How Physical Therapy Can Help After a Soccer Concussion
A concussion is a mild traumatic brain injury that can result in disrupted neurological function and cause a wide range of physical, cognitive, and behavioral symptoms. The sport of soccer poses a significant risk for concussions and head injuries. During soccer, the head is at risk of contact with the ground, with soccer goalposts, with the ball, and with other players’ heads, elbows, knees, or feet. Physical therapists can effectively manage concussion injuries through evidence-based treatment and a careful, personalized rehabilitation program.
What is a Concussion?
Sports-related concussions have been increasing over the last several decades. A concussion is a mild traumatic brain injury that can result in disrupted neurological function and can cause a wide range of physical, behavioral, and cognitive symptoms.
Concussions are often caused by a blow, jolt, or bump to the head or a jarring motion to the body that can cause the skull and brain to move back and forth rapidly. Brain tissue is soft and vulnerable to forces upon it. When the brain tissue is damaged during a concussion, a neurometabolic cascade occurs in which the lining of the brain cells is negatively affected, causing nerve cells to function incorrectly and inefficiently leading to brain impairment and concussive symptoms.
Concussions are more dangerous in younger populations as children and adolescents have underdeveloped nervous systems, underdeveloped neck muscles, and a lower body weight, which makes the head and brain more susceptible to acceleration and deceleration forces that can cause a concussion.
Symptoms vary from person to person depending on which area of the brain in affected and injured. Cognitive symptoms can include confusion, slowed processing, brain fogginess, difficulty concentrating, and difficulty with short or long-term memory. Behavioral symptoms may involve irritability, depression, or increased nervousness or anxiety. Physical symptoms can include dizziness, headaches or migraines, nausea or vomiting, fatigue, balance and coordination issues, difficulty sleeping or increased sleepiness, double or blurred vision, slurred speech, or sensitivity to light and noise.
Loss of consciousness after a concussion occurs in less than 10% of individuals. However, a loss of consciousness longer than a minute is an indicator of higher concussive severity. Symptoms can begin immediately upon impact or soon after an injury but may also evolve over the following hours or days.
Causes of Soccer-related Concussions
The sport of soccer poses a significant risk for concussions and head injuries. During soccer, the head is at risk of contact with the ground, with soccer goalposts, with the ball, and with other players’ heads, elbows, knees, or feet. With contested headers and set plays like corner kicks, there is a greater chance of concussive impact as players are in close contact, jostling for position and the ball.
After football, high school and college soccer players are most at-risk for suffering concussions. Nearly 22% of all soccer injuries are concussions, placing soccer in the sport high-risk category for concussions along with football, hockey, boxing, and rugby.
Causes of soccer-related concussions include:
The most common cause of concussions in soccer is due to colliding with another player, particularly when jockeying for space in a tight area. A collision can occur via head-to-head trauma when players battle for aerial supremacy to head the ball or via other body parts of another player, like an elbow, knee, or foot colliding with the other player’s head. A national high school sports-related injury surveillance study showed that 69% of boys and 51% of girls experienced a concussion due to player-to-player contact.
“Heading” the ball can also cause a concussion. Heading the ball involves hitting the soccer ball with your head. A national high school sports-related injury surveillance study showed that heading was associated with concussions in 31% of boys and 25% of girls.
Head-to-ground contact from a fall during competition can also cause a concussion. A 2020 study found that concussions that resulted in hospitalization occurred most in head-to-ground contact. The type of field on which soccer competition occurs can heighten the risk of head-to-ground concussions. One study found that artificial turf leads to significantly higher injury rates of the head and neck in soccer players compared to grass.
Head-to-soccer goal post contact can also contribute to concussive injuries, although this is a less common mechanism for soccer-related concussions.
A 2020 study examining the prevalence and incidence of youth-soccer-related concussions found that during the study period, 2008-2016, the incidence of concussions in youth soccer has increased over the last decade and that player-to-player contact was the most common cause of youth soccer-related concussion. Over the study period, 3,285 concussion injuries were identified with an average of 386 concussions each year and the average age at concussion was 13.5 years.
Researchers noted no differences in the incidence of concussion between males (49%) and females (45%). An average of 202 concussions occurred in male players each year and an average of 184 concussions in female players each year. The study found that player-to-player contact accounted for 33% of concussions, followed by head-to-ball contact (24%) and finally head-to-ground (18.2%) and head-to-goalpost (2.6%) contact.
Physical Therapy Management of Soccer-related Concussions
Physical therapists can effectively manage concussion injuries through evidence-based treatment and a careful, personalized rehabilitation program. Physical therapists work with a multidisciplinary team of doctors to ensure the concussive patient receives proper, timely care for optimal recovery.
A physical therapist conducts a thorough examination to evaluate the concussive athlete’s symptoms. The examination involves a dizziness handicap inventory, a post-concussion system inventory assessing the cervical spine and neck, a vestibular exam, and an exertion treadmill test to measure the patient’s tolerance for exercise and in order to appropriately prescribe graded aerobic exercise as part of the treatment protocol.
Following a concussion, it is critical that the athlete rests for a 24–48-hour period. After that period, the athlete can gradually and progressively return to physical activity under the supervision of a physical therapist who will monitor the patient to ensure the athlete stays below the symptoms threshold when exercising and does not exacerbate symptoms.
Physical therapy treatment for concussions can include:
Vestibular rehabilitation therapy is an exercise-based program to reduce vertigo and dizziness and address gaze instability and balance issues.
Balance testing and training to help the athlete regain proprioception or spatial awareness of the body and neuromuscular movement control.
Headache treatment using manual therapy, dry needling, myofascial release, and therapeutic exercise.
Manual therapy and neck pain treatment, including targeted neck strengthening and stretching exercises and manual joint mobilizations to relax and reduce tension in the neck muscles.
Graded sub-symptom aerobic exercise is effective in helping shorten recovery time and help the brain adapt to the increased physiological demands of activity over time in a controlled environment with careful monitoring. Mild aerobic activity increases blood flow and oxygen to the brain, which promotes healing in the brain. A structured exercise program with gradual progression of intensity and duration allows the patient to regain fitness without exacerbating symptoms.
Return to sport testing to determine when the athlete is ready to return to competition.
A concussion is a mild traumatic brain injury that necessitates appropriate, timely, and well-monitored treatment to achieve optimal recovery and a safe return to activity. A physical therapist is qualified to manage a concussive patient’s treatment using evidence-based protocols and a rehabilitation program for positive post-concussive outcomes.
