Baseline testing should be given by a health professional. You may find a health professional certified in this testing at a children’s hospital or a doctor’s or trainer’s office. The post-injury test, evaluation and return-to-play approval should also be given by a health professional.
One baseline test that comes recommended is SCAT3 (Sports Concussion Assessment Tool). This test doesn’t need a computer and takes 10-15 minutes. It should be administered by health-care professionals. Coaches should ask if the trainer giving the test or evaluating a post-injury test is certified in SCAT.
Concussion discussions have evolved over the years. What started out over a decade ago as “There might be a problem,” has changed to both the Recognize to Recover (R2R) initiative along with practice and play recommendations put forth by U.S. Soccer.
It is recommended that:
- There be NO headings in practice or games for U-11 and younger players.
- For U-12 and U-13 players, 30 minutes of heading practice per week per player is recommended with limits of 15 to 20 headers to week per player.
And look for these rule changes:
- If a player suffers a blow to the head, s/he should be removed from the playing field.
- The team will not be punished, and a medical substitution can be made if a player leaves the field for this injury.
- A health-care provider (HCP) must clear the player before s/he can return to play, but there is no return to play that day.
To view all of the governing rules and rule changes, visit nscaa.com/news/2015/11/us-soccer-s-recognize-to-recover and click on the U.S. Soccer Concussion Guidelines link.
You should know whether any of your players suffer from:
- Previous concussions
Get to know them!
Did you know?
- Loss of consciousness is not a necessary symptom of a concussion.
- The many different lobes of the brain bring on the many different symptoms of a concussion.
- Once concussed, another concussion is more likely, especially if brought on within the first 10 days.
- There are more concussions suffered in girls sports.
- Normal recovery with the suggested six recovery steps is two to three weeks.
There are six steps to recovery from a concussion:
- Rest, quiet
- Light aerobic activity
- Sports-specific activity
- Non-contact training drills
- Full contact practice
- Full contact games
Allowing 24 symptom-free hours before progressing to the next recovery step means that a player should be sidelined for at least a week. And please note that if symptoms return at any step in the process, the player should be stepped back, and the 24-hour symptom-free process should start again at the previous step.
Coaches will need a doctor’s opinion to diagnose a brain bleed. The conservative approach for a coach to give NO ASPIRIN and NO IBUPROFEN, both of which would exacerbate a bleed if there is one.
The coach should watch the player carefully for worsening symptoms or cascading symptoms (where additional symptoms keep presenting) especially for the first 4 – 6 hours.
There are differing approaches needed for these two very different collapses.
Contact Collapse: For the most part, a coach will see a head or abdominal injury happen (with aerial challenges being the most dangerous plays). Be warned in this contact case to look for progressive or worsening symptoms. A coach should watch out for neck pain (do not move the player), numbness, vomiting, blood in the urine or an altered/confused state. These symptoms can present and worsen, or they can cascade — meaning additional symptoms keep appearing. These are all warning signs of a possible concussion and should be addressed by a doctor or health-care provider.
Non-Contact Collapse: A non-contact collapse is considered to be the worst scenario. It usually means that the player has suffered a neurologic or cardiac event. 911 should be called immediately. If it is a cardiac event though, there is no time to wait for the EMS. Heart compressions (CPR) should be started immediately. Hands-only CPR at 100 compressions per minute could mean the difference between life and death. Even better would be the proximity to and use of an automated external defibrillator (AED). Appropriate action in the first five minutes after a non-contact collapse translates to a 75% chance of survival.
NOTE: There is a chance that it will be a coach or a referee who has a cardiac event. CPR training should be provided for coaches and referees, of course, but also for players.
There are two types of cramping that can be caused by heat:
- Sudden cramping, described as a muscle overload, is localized and in one muscle group. It can be helped by stretching.
- When cramping is widespread, intermittent, bilateral and accompanied by excessive sweating, this may indicate a sodium deficit.
Heat-related injuries and deaths are rising, and they are preventable. Risk factors include:
- Poor player preparation
- Excessive exertion
- Poor hydration
- Lack of recovery time (same-day sessions)
- Player fitness
- Clinical risks (e.g., player illness or meds)
Possible actions to take:
- Increase fluid intake (be sure to include electrolytes and sodium)
- Modify activities for the team
- Allow time to acclimatize players
- Increase rest/recovery
- Increase monitoring
Be sure to be familiar with the information available on the U.S. Soccer website: ussoccer.com.
Even doctors have a difficult time assessing whether a player has been concussed. And concussions all present differently. With that being said, what should a coach look for?
- Confusion/difficulty with orientation
- Blurred vision
- Poor concentration (unable to repeat five words)
- Neck pain (requires using a stretcher to take player off field)
- Ringing in the ears
Remember that any or all of these symptoms may present. Any ONE symptom rates taking the player off of the field.
Also, look for cascading symptoms. This happens when new symptoms start appearing and stacking on ones already present. This cascading generally means a more severe concussion and may lead to emotional changes, trouble sleeping, forgetfulness or an inability to work or concentrate.
It is worth noting here that a loss of consciousness is not necessary to diagnose a concussion. And once a player is concussed, another concussion within the next 10 days is easier to bring about.
U.S. Soccer has initiated a program, Recognize to Recover (R2R), to help reduce injuries to athletes. This program provides a place for coaches to search for information about concussions and heat stress for example, and there are plans to continue to grow the R2R program and cover even more safety initiatives for our players (for example, in the future they may take a look at injuries sustained from sliding on turf). To view the findings, recommendations and the enormous amount of information that has already been gathered for your use, please visit their website (ussoccer.com).
If your club/league is sponsoring a tournament, these subjects should be addressed:
- Are there access points throughout the fields for emergency vehicles to get in and out?
- Where can players be sheltered in case of severe weather?
- Will there be doctors or other health-care providers on site?
- Will there be automated external defibrillators (AEDs) available throughout the fields of play?
- Do your referees know the laws of the game covering concussions?
Heat is a big hurdle to overcome in getting players acclimatized, especially in this age of air conditioning. Our players go from air-conditioned houses/schools/cars to a field and much physical activity and exertion. All of the guidelines suggested by U.S. Soccer — the WBGT chart, the work-to-rest ratios, and suggestions for parameters for cancellation of training and match play — can be found in the Recognize to Recover program at ussoccer.com.