The Concussion Protocol: What Every Soccer Coach Needs to Know

***This article is part of an educational series for soccer parents and youth players new to soccer***

A teenage soccer player jumps up for an aerial challenge and then collides head-to-head with an opponent and then falls to the ground. It was a hard hit. Nevertheless, she gets up and jumps right back into action, seemingly unharmed.

Later on, before a conditioning session, her nose bleeds, but she ignores it to continue training. With each successive workout, she fatigues easily and in a subsequent match, she falls to the ground again, but this time, she’s unable to pick herself up to play.

This is a description of The Ontario Government’s concussion commercial that made its debut in 2019. The commercial provides a powerful message for coaches. It’s telling them to prioritize safety over performance by recognizing the signs of a concussion and how to treat them.

With that said, this post will help coaches, parents and players to recognize what concussions look like and how they can be handled.

The Insidious Nature of Concussions

Hard hits to the head themselves aren’t always the most dangerous aspect of concussions. After all, the brain (and the skull) can absorb a surprising amount of trauma and still heal itself if given enough time. But that’s where the problem lies. The signs of a concussion can easily go unnoticed and it is now a widely accepted fact that concussion victims don’t always lose consciousness.

To complicate the diagnosis of a concussion is the fact that X-rays, standard CT scans and MRIs can’t easily detect them. When a player sustains a hit and shows no obvious signs of a brain injury, coaches and team staff may assume that they’re “good to go”. However, that decision can be deadly.

Take, for example, the late Rowan Stringer (pictured below). She was an Ottawa high school student and rugby player who died on May 8th, 2013 after she was tackled during a game. It wasn’t the first concussion that killed Stringer - she succumbed to severe brain trauma after sustaining multiple concussions. It’s clear that she slipped through the cracks so-to-speak, showing few signs of brain injury until it was too late.

This demonstrates the sobering reality that an initial impact may not be severe enough to injure a player immediately, but significant enough to leave them vulnerable to fatal after effects. Medical experts now refer to this as second impact syndrome - the cause behind Rowan Stringer’s death - which is a rapidly life-threatening condition requiring immediate medical treatment.

Unfortunately, some players like Stringer who progress to this stage can’t be saved because the damage they sustained beforehand was too severe. That highlights the importance of addressing concussion symptoms before they worsen.

Stringer’s passing, tragic as it was, led to the creation of Rowan’s Law, Ontario’s concussion safety legislation that also inspired the commercial mentioned at the beginning of this post.

The key takeaway here is a cliche one - prevention is better than cure. It’s not entirely possible to prevent a concussion, but steps can be taken to prevent their more adverse effects.

The Concussion Protocol That Every Soccer Player Should Know

As we mentioned in the previous section, concussions can be tricky to diagnose. It’s not as simple as identifying a bone fracture or muscle tear - it takes a systematic approach to determine whether a player has sustained a concussion or not. With that said, there are criteria set out by the Government of Ontario’s Ministry of Health that coaches can follow after a player is involved in a head-to-head collision.

Know the Signs of a Concussion Ahead of Time

Treating a Conscious Player

1. Remove the participant from the activity immediately.
2. If signs are observed or symptoms are reported, a concussion should be suspected.
3. If a concussion is not suspected (i.e., signs are not observed and symptoms are not reported), the participant may resume physical activity; however, if applicable, a parent/guardian should be contacted and informed of the incident.*
4. If applicable, contact the parent/guardian and inform them of the injury and the need to be examined by a medical doctor or nurse practitioner.
5. Stay with the injured participant until a parent/guardian or emergency contact arrives.
6. Monitor and document any physical, emotional and/or cognitive changes. * Remember: signs and symptoms of concussion may appear within hours or days of the injury.

For a Participant who is Conscious:

• If in doubt, sit them out.
• Do not administer medication (unless conditions require it – e.g., insulin for diabetics).
• If applicable, ensure a parent/guardian is aware that he/she must inform the coach, administer and/or supervisor of the participant’s condition (i.e., concussed or not concussed) prior to their return to physical activity.)

Treating an Unconscious Player

1. Initiate emergency action plan and call 911.
2. If applicable, contact the child/youth’s parent/guardian to inform them of the injury and that their child is being transported to the hospital.
3. Stay with the individual until Emergency Medical Services arrives.
4. Monitor and document any physical, emotional and/or cognitive changes.

For someone who is Unconscious:

• Assume there is also a possible head and/or neck injury and, only if trained, immobilize the individual before ambulance transportation to hospital.
• Do not remove athletic equipment (e.g. helmet) unless there is difficulty breathing.
• If applicable, ensure the child/youth’s parent/guardian is aware that he/she must inform the coach, administrator and/or supervisor of the child/youth’s condition (i.e., concussed or not concussed) prior to the child/youth returning to physical activity.
• Even if consciousness is regained, he/she needs to be examined by a medical doctor or nurse practitioner. (see steps below for someone who is conscious)

Reminders for Concussion Risk Reduction in Soccer

Encourage the Use of Soccer Headgear

First, we recommend to players of all ages that they should wear soccer headgear where and when appropriate. While more research needs to be conducted, and while there is no silver bullet solution against concussion risks, recent studies suggest that the right type of soccer headgear may be effective at dramatically reducing risks.

For example, our Storelli Exoshield Head Guard was rated by Virginia Tech as a top soccer headband on the market. It has been estimated to reduce the occurrence of concussions by 84% in the Virginia Tech lab tests. Furthermore, a 2-year study of high school soccer players by University of Wisconsin Madison showed that- while the "average" headgear did not significantly reduce the risk of concussions- the Storelli ExoShield Head Guard statistically reduced the relative risk of concussions by 60%, the only product studied to achieve a statistical benefit.

Teach Proper Ball Heading Technique

Soccer players often sustain concussions during header attempts and that often occurs due to a lack of good technique. With poor technique, players increase their concussion risk because they will either head the ball poorly or lose awareness of where an opponent is and collide with them. To prevent either scenario from happening, it's helpful for coaches to teach players the following techniques.

• Keep an eye on the ball while it’s in flight
• Talk to your teammates while the ball is in the air
• Aim for the center of your forehead
• Keep your eyes open until contact is made
• Push the ball through at contact

If They're Hit, Make Them Sit

In the best scenarios, players will heal from concussion damage relatively quickly. However, these brain injuries can be silent killers if they're unrecognized and further aggravated.

So don't take the risk.

If you suspect that a player has sustained a concussion or even a mild injury from a head impact, take them to the sidelines immediately. This will prevent an otherwise manageable injury from escalating into a life-threatening one.