A Close Inspection: Heading the Ball

In recent years, research has raised awareness in both amateur and professional sports by demonstrating the link between collisions, blows to the head, and concussions. While it is believed that 80-90% of concussions will resolve without therapeutic or pharmaceutical intervention in 7-10 days, it is suspected that repetitive impact exposure may lead to permanent damage. Sub-concussive injuries are an emerging and under-recognized phenomenon resulting from low magnitude head impacts. It is suggested that these injuries are not severe enough to result in clinically observable deficits, but may have the potential to cause significant long-term neurological changes. As a result, the effects of soccer heading on the brain has become a popular area of study, particularly due to the exposure of head impacts to young children.


Soccer is the world’s most popular sport with 240 million participants. In soccer, concussions are suspected to occur not only during head-to-head collisions, but also during head-to-ball. Recent studies on the topic of soccer heading suggest a wide range of changes to the central nervous system such as white matter microstructural and cognitive abnormalities (Lipton et al. 2013), vestibular deficits (Hwang et al. 2016), and improper pituitary function (Greco et al. 2013). Last year in the Emirates FA Cup, Andy Wilkinson suffered a concussion after a volley to his temple reduced his peripheral vision on his right side. Over the following 6 months, Wilkinson struggled with his recovery, often getting ill after practice. Wilkinson retired from soccer in February at the age of 31.


It isn’t professional athletes that are most susceptible to these changes to the nervous system. In fact, research is showing that youth are the most at risk. Perhaps most alarming for youth soccer players, damage to the pituitary gland following concussive and sub-concussive blows could result in altered brain development due to this structure’s role in the release of developmental hormones (e.g. growth hormone).


Fortunately these research findings appear to be a strong reason behind the US Soccer Federation’s move to eliminate heading for children 10 and under, and limit heading in practice for children between the ages of 11 and 13. Other coaching methods are being used as well, including increased focus on foot fundamentals and heading technique lessons using inflatable beach balls. Concussion experts estimate that delaying the introduction of heading until high school will result in the prevention of 100,000 concussions among middle school soccer players in the US every three years. Certainly a move in the right direction.


The Men’s FA Cup final will be underway tomorrow (at 9:30am PST). We’ll be watching and like Andy Wilkinson, we’ll be hoping that the game will be incident free.

Impacts on the Brain Caused by Repeated Blows - A look at the Martial Arts

Mixed Martial Arts (MMA) has seen a rapid growth in popularity over the last decade. The Martial Arts encompass several different styles, techniques and philosophies of self-defense and combat such as Karate, Judo, Jujitsu and Kickboxing. Participants of all ages benefit from the practice of discipline, physical engagement, and self-defense. However, like many other sports, sports injuries in martial arts are common. The prevalence of head injuries are only enhanced when you examine MMA, a full contact combat sport that allows for a wide variety of fighting techniques to be used in competition. In MMA, roughly 31% of professional matches end as a result of head trauma (knock-out or technical knock-out).


On Saturday in Copenhagen, Vancouver’s own “Bazooka Joe” called the #GLORY29 kickboxing fight that he would have headlined. He was sidelined from competition last year after he noticed increasing sensitivity to light and noise and was diagnosed with post-concussive syndrome. He was forced to withdraw his name from competition and focus on other activities including opening his own gym and play-by-play announcing.


The GLORY event comes just days after the tragic death of 28-year old MMA fighter, João Carvalho. João suffered a traumatic brain injury directly linked to the technical knockout he received at the Total Extreme Fighting event in Dublin. While he did not lose consciousness during the fight, his symptoms appeared shortly afterward and rapidly increased. Despite emergency brain surgery, he succumbed to his injuries and now people are questioning the rules and regulations of MMA.


Sports with repetitive blows to the head, like boxing and MMA, have direct links with brain injuries and neurological abnormalities with symptoms that include motor, cognitive or behavioural impairments. Knock-outs and Technical Knock-outs are dangerous, without question. Researchers now believe there is a risk with sub-concussive hits (hits to the head that don’t result in concussion) which they believe might be priming the brain and making it vulnerable to a concussion. Preliminary evidence is showing that sub-concussive injuries might have cumulative effects that change the brain. There seems to be a link with cumulative hits and likelihood to develop a pituitary dysfunction (hypopituitarism), microstructural brain damage, and even Chronic Traumatic Encephalopathy (CTE) which presents itself with symptoms similar to dementia and can only be ID’d during an autopsy.


With so many hits to the head, athletes practicing any martial arts need to be aware and educated about the risk of brain injuries in their sport. Physicians and athletic trainers should be present at all athletic exposures, and ringside tests should be performed on competitors before, during, and after a match. While there is still a culture of resistance among athletes to report concussive symptoms, sports organizations should look for opportunities to protect athletes from unnecessary permanent injury, whether through rule changes or stringent policies around return-to-sport.