Transcript Demetri Menegos, DO

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