WPC1 |58FE .~Y^3WtC <X^k%7lxȮӐ'm eqQkRbKB2K2@?:TYmoŻց*pP+)Jx=n5~;'ƒTro 57plKCRho 0?Fvbk^x<$.ɱZ^R|:\9WQVucpKBg|a(kYZ!g̕)#؃ Bc ߻#ۛ ĕRz+a'?ٞz,xMdP)j;5N-rUk_X:x["_Ҳ K8>Rs5gw)IvD c|iH!ݥ:_[- F@>Tw ^޹N[EBPLs̶@z` bz^B #U:i % 0:^ w4 mN/HP DeskJet 690C Series v11.00,,,,00,rAZ"Arial RegularX($USUS.,9( a('USoccer3|xU !USUS.,  _ HeadInjuryandSafeHeadinginCompetitiveYouthSoccerLeagues   byDaniel_Frankl_,Ph.D.  TheAmericanAcademyofPediatricsPolicyStatement(1988)definedsoccerasa h  contact/collisionsport,andthusaddedittothealreadycontactclassifiedsportsof T  footballandhockey.This upgradewasnosurprisetothosefamiliarwithhospital @  emergencyroomstatisticsthatrevealsoccershighconcussionrateper1000athlete , | exposures!aratethatequalsfootballstatistics(_Tysvaer_,_Storli_,&_Bachen_,1989).A  h numberofpublishedstudiesinprofessionaljournals,suchas, AmericanJournalof  T  SportsMedicine, APediatricPerspective, BritishJournalofSportsMedicine,  @   JournaloftheAmericanMedicalAssociation, MedicineandScienceinSportsand ,  Exercise, Neurology, _Neuroradiology_,and SportsMedicine,highlighttherisksof   headtraumaincompetitivesoccerandpointouttheneedto developandadopt   methodsofsurveillanceandpreventiontomaximizeplayersafety(_Matser_,J.T.,et.al.,   1998).   Causesofheadinjuriesinsoccerincludecollisionswithgoalposts,headbutting d betweentwoormoreplayers,blowstothehead(resultingfromillegalhighkicking P and/orlowheading,elbows,knees,andotherbodyparts),andlastbutnotleast,the < gamestrategyofheadingtheball._Tysvaer_Ԁ(1992)reportedthatheadinjuriesaccount (x for4toupto22percentofallsoccerrelatedinjuries.Extrapolatingfromavailable d statisticsonfatalsoccerheadinjuriesintheUnitedStates,oneyearlydeathcausedby P traumatotheheadinsoccermayoccur(_Demarco_Ԁ&Reeves,1994).Traumatichead < injuriesthatresultinseveredamageordeathcannotbedismissedbecauseitpresents ( anundeniablebadoutcome.Sincefatalaccidentsinsoccerarerelativelyrare  (statisticsareavailableregardinghighschool,college,andprofessionallevelsof  competition),therelevantquestiontotheyouthsoccerparent/coachis whethertheact  ofheadingduringleaguepracticeandgamespresentsaconsiderableriskforbrain  injury?Theavailabledataonsoccerrelatedheadinjurieswasmostlyderivedfrom t studiesonhighlycompetitiveandveryskilledamateurandprofessionaladultsoccer `  players(e.g.,Jordan,et.al.,1996;Master,J.T.,et.al.,1998;_Muellar_Ԁ&_Cantu_,1990). L! Studiesandreportsthataddresstherelationshipbetweenheadingandbraintraumain 8"  youthsportshavesofarreceivedlittleattention(_Briscoe_,1985).Totheskeptic,the $#t! answertothequestionregardingtheinherentriskinyouthsportheadingmaynotbeas $`" clearcutandstraightforwardasitistoconcernedathletictrainers,coaches, $L # educators,neurologists,orthopaedicsurgeons,pediatricians,andparents. %8!$ Highlyskilledplayersplaylongerduringsinglegames,playmoregamesinanygiven '#& season,andusetheirheadingskillsmoreoftenthanlessskilledplayers.Asthelevel (#' ofcompetitionincreasessodoesthesize,weight,pressure,andvelocityofthegame )$( ball.Advancedsoccerplayersareoftenfacedwithahard,fastmovingballwhen *%) heading.Itwouldbereasonabletoassumethatwhencomparedtothepros,youthplay p+&* fewerandshortergames,arefacedwithalighter,softer,slowermovingball,andhead \,'+ lessfrequentlyduringpracticeandgames.Developmentally,however,childrenare H-(, quitedifferentfromtheiradultcounterparts.Frombirthtotheageof10achildsbody  weightrepresent5percentand50percent,respectively,ofanyoungadultsweight  (_Gabbard_,1992).Thesamechildsbrain,however,reaches90percentofitsadultsize  bytheageofthree(_Trevarthen_,1983),andreachesitsfulladultsizeattheageofsix t (_Kessen_,_Haith_,&_Salapatek_,1970).Achildsheadisthusdisproportionatelyheavy ` andlargewhencontrastedwithachildstotalbodyweight.Doestheabovedescription L  mean lessriskorshoulditbeinterpretedas samerisktobraininjuryresultingfrom 8  headinginyouthsoccerleagues?Sincetheriskofbraindamageresultingfrom $ t headingattheprofessionalleveliswelldocumented(Jordan,et.al.;1996;Master,J.  ` T.,et.al.),therecentandongoingtrendsinyouthsoccerneedtobeexamined.  L  Asyouthleaguesarebecomingmorecompetitive,coachestendtoincreasethe $  numberofweeklypractices.Practicepreseasongamesarecommonplace,asare   postseasonallstargamesandvariousadditionaltournaments.Manylittleleague   participantsalsoplaysocceratschool,andattendspecialsoccercampsessions   throughouttheschoolyearandoverthesummerbreak.Alogicalconclusionbasedon   theabovepresentedscenarioisthatthemoreseriousachildisabouther/hissoccer p participationthemorehe/sheisatriskofcumulativedamagetothebrainfromheading \ andothersoccerrelatedtraumatothehead.Institutingarequirementforsomeformof H protectiveheadgearorforthewearingofamouthguardforcompetitiveyouthsoccer 4 shouldthereforebeconsideredasalogicalandsensibleaction.Ourchildrenswell  p beingisatstakehere.Letusnotwaitfortheperfectlyconclusivedataorforcostly  \ headinjurylitigationbeforewetakepreventiveaction.Theoldcliche bettersafethan H sorryisaveryappropriateoneforaddressingthisissue.Apossiblepositiveside 4 effectofheadand/ormouthprotectiongearwouldbethecurbingofthecurrenttrendof   increaseinsportsinjurylitigation(Davis&_McKelvey_,1998).   Shouldfuturedataestablishbeyondreasonabledoubtthatheadinginyouthsocceris  safe,stillprotectionfromheadcontactwithgoalposts,contactwithground,andcontact  withotherplayersheads,elbows,knees,etc...isenoughreasontorequirehead l protectiongear_and/__or_Ԁthewearingofamouthguardwhileplayingthisotherwisegreat X  game. D! Daniel_Frankl_ԀservesasAssociateProfessorof_Kinesiology_ԀandPhysicalEducationat $D # CaliforniaStateUniversity,LosAngeles.HeisthecoauthoroftheAmateurAthletic %0!$ FoundationsCoachingProgramSoccerWorkshopManualandtheauthorand &"% webmasterofthepopularandhighlyrecommended TipsforSoccerMomsandDads '#& youthsoccerwebsite.Youthsoccerquestionsandcommentsarewelcomeat: (#' . )$(  @-(, Ї References:   AmericanAcademyofPediatricsPolicyStatement.(1988).Recommendationsfor  participationincompetitivesports.PhysicianandSportsMedicine,16,65167. t _Briscoe_,J.H.D.(1985).Sportsinjuriesinadolescentboardingschoolboys.British L  JournalofSportsMedicine,19(2),6770. 8  Davis,P.M.,&_McKelvey_,M.K.(1998)._Medicolegal_Ԁaspectsofathleticheadinjury.  ` ClinicsinSportsMedicine,17(1),7182.  L  _Demarco_,J.,andReeves,C.(1994).Injuriesassociatedwithsoccer_goalposts_,United $  States,19791993.JournalofAmericanMedicalAssociation,271,1233.   _Gabbard_,C.(1992).Lifelongmotordevelopment.Dubuque,IA:_Wm_.C.Brown.   _Kessen_,W.,_Haith_,M.M.,&_Salapatek_,P.H.(1970).Humaninfancy.Abibliography p andguide.InP.H._Mussen_Ԁ(Ed.),Carmichaelsmanualofchildpsychology(Vol.1,3rd \ ed.).NewYork,NY:Wiley. H _Matser_,J.T.,_Kessels_,A.G.H.,Jordan,B.D.,_Lezak_,M.D.,and_Troost_,J.(1998).  p Chronictraumaticbraininjuryinprofessionalsoccerplayers.Neurology,51,791796.  \ _Muellar_,F.O.,and_Cantu_,R.C.(1990).Catastrophicinjuriesandfatalitiesinhigh 4 schoolandcollegesports,19821988.MedicineandScienceinSportsandExercise,   737741.   _Sortland_,O.,and_Tysvaer_,A.T.(1989).Braindamageinformerassociationfootball  players:Anevaluationbycerebralcomputertomography._Neuroradiology_,31,4448.  _Trevarthen_,C.(1983).Developmentofthecerebralmechanismsforlanguage.InV. X  Kirk(Ed.),Neuropsychologyoflanguage,readingandspelling.NewYork,NY: D! AcademicPress. 0"  _Tysvaer_,A.T.(1992,Sept.).Headandneckinjuriesinsoccer:Impactofminortrauma. $X" SportsMedicine,14(3),200213. $D # _Tysvaer_,A.T.,and_Lochen_,E.A.(1991).Soccerinjuriestothebrain:A_neuropsycho_Ԅ &"% logicalstudyofformersoccerplayers.AmericanJournalofSportsMedicine,19,5660. '#& _Tysvaer_,A.T.,and_Storli_,O.(1982).Associationfootballinjuriestothebrain:A )$( preliminaryreport.BritishJournalofSportsMedicine,15,163166. |*%)  @-(, Ї