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Clearing up common myths about soccer and concussions

CC Flickr/Bob-Bradburn

Heading the soccer ball causes concussion, fact or fiction? CC Flickr/Bob-Bradburn

With soccer on the brain these last few weeks during the U.S.A. team’s most recent appearance in the FIFA World Cup — up until yesterday’s disappointing defeat and elimination — I wanted to clear up a few misunderstood facts about the high-energy sport and concussions.

While talking in studio yesterday with WAKR morning show host Ray Horner, I quizzed him on this topic. We also clarified the difference between sports drinks and energy drinks to eliminate confusion.

Below is an audio file and transcript of our discussion. Originally aired on 1590 WAKR-AM on July 2, 2014.

0:00

HORNER: Joining us live right now is Dr. Joe Congeni (Sports Medicine Program at Akron Children’s Hospital). He joins us once a month in our studio. We always appreciate him taking time [to come in]. You’re giving me a quiz this morning?

DR. CONGENI: Yeah, you love to give quizzes. I love to listen to you do it to Aaron, and you have all these quizzes. How about a quiz related to soccer?

Soccer is at an all-time interest level until yesterday, unfortunately, with the World Cup. You know, there’s been a lot of questions and studies in the last 10 years. … You hear me always say, “You gotta research these things.” [I want to quiz you on] a few things about soccer and concussions and heading the ball.

First question: Heading the soccer ball causes concussion, fact or fiction?

HORNER: I’ll say fiction.

Dr. Joe Congeni

Dr. Joe Congeni

DR. CONGENI: I think you’ll get every one of these right. You’re such an informed [person].

You’re right, fiction. Although, I’ll tell ya it’s pretty close because what I worry about is there are these sub-concussive blows that people get. And, if people have a number of those, I think sometimes heading the ball can be the one that pushes you over the edge.

HORNER: I was thinking that it might be [fact] because if you’re constantly doing it, it might push you over the edge.

DR. CONGENI: Right. Right. Or, if you had a couple head-to-knee, head-to-ground [hits]. But, anyway, it’s fiction. Heading the soccer ball does not cause concussions as of what we know right now.

Most concussions in soccer occur from contact with another player, often while heading the ball, fact or fiction?

HORNER: I would say hitting another player, so I will say that is fact.

DR. CONGENI: It’s fact. Yes, that’s when it happens the most. You see so many people in the World Cup going up, 2 people head-to-head trying to head the ball …

HORNER: … and their knees hit.

DR. CONGENI: Yeah, that kinda thing. Elbow-to-head, knee-to-head. That’s the No. 1 cause of concussions in soccer.

No. 3: Male soccer players are at greater risk for concussions than female soccer players.

CC Flickr/Zach-Stern

CC Flickr/Zach-Stern

HORNER: I’ll say fiction.

DR. CONGENI: Oh, you’re so good. Unbelievable. Not only is that fiction, you know, the studies are showing recently [that there's] a little bit of an increased period of time to recover from concussions for female athletes than for guys, in soccer and in any other sport.

We’re getting near the end. You [have a] perfect score. Unbelievable.

HORNER: So far.

DR. CONGENI: Heading the soccer ball has a negative long-term affect on brain health, fact or fiction?

HORNER: I will say that’s fact.

DR. CONGENI: That’s fiction right now. We have not proven that heading the ball in the long run [is harmful].

Now, if we proved that, that would really scare a lot of people about their kids playing long-term soccer. And, that’s the big one that people want to know. Have we found anything yet to say long-term [affects] in 3- or 5-year follow-up studies? The answer is no.

HORNER: And, that’s why we’re not seeing the overuse of [protective headgear].

DR. CONGENI: Yeah, and now you’re stealing the last question, too.

Protective headgear reduces the risk of concussions in soccer players, fact or fiction?

HORNER: I would say fact.

DR. CONGENI: Protective headgear reduces the risk of concussion in soccer players, fact or fiction?

HORNER: Yeah. Fiction.

DR. CONGENI: It’s fiction.

HORNER: It has to be.

DR. CONGENI: If it was fact I would be in here with you saying, let’s get every kid playing in protective headgear. So far, we have not proven through research that wearing those headbands, headgear, HeadMinders, all those kinds of things, [reduces concussions].

HORNER: … or else they would be mandatory.

DR. CONGENI: They’d be mandatory. You know we’d be pushing for those.

HORNER: Right.

DR. CONGENI: So, you as usual, you’re in a good seat, man. You are always well informed about this stuff.

HORNER: [laughter] That’s because you guys train me.

DR. CONGENI: [laughter] You have a lot of good people that come in and you do a great job in our community keeping people updated.

But, that’s some of the latest stuff on soccer that we’ve learned in the last 10 years of study.

HORNER: Joe, you know, speaking of the concussions and headgear … I did see last week the first, I saw a Major League Baseball pitcher, I believe for the San Diego Padres, wore the protective hat while pitching. Knowing how you are clued in to this concussion thing, you probably saw it, as well. Will we see more of this?

DR. CONGENI: I think we’ll see more of this. Baseball’s not the highest risk sport, but one of the biggest things is batted ball coming back toward the pitcher. The pitcher is obviously closest to the batter, uh to the hitter.

CC Flickr/Charlie-Kindel

CC Flickr/Charlie-Kindel

Because of some of the things we’ve seen in just the last couple of years, some pretty significant concussions, [we'll see more of this]. We got on last year and said several of those guys did not do very well after they had their significant concussions. I think that wearing the harder-lined shell in the hat is something that we will see more of.

HORNER: The other thing I wanted to talk to you about this morning, and we were talking about Mike a little bit, is the caffeine incident with the teen in the area who passed away [from a] caffeine overdose.

I’m not asking you to analyze that particular situation, but you and I have had many conversations about energy drinks, about these … kinda shot glasses full of caffeine and you’ve talked about the dangers.

There’s gonna be a lot of people out the next 3 or 4 days, playing baseball, Wiffle Ball, running around, hot and steamy weather, I want you to throw maybe some words out from your profession pertaining to caffeine use. We’re talking energy drinks. There’s a big difference between sports drinks/energy drinks. Talk  about this.

DR. CONGENI: Yeah, we just are very concerned about hyperstimulating the cardiovascular system — the heart and lungs to have to work overtime — over and over again. So, think about what you’re constantly doing to your heart rate, your blood pressure by this constant overstimulation. So, yeah, it’s a very big concern to me.

This time of year, you throw on top of it, we’re worried about dehydration and other issues related to, you know, other things that kids take that is that double- or triple-hit effect to the kidney and the brain.

[We are] very concerned about how much caffeine in so many different areas, and the No. 1 area we worry about the most — 2 cups of coffee, 3 cups of coffee per can — are those energy drinks. And, I think that kids should really avoid those things, particularly athletes. There’s no place for it at all in sports.

HORNER: Caffeine from a sports perspective does what to the heart? And then, if you’re adding stress on the heart, running, exercise and such, talk about what happens.

DR. CONGENI: Yeah, it stimulates the heart. It’s a hyperstimulant to the heart. It’s a very effective stimulant. It’s why so many of us as adults start out our day using caffeine to stimulate ourselves.

The hyperstimulant effect when you’re in sports is from the standpoint of blood pressure, pulse. How long can you continue to whip that pony and continue to keep pushing yourself?

So, the stimulant effect is worrisome under high-pressure sport activity and it’s also worrisome from the standpoint of dehydration and, like I said, on the playing field, there’s no place for it.

You’re gonna have issues of jitteriness; you’re gonna increase blood pressure; you’re gonna increase heart rate, and those are things that we don’t want to elevate on a regular basis.

HORNER: Talk about sports drinks/energy drinks. A lot of parents don’t understand the difference between the 2.

DR. CONGENI: Yeah, what we’re trying to do with sports drinks is come up with the ideal form of rehydrating solution. That’s really what we’re looking at.

We say very often that water’s fine if you’re in an activity over an hour, hour, hour and a half, whatever. But, as you get to more endurance – type of events that maybe 2 hours and beyond — hour and a half and beyond — then we add electrolytes, a nice combination of electrolytes and carbohydrates, to help athletes stay at their best performance-wise.

… So, people get confused about energy drinks and hyperstimulation of caffeine versus sports drinks where we’re trying to rehydrate.

HORNER: Joe, to wrap up our conversation, you started it off with soccer this morning. A lot of kids in soccer, travel teams and then the high-school soccer teams will start practicing in about four weeks. Talk about injuries in soccer, preventative measures. How dangerous is it?

DR. CONGENI: Soccer’s a mid-range sport from a standpoint of danger. A lot of lower extremity issues. One of the things that’s been interesting watching some of the cramping in the World Cup, as you see these guys being out in the heat and humidity that we’re gonna start to have. We have those couple of months of heat and humidity.

So, it’s a lower-extremity injury sport. It’s a mid-range sport. It is a great sport, a great cardiovascular sport. You see how many miles these guys run? These guys are Ray-Horner types. They’re running so much mileage when they play just a game of soccer. So, it is a great sport.

HORNER: [laughter]

DR. CONGENI: I’ll give you one more thing. We are on July 1st yesterday, Ray. If you want your team to be at its best, if you’re a coach around [town], if you have some kids with nagging injuries now, July is the perfect month to take care of a hamstring, a knee problem, a calf problem.

Don’t go into the season where they’re already performing at a lower level because of the injury. July is the month. Get it evaluated by somebody. Get rehab or physical therapy if need be. Treat those injuries now. Don’t wait until August 15. So, that’s one other point.

But, soccer’s a great sport; a wonderful lower-extremity sport; a wonderful cardiovascular sport.

HORNER: Alright, Joe. Good seeing you again. Thanks for coming in and enjoy the holiday with the crew.

DR. CONGENI: Thanks, Ray. You too.

HORNER: Alright. Dr. Joe Congeni, a good friend of ours, joining us in studio here at 1590 WAKR.

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About Dr. Joe Congeni - Director of Sports Medicine

Dr. Joe Congeni is the Director, Sports Medicine; Clinical Co-Director, Center for Orthopedics and Sports Medicine at Akron Children's Hospital. For the past 25 years, Dr. Congeni has been the “go to” source for national and local media looking for information about pediatric sports medicine.