to ignore the health of our brains and just assume that the brain keeps working as designed. And we don’t seem to understand that many brain injuries cause devastating effects only years or even decades later.

But why should we treat the brain with any less care than other body parts? If you knew that a certain type of activity causes repetitive micro-fractures in your legs’ bones and eventually complete lifetime loss of use of your legs, would you continue to encourage your child to perform that activity?

So why would you do this for activities that damage the brain and lead to lifetime impairment and possibly even early death? It doesn’t make sense!

Take this seriously folks!

For more background, please see below for an overview of how impact head injuries occur and click here for a CNN clip on the impact of concussions in soccer.

 

When coaches lose perspective and hurt youngsters and the beautiful game

Take a look at the 30-second clip below showing one serious foul and then one reckless foul by the same player during the U13G semifinal at US Futsal Nationals this past weekend in San Jose.

These fouls were about 7 minutes apart during the last 15 minutes of the game and earned the offender two yellow cards and then a red.

The first foul could have been a straight red card, especially in a futsal context where the laws of the game are tighter than for outdoor soccer.

The coach had assigned the offending player to man-mark orange #6 and had berated her repeatedly for not being physical/aggressive enough. This coach got increasingly frustrated as the game unfolded and then channelled that into his players.

I don’t believe that this girl had the intention to hurt orange #6 earlier in the game, but she was eventually pushed too far by her coach. She was under increasing pressure and finally snapped.

Orange #6 could not continue playing and had to be carried off the court. Later she had difficulties walking and her lower back and right hip was very painful. She was lucky to avoid serious injury.

And by way of context, the orange team was winning 6:0 when the first offense occurred. And let’s remember that futsal in particular is about footwork, skills, and creativity. So let’s coach those aspects of the game, win or lose.

This is an example of what can go wrong with youth coaching when coaches lose perspective.

The offending player learned nothing from this kind of coaching and ended up evicted from the game. She didn’t strike me as someone who would wear that with pride. I very much doubt that this experience furthered her interest in soccer.

And the injured player could have sustained career-ending injuries, which would have a been a major blow for her, of course, but also soccer more broadly – orange #6 is very talented and very likely to make the U.S. Soccer national player pool soon.

[Update: turns out, this player did take pride in her red card afterall. Due to some social media sleuthing by an observant parent, we also know that at least two parents on that team congratulated this girl on the red card. So it’s clearly not just a coaching problem as was pointed out in the comments below. Disgraceful in my view.]

Surprising effect of no-heading rule

We’ve just completed the first season with the no-heading rule for U11/U12 kids and younger.

I’m sharing a surprising observation half way down this page, but first let’s remind ourselves that there was a lot of concern that this would be difficult to implement and lead to a lot of confusion during games.

Well, here are two personal observation from officiating many games this last season where this rule applied:

First, it did not lead to the widespread confusion some naysayers predicted. Yes, there were instances of momentary parental confusion and delayed or missed calls from referees, but overall this new rule had no material impact on games.

It’s quite possible that you witnessed a game where a controversial heading infraction impacted the outcome of the game (e.g. was that really an intentional header?), but those were unfortunate exceptions, not the norm.

Everyone adjusted just fine. And we’ll see further adjustment this coming Fall season. It will fade into the background as a non-issue and the usual ‘handball’ and ‘offside’ controversies will dominate again….”It’s sooo obvious, ref!!”.

Second, and much more interesting, I saw many kids try to control airborne balls with their feet (!) by attempting to ‘catch’ or trap the ball instead of just letting it bounce repeatedly and then chase after it.

This is a much more difficult skill than heading. And it’s something you want to practice when you’re young so it gets hardwired into your brain. Don’t underestimate how difficult this is.

Heading the ball also needs to be practiced, of course, but youngsters can learn that even as late as 14 onwards. It’s a gross motor skill that can be learned relatively easily compared to the fine motor skills needed to control an airborne ball approaching at high speed with your foot.

And, in general, receiving the ball with your foot gives a player more control over the ball. When executed well it is very effective.

So in my view this no-heading rule turns out to be a blessing in disguise when it comes to player development.

There was a lot of complaining that this rule would develop players that aren’t as proficient in heading as our international competition, and in some cases heading the ball is indeed the better/smarter choice, but I very much doubt that this no-heading rule will impact the performance of our national team or players that want to go pro at 16, 18, or later.

And to be clear, I also believe that this no-heading rule is a blessing for the health of our children. It’s not so much the risk of concussions (which are bad, of course), but the damage from repeated impacts on the brain that worries me.

There is growing evidence that it’s these many non-concussive impacts that ultimately lead to permanent brain damage. To quote Dr. Michael Grey from the Department of Neuroscience at the University of Birmingham in England:

“The cumulative effect of repeatedly heading a ball could be damaging. We call these sub-concussive events that might not lead to [an obvious] brain injury each time but a little bit of damage builds up over time. There is some belief that these sub-concussive blows may lead to neuro-degeneration.”

Medical research into these sub-concussive blows is underway and we’ll see a growing list of scientific results emerge in the coming years.

I actually think we should make no-heading mandatory until U14/U15. I don’t think we’ve heard the last of it.

New rules for heading balls

U.S. Soccer resolved an ongoing lawsuit yesterday and agreed to strictly limit headers for youth players.

Players who are 10 years old and younger (so U11 and below) won’t be allowed to head the ball anymore. And players between the ages of 11 and 13 will have a soon-to-be-announced heading limit during practice.

These new regulations will be mandatory for U.S. Soccer youth national teams and academies, including Major League Soccer youth club teams, but the rules will be only recommendations for other soccer associations and development programs that are not under direct U.S. Soccer control.

I believe that this precaution is wise and won’t impact the game materially. Put pressure on your local league and club to follow the new U.S. Soccer guidelines.

Click here for my related post on concussions in soccer.

Possible spinal cord injury – do NOT move player!

One important disclaimer, of course: I have no medical training so I’m simply sharing what I experienced and learned recently from a concerned referee/dad’s perspective.

During two of the games I officiated these last six weeks (details below) we had to deal with possible spinal cord injuries. The cervical spine is the highly vulnerable area between the first and seventh vertebrae that protects the spinal cord connecting the brain to the body.

In these cases it is absolutely critical that

  1. the player’s neck and/or head is NOT moved in ANY way, and
  2. that 9-1-1 is called immediately.

Referees and coaches should observe whether the injured player lost consciousness at any time. Emergency personnel will ask.

Use umbrellas to shade the player from sun or rain and use blankets/jackets as needed to keep the player warm until emergency responders arrive.

If there is any doubt at all assume a spinal cord injury.

The injured player, teammates, coaches, and referees may not instantly recognize the severity of the damage, and the wrong move can further damage or sever the spinal cord, resulting in immediate paralysis or even death.

I was the Center Referee (CR) for the first game (U17G) and Assistant Referee (AR) for the second game (U18G). When it rains, it pours I guess.

During the first game a girl was tripped from behind while running at speed with the ball. She fell forward like a felled tree without using her hands to brace for impact. So her head slammed face-first into the surface, then snapped back up and down. She did not move after this and cried quietly.

During the second game a defender jumped from behind into the upper back/neck area while using her arm across her upper body to protect herself from the impact. The injured player couldn’t see this coming and wasn’t able to tighten her neck muscles so the head rapidly snapped backwards and then forwards. She heard/felt a cracking sound in her neck. This player also didn’t move and cried quietly.

The Centers for Disease Control and Prevention estimate that around 2,000 spinal-cord injuries occur annually in U.S. sports. So this is a relatively rare injury given how many games take place nationally every weekend across various sports, but let’s be very cautious if a spinal cord injury might be a possibility.

Good travel chair

GCI Outdoor Quik-E-Seat foldedIf you’re looking for a lighter-weight travel chair I can recommend the GCI Outdoor Quik-E-Seat. You can get it through Amazon HERE for ~$35.

I find these lighter chairs very useful during tournaments, especially travel tournaments. I carried mine onto the plane to Surf Cup in San Diego, for example.

The challenge with these lighter chairs is to find one that is relatively light yet also sturdy enough to survive a couple of seasons. I had a couple before this that were lighter than this one, but those broke within a couple of months.

I also tend to look for a back support that this one has. Adds a little weight and bulk, but it’s worth it in my view.

Does anyone have any other recommendations? Please share in comments below. Thank you!

Soccer replacing American football due to brain damage and injury risks?

Related to my post about the role of headgear in soccer to prevent concussions, here’s a NPR and a New York Times news story from yesterday about an increasing number of school districts canceling American football due to high injury risk, especially brain damage, and replacing it with soccer:

CLICK HERE for NPR’s Missouri High School Joins Others In Canceling Football Program

CLICK HERE for NYT’s As Worries Rise and Players Flee, a Missouri School Board Cuts Football

When I first watched the below Frontline report on brain damage in American football I immediately thought about what this might be doing to kids that practice and play american football from a young age and over many years, and what all this might mean for the future of the sport.

Violent impacts on the body and the brain are simply part of the sport and I can’t see how, realistically, it can be made safe enough to be played by kids (and adults for that matter).

And if an increasing number of parents decide that American football is not worth the risk of longer-term brain damage for their kids then one obvious alternative team sport is soccer. This should bode well for the continue growth of soccer in our country.

If you want to learn more about brain injuries in American football and the cover-up by the NFL check out Frontline’s report League of Denial: The NFL’s Concussion Crisis.

Does protective headgear help?

The risk of concussions in sports has become an increasingly important topic over the years. American football is facing a crisis in this area, triggered by a recent Frontline documentary (click here to watch), but other sports have to look closely at concussions too.

While not nearly as violent as American football, soccer is nevertheless classified as a high- to moderate-intensity contact sport. The good news is that this contact rarely involves the head, but heading the ball during a game is common and there are times when players challenging for an incoming ball will knock heads together. Another way to get a concussion is when a player’s body suddenly and violently changes direction after an impact with another player. In these cases the head can snap backwards or sideways, which causes the brain to impact the skull and hence possibly lead to a concussion.

One very recent authoritative study (click here) completed a retrospective analysis of data collected from mid-2005 through mid-2014 in a large, nationally representative sample of boys and girls who were high school soccer players. Overall, around 500 concussions were sustained by each gender during around 1.5 million games and practices. (This is arguably encouragingly low, but I suspect that many concussions went un-diagnosed and/or un-reported.).

By far the most common cause of concussions in soccer is a head-to-head (or head-to-elbow) collision. The second most common cause of concussions is when a ball strikes a player’s head, BUT only when a player was hit in the head by a ball kicked from close range such as an attempted shot on goal. The player simply did not have time to react and the ball might impact more vulnerable areas such as the temple. It’s important to note that concussions from simply heading a ball are rare.

So, naturally, we as parents might be tempted to force our kids to wear protective headgear such as the Full90 product. Some padding on the head should help, right?

Well, turns out that these kinds of headgear appear to offer no measurable protection against concussions and might actually increase the risk because players apparently tend to play more aggressively with headgear.

That said,  I suspect that this isn’t necessarily so for every personality type. For example, ‘softer’ kids might not change their behavior whereas more naturally athletic/aggressive kids might well step it up even more.

I have listed below a number of articles I found especially informative, but you MUST definitely watch the following ten-minute NBC News report in its entirety: CLICK HERE.

The risk of injury, including potentially suffering one or more concussions over the years, is unavoidable in contact sports. Maybe future equipment and, possibly, rules modifications will help reduce this risk, but as parents and players we have to accept this as part of the risk/reward decision we have to make.

Disclaimer: please keep in mind that I’m not a doctor nor scientific researcher. Just a dad sharing his personal observations. Please also note that this post focuses on concussions and not on other types of injuries such as bruising or scrapes.

Additional background reading:

Can Headgear Halt Soccer Concussions?

Use of headgear at recent Women’s World Cup

Helmets for soccer? Why some parents are saying no thanks.

Review of Full90 Headgear

Soccer Headgear: Does It Do Any Good?

The Efficacy of Soccer Headgear

How can we keep young soccer players safe?

Shin guards are very important

As a referee I see many players that wear shin guards that are too small or ill-fitting. Players typically view them as a necessary evil and feel that their weight interferes with their leg movements. Very few understand how critical shin guards are.

One youth player I know very well plays central defender on a top U13 team and really doesn’t like to wear them (here’s looking at you Sammy). She wears what looks like shin guards that are size XS and she also doesn’t like to pull her socks up. Half of her shin is exposed, the shin guards don’t stay in place (they rotate around her legs), and often fall out during games. My kids don’t like them either and try to wear a size down.

Shin guards worn during soccer matches can reduce the force delivered by a kick to the leg by 44-77%, depending on the type of protective guard worn. A study conducted at the Institute for the Preventative Sports Medicine and reported in the Clinical Journal of Sports Medicine concluded that shin guards can significantly reduce the risk of injury.

The shin is the third most common area of the body injured in soccer (after the ankle and the knee). Blows to the shin commonly occur when players kick each other instead of kicking the ball. Bruises and fractures are the likely injuries resulting from being kicked in the leg. (At this point I was going to post an image of a soccer player’s broken leg, but it’s simply too distressing to see. Google ‘broken leg soccer’ images if you’re feeling up to it.)

The force delivered by a kick from a fast moving player is enormous. This weekend I refereed a U17 boys game and at one point a kick was delivered by an outstretched leg (or possibly two at the same time – it happened too quickly for me to be sure) to the shin area of another player. Both players were traveling at high speed to be first to the ball. I am absolutely convinced that the leg would have snapped in half (or at least fractured badly) if it wasn’t for the shin guards and probably a somewhat off-center impact.

This kind of impact can easily occur at younger age groups too, and for both boys and girls. Older boys and girls deliver more force, but also have stronger legs. Younger boys and girls don’t deliver the same force, of course, but they also have weaker legs that don’t need much force to be seriously injured. And a player’s leg will never be the same after this kind of injury.

Please wear the right-sized quality shin guards and pull your socks up, Sammy. Thank you!

Click here for a good shin guard guide

P.S.: Make sure to replace them every season and/or wash them regularly. They get very sweaty and dirty and typically don’t get cleaned. Your son/daughter is more likely to wear them and not develop a rash.

Hydration is critical

A friend of mine, who is also a very good soccer player and coach, strongly suggested that I remind folks of the critical importance of fluid intake, especially for youth players. Here are the US Soccer Federation guidelines regarding fluid intake:

Hydration Guidelines USSF

2015 US Soccer Heat Guidelines

For ease of reading I am quoting here key passages from the first document:

Heat-induced illness is one of the most preventable sports injuries. Parents, young athletes
and coaches need to understand the factors that put children and adolescents at risk for heat related illness and take steps to prevent it. Children face unique stresses when they exercise in the heat. Here are physiological/psychological reasons placing children at risk:

1. Children absorb more heat from a hot environment because they have a greater surface area to body-mass ratio than adults. The smaller the child, the faster they absorb heat. They also have a reduced ability to lose heat through sweating.

2. During prolonged exercise, children and adolescents frequently do not have the physiological drive to drink enough fluids to replenish sweat losses.

3. Some youth athletes may be under intense pressure to make a competitive squad and may not want to report feelings of heat distress or take the appropriate amount of time to rehydrate.

According to the American Academy of Pediatrics:

• Before prolonged physical activity, the child should be well hydrated. The child should drink 12-16 ounces of fluid approximately 30 minutes before getting to the field.

• During the activity, periodic drinking should be enforced even if the child does not feel
thirsty. Each 15-20 minutes the child or adolescent should consume:
− 5 ounces of fluid for a player weighing 90 lbs or less
− 9 ounces of fluid for a player weighing more than 90 lbs

• Once the activity is over, players should drink water or a sports drink every 15-20
minutes for the first hour after activity. The rate of fluid ingestion is generally 1.5 pints
of fluids for each pound of weight lost.

• Adolescent males typically lose 1-1.5 liters per hour when performing intense soccer practices/games in the heat, while younger males and females will lose from 0.6 to 1 liter per hour.

Great team shelter

I can fully recommend this team shelter: http://premier-sp.com/home. It’s expensive (around $350 to $500 incl. shipping, depending on degree of customization and volume discounts) but provides very good protection against sun, rain, and wind.

It’s sturdy and looks sharp too, especially with a club and/or team logo. The sides and backs roll up and down and set-up is relatively straightforward. It can be weighted down on turf and there are stakes for grass surfaces. One person can carry it, but it’s definitely heavier than the typical lightweight canopies.

Please note that I do not know the folks that make this shelter nor do I gain financially in any way from recommending it. I’m simply sharing something that I’ve seen work well and benefits the players. This is probably worth the investment for busier teams that play two games per weekend and compete in multiple tournaments per season.

The dangers of sun exposure

I am pasting below an article I came across recently from a U.S. Soccer Referee. I can’t find the actual website anymore despite googling for it so I can’t add a link here. But I pasted it into an email and sent it to my wife so I’m pasting the actual (shortened) text below:

My Time in the Sun – Mike Krebs, U.S. Soccer Referee

George W. Bush. John McCain. Maureen Reagan. I’ll never make the headlines like these people, but I suffer from skin cancer just as they have. Skin cancer is caused by too much exposure to the sun over a long period of time. The problem usually does not appear until later in life, twenty or thirty years after exposure.

I spent my teenage years outdoors – camping, hiking, swimming at a pool or the beach, playing baseball (soccer was not an option then) and working as a lifeguard and summer camp counselor. I loved the sun but hated the greasy, oily feeling of sun lotions and a white zinc oxide nose was just not cool.

I have been visiting a dermatologist every three months for many years and every visit yields new skin pre- or cancerous sites that need to be treated. I will be doing this for the rest of my life.

Here are a few facts about skin cancer:

  • The chronic effects of overexposure to the sun are cumulative, persist throughout life and are irreversible.
  • People can acquire 50% of their lifetime exposure to the sun’s rays by age 18.
  • By age 21, more than 80% of a person’s lifetime sun exposure can be acquired.
  • One serious sunburn early in life can increase the risk for skin cancer by as much as 50%.
  • It is estimated that one of five people will get skin cancer at some time during their lifetime.
  • There are over one million cases of skin cancer reported yearly, increasing yearly.

Regular use of a sunscreen of SPF-15 starting at age 6 months through 18 years is reported to reduce the lifetime incidence of skin cancer by as much as 78%. An SPF-30 or higher product would be even better.

When UVA and UVB (ultraviolet) radiation is absorbed by the skin, it causes a series of damaging reactions called photo trauma. Sunburn, blistering, and redness are typical signs of photo trauma; even tanning is damaging to the skin. Prolonged exposure to either natural or artificial sunlight can cause a range of problems:

  • Prematurely aged, or photo-aged, skin appears dry, scaly, leathery, deeply wrinkled, rough, sagging, age-spotted, freckled, or yellowed.
  • Actinic keratosis – a pre-cancerous lesion or rough, crusty spot on the skin.
  • Basal cell carcinoma (cancer) – the most frequently reported skin cancer develops slowly over a lifetime and does not metastasize or spread to other parts of the body.
  • Squamous cell carcinoma – may develop into tumors and metastasize to other parts of the body.
  • Malignant melanoma – the most serious skin cancer; can spread to other tissues, resulting in death.

Most of my sites have been actinic keratoses. They are usually found on the face, neck, arms, hands and legs, the parts of the body most exposed to the sun. Sometimes a site appears more advanced and a biopsy (a test for cancer) is needed. With three biopsies in the past two years, two have identified sites of skin cancer, one a basal cell carcinoma and one a squamous cell carcinoma; both were surgically removed.

How can you minimize the risk of skin cancer? Easy, if you are going to be in the sun, use an SPF-30 or higher sunscreen. There is even a mixture of sun lotion and insect repellant available for those spring matches near the woods. Apply it before you leave home. If you will be outside all day working a tournament, reapply every couple hours and find some shade under the trees or in the referee tent in between matches. It will help prevent the ultraviolet rays from reaching your skin. Simple!
Play Hard! Play Fair! Have Fun! And Use Sunscreen!