Understanding Concussions in Youth Soccer: Risks, Prevention, and Future Measure

0:00:08 - Shane Smith Hey, welcome to Mind Matters: Navigating Head Injuries and Concussions. I'm here today with Thomas, one of the attorneys here at Shane Smith Law on the Concussion and Brain Injury Group. Today we're going to be talking about youth sports and the impact concussions can have on them, but also maybe some of the ways we're trying to prevent them. So, Thomas, thanks for being on the show, and let's get into some youth sports. So particularly the one that comes to mind, you know, once we knock football out, which we discussed in a prior episode, is soccer. I mean, because soccer in the last 10 years has just really grown and seems like it's everywhere. You know, it's on ESPN, it's in the high schools. I mean, it seems like soccer's just grown, grown, grown. And you know it's not like football or martial arts where you're kicking people in the head or slamming into each other, but it's certainly not a no contact sport, right, or something where you can't get injured. And I know people think about knees, but is concussions a big deal? Well, obviously concussions is a big deal in soccer. So let's talk a little bit about that. What can you tell us about concussions in soccer?

0:01:05 - Thomas Ozbolt Yeah, when you think about youth sports a lot, I think the first thing that everyone's mind goes to when they think about concussions is football. It's like, oh, that's so dangerous, and you know they're just running into each other and smashing each other and you know, if you think about football, it just catches a lot of strays there and soccer just manages to scoot by because people aren't getting tackled in the true sense of the word. They have their slide tackles and stuff. But this is another sport where concussions are a significant concern. Football gets the headlines because, due to the nature of the sport. Soccer has its own risks, especially you're talking about heading the ball, whacking your head on a ball that's coming in 50 miles an hour, maybe faster, or collisions with other players, the ground, goalposts.

0:01:45 - Shane Smith I was gonna say soccer has evolved over the last 10 or 15 years where it's just much-- everybody's better is what I'm gonna say. So 40 years ago when I was a kid, it was sort of new, at least in the States or where I live, so the skill level was much, much lower. Now, I mean soccer's everywhere. Kids have played soccer from the time they're four years old, all up to high school. So that's 10, 15, 12 years of you know coaching, so they're much better. I mean travel leagues, all that kind of stuff. So as the skill level rises, my guess is the risk of injuries goes up significantly because the players are better.

0:02:20 - Thomas Ozbolt Yeah, you think about what we talked about before: bigger, stronger, faster. And you look at old videos of soccer and Diego Maradona. He looks like he's about 40 pounds-- well, maybe not 40, you know somewhat overweight guy scooting down the field. You look at the guys now running around like gazelles. It's just a whole different game. A whole different game.

0:02:36 - Shane Smith And as they get faster and stronger and their techniques improve, injuries goes up.

0:02:44 - Thomas Ozbolt Yeah, it's right up there. It's among the leading sports with concussion rates in youth athletics, along with football, basketball and hockey.

0:02:51 - Shane Smith Anything they're talking about, any specific measures coming up in soccer to sort of deal with this?

0:02:56 - Thomas Ozbolt Yeah, there's been some efforts to make the game safer. For example, one of those is US Soccer. They implemented guidelines that prohibit players 10 and younger from heading the ball. Okay. And also limits the amount of heading in practice for those between the age of 11 and 13. This is for the purpose, of course, of reducing those head impacts that could potentially lead to concussions. And, along with that, there's a growing emphasis on education, like we talked about with coaches, players, parents about recognizing those concussion symptoms and the importance of proper recovery before returning to play.

0:03:29 - Shane Smith Now soccer, unlike football, which is, I'm going to say, mostly in the United States played. You know, soccer is played all across the world. Is any area doing a better job of concussion management, or is it just sort of there's room for a leader to come by and say, hey, let's make it safer for everybody, or how's that come into play?

0:03:49 - Thomas Ozbolt Yeah, I don't know that we have the data quite yet to know for sure. You would think that you know maybe the United States, because we have some guidelines that are in place. But you just got to think about is there reporting in countries where there's not as much capability to do that reporting and get that data to somebody who's going to collect it?

0:04:09 - Shane Smith So yeah, I guess ours is more centralized, or more, I'd say, we just like more data.

0:04:14 - Thomas Ozbolt Yeah.

0:04:15 - Shane Smith I mean, you know, for lack of a better word. So there's no, it's not like we can say, hey, in Argentina they're great at managing concussion of their players. So there's no clear leader. So it looks like it's an opportunity for the United States to sort of establish those hard lines and say, yeah, this is what we think the world ought to do. Yeah. So we've talked about in football, you know, in the NFL in particular, you know, if they think somebody's got a concussion, they're pulling them out through the NFL protocols. And some of the Heads Up programs that they're pushing out through youth football. They're saying you know, if we think you've got a concussion, you shouldn't play. Is that trickling down to youth soccer as well, or is it just not there?

0:04:52 - Thomas Ozbolt Whether it is or not, I think we're going to see over the, you know, the coming years. I think what everybody's really concerned about is ensuring that athletes can enjoy the sport they love while minimizing that risk of injury. But the focus needs to be on health and safety and having those measures in place like educating about concussions, the safer play rules. And just fostering that culture that we talked about with football, that takes player well-being and, you know, their future as as being more important than, you know some outcome of some minor game, whether it's football or on the soccer pitch.

0:05:23 - Shane Smith And I would feel like probably, as, you know, the professional soccer leagues have got continue to develop and grow, we're gonna see more of that safety come into play because soccer is treated as a more serious sport as opposed to when there were no pro leagues, or they're very small. It's just not the money and attention and focus on it.

0:05:42 - Thomas Ozbolt Right. Yeah, as it continues to grow, I think we'll see even more, things get more systematized, more centralized in terms of data collection and just probably, as leagues grow around the country, we'll just probably get more and more data to help influence what we do.

0:05:57 - Shane Smith All right, now legislation, any governing bodies or even sports associations pushing anything down for soccer, or is it still in the developmental phases right now?

0:06:09 - Thomas Ozbolt Yeah, it's a, it's a little bit broader than than just soccer alone, but since 2009, every state in the United States has passed legislation that's aimed at protecting young athletes from the dangers of concussions. These laws are focusing on three components. We've basically mentioned those, first one being education. Second one immediate removal from play if the concussion is suspected, and not allowing a return to play without medical clearance.

0:06:33 - Shane Smith And are they pushing a lot of guidance for coaches and parents and referees on, hey, this is a suspected, you know, these are the criteria for a suspected concussion? Because, to be honest, when I was a kid, the whole criteria was, can you, you know, how are your pupils? That was it. I mean, that was really all anybody ever talked about or was on TV. So what are we doing to to help with that?

0:06:54 - Thomas Ozbolt Yeah, I think they're trying to educate, you know, stakeholders in different sports on things like that SCAT test that we talked about for the NFL. You know, just orienting, trying to get their orientation on where they think they are. Like, hey, where are you, what time is it, who are you playing, what's the score? Things like that can be where you're at, I mean, I played a little bit of soccer and the only thing that they'd check with me when I took a header and got my bell rung, they'd say, you okay, yeah, yeah, I'm good, like let's go, let's get play, yeah. So, uh, I think there's an effort to get some of the knowledge that the NFL has brought in terms of of those different assessments, to bring some of those to soccer and you know other uses.

0:07:36 - Shane Smith And how many questions you think would would be on one of those on a day-to-day you know kind of thing, if I saw a kid take a hit?

0:07:41 - Thomas Ozbolt Three questions. I think it's usually, I think we talked about before the Maddock's questions. And you know it's just getting that general orientation as a baseline. It's like, all right, where are you, who are you playing, what's the score? What team are you on? You know different things like that, or what are we doing?

0:07:57 - Shane Smith We could download that and we could put those together, but they're pretty simple. We could do a checklist like that. So if anybody was interested, they could just download it, say okay, this at least gives me a starting point on knowing if somebody's in the game or not.

0:08:07 - Thomas Ozbolt The workaround with that is, you know, you'll probably see one of our other videos. You got Julian Edelman and Danny Amendola from the Patriots talking about hey, you know, I got rung up in one game and you know Danny's running over to me and telling me hey, we're playing the Browns. You're down seven.

0:08:23 - Shane Smith Here's the cheat sheet.

0:08:25 - Thomas Ozbolt Yeah, I just see-- so there's, there's ways to work around that, enterprising youth will certainly find.

0:08:31 - Shane Smith And I'm sure they will. It makes me think, years ago I was at a youth and the kids were really really small and uh, I showed up because it wasn't my kid and they, I said, what's the score? And they're like, well, they don't keep score at this level in the league because we just want the kids to play. And then I said something to one of the kids and they immediately told me the score and told me who won. And they knew every-- you know what I mean? The parents aren't keeping score with, but they all are. Yeah, that's right. So you know there's going to be a workaround that the kids will do, but certainly it's, it'd be a start. That's what I say. At least they got to work around it, that's what I'll say.

0:09:00 - Thomas Ozbolt Yeah, they got to have the wherewithal to actually, you know, be there enough to work around.

0:09:05 - Shane Smith Have their buddy fake the answer. I know we're all worried about, you know, kids and concussions, or at least we're very worried about it, and I know parents are worried about youth safety. We've got laws, guidelines. Do you think there's ever going to be a spot where we're going to shift over to, you know, if we're in doubt, you know, pull them out of the game, basically like the NFL has. Or do you think that's not going to happen?

0:09:28 - Thomas Ozbolt Yeah, I think that whole phrase we hear when in doubt, sit them out. It's simple, powerful. It's a guideline that emphasizes erring on the side of caution when it comes to head injuries. It means that if there's any suspicion of a concussion, the athlete should be removed from play immediately and not returned until cleared by a medical professional. I think that's crucial, because the signs of concussion can be subtle, may not be immediately apparent, but if you adopt this mantra and this kind of you know motto for life and sports, coaches and parents can play a crucial role in preventing further injury, including tragic things like what we talked about earlier with second impact syndrome.

0:10:07 - Shane Smith That's what I was going to say. This is exactly like that. Second impact syndrome would all be prevented. If we were questionable, we pulled the kid out. They weren't another-- now, obviously hindsight's 20-20 or you know, Monday morning quarterbacking or whatever, but I think that's where we need to get to. When in doubt, pull them out, you know, or let them rest and get checked out by a nurse or a volunteer nurse or some, you know, somebody who can make that call other than just the kid themselves.

0:10:31 - Thomas Ozbolt It's like, what's the worst thing that happens if you pull the kid out? I mean that's, I think that's a good question to ask. What's the worst thing that happens? You miss a couple plays and they go back. What's the worst thing that happens if you keep them in?

0:10:42 - Shane Smith Right. A lot of people worry about it, you know, concussion protocols, and regular folks I'm gonna say coaches, parents, you know implementing these. Where do the medical professionals come into play? I know we talked a little bit about Dr. McDonald from the American Academy of Pediatrics as a medical establishment on board with this so they're fighting it, what do they say?

0:11:01 - Thomas Ozbolt Dr. McDonald, he's had some interesting comments and it brings an interesting perspective to the situation. He's someone who's both a physician and an attorney. He's expressed concerns about the potential for concussion laws to create unrealistic expectations. And with that, he worries that, even with proper evaluations and treatments, athletes might still experience complications from concussions, and this in turn could lead to a situation where medical professionals, they're seen as being responsible for any adverse outcomes, potentially resulting in medical malpractice cases.

0:11:33 - Shane Smith So, like we talked about earlier, I'm the doc on the sideline. The player gets a workaround by his buddy, and then I say, okay, you're cleared to go back on the field, and then you get second impact syndrome or something else happens and it's made worse. Now it's like, well, why, doc, why didn't you catch it, right? Is that what he's worried about?

0:11:51 - Thomas Ozbolt Yeah, I think you see situations like that, or in the instance of one of these other young men who suffered tragic consequences on the field. It's, you know, maybe one of them, it was the initial traumatic brain injury that caused it. It's hard to really put a finger on that, and if the doctor's being blamed for that, it just gives us that idea of that balance that we're looking at.

0:12:16 - Shane Smith I was gonna say, yeah, so he's concerned about concussion laws. Everybody's concerned about and, like we said, you don't overrule it, basically, and and take all the, suck all the joy out of sports and get rid of that, because I think we all agree it's great for our children. So what's the next step I guess, or where are we at?

0:12:34 - Thomas Ozbolt Yeah, I think if we just keep going back to that thought of having comprehensive education and training for everyone involved in youth sports, and that's not just in recognizing and responding to concussions but understanding the nuances and limitations of medical evaluations and the unpredictability of recovery processes.

0:12:56 - Shane Smith So sort of like the medical malpractice laws, you know, a lot of the medical malpractice laws, there's an emergency room sort of escape hatch. It says if it's in the emergency room they're given a little bit of leeway and bandwidth because they don't have a lot of options. Same as like a coach or a nurse or somebody out on the side of the field. They don't have all the tools in place to do a full diagnosis. They've got what they've got. So I mean, the law shouldn't be used to penalize that person.

0:13:17 - Thomas Ozbolt Right yeah, it's just creating that culture of safety that respects the complexity of brain injuries.

0:13:22 - Shane Smith And understands it's not an easy thing to diagnose. I mean, I would say even doctors struggle to understand the complexity of a long-term concussion or a brain injury, which is why you sometimes hear well, you just have a concussion, even from medical professionals.

0:13:34 - Thomas Ozbolt And then the advances that we have in terms of what we're learning every day. And you know it's hard, you would think that everybody would be up to speed on that, but you know, you see it all the time. It's, everybody has a responsibility to have continuing medical, continuing legal education, but does it always turn out like that in practice in terms of what people should know and do know? No.

0:13:53 - Shane Smith And I think concussions, as we've discussed, everything we've learned is growing so rapidly and quickly. If you're not an expert in this area or don't spend a ton of time on it, maybe you didn't take the CLE that talked about concussions this time. And if you're a primary care doctor, maybe you just took a class on what you see a lot of, I mean broken arms or-- yeah. So just because they've got continuing education doesn't mean a continuing concussion education this year or in the last five years, right?

0:14:19 - Thomas Ozbolt Right, yeah, I don't know that there's any specific requirement broken down into subject matter. So it's, you know you satisfy your continuing medical education credits and you know you might never have to touch neurology since you looked at it back in med school in 1988. So now you're working off science.

0:14:36 - Shane Smith That's 35 years old, right? And I know when my wife was a nurse she talked about sometimes, you know, they have a stat delivery coming in and there's no labor and delivery doctor on site. They just ring for a doctor. You could get a you know a cardiologist, who he's a doctor or she's a doctor, but they don't know anything about birthing babies. Yeah, that's wild. So it just comes right into this. Thomas, I know we've dug down into concussions and how they're managing it in youth sports. I think this is a key topic for you. I know you've got some young children. I used to have young children. For our listeners I think it at least gives them something to think about. And look at those five questions. You know it's just something that can be pushed out as we continue to sort of dig into this and and talk about things that are coming up. For all of our listeners. This is Mind Matters: Navigating, Head Injuries and Concussions. If this is a topic that interests you, hit like and subscribe and hit the bell down below for notifications and remember, if you're in pain, call Shane 980-999-9999.