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Management of concussion in soccer

  • Review Article - Brain trauma
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

When participating in contact sports, (mild) head trauma is a common incident—observed in both professional and amateur sports. When head trauma results in transient neurological impairment, a sports-related concussion has occurred. Acute concussion, repetitive concussions, as well as cumulative “sub-concussive” head impacts may increase the risk of developing cognitive and behavioral deficits for athletes, as well as accelerated cerebral degeneration. While this concept has been well established for classic contact sports like American Football, Rugby, or Boxing, there is still an awareness gap for the role of sports-related concussion in the context of the world’s most popular sport—Soccer.

Methods

Here, we review the relevance of sport-related concussion for Soccer as well as its diagnosis and management. Finally, we provide insight into future directions for research in this field.

Results

Soccer fulfills the criteria of a contact sport and is characterized by a high incidence of concussion. There is ample evidence that these events cause functional and structural cerebral disorders. Furthermore, heading, as a repeat sub-concussive impact, has been linked to structural brain changes and neurocognitive impairment. As a consequence, recommendations for the diagnosis and management of concussion in soccer have been formulated by consensus groups. In order to minimize the risk of repetitive concussion in soccer the rapid and reliable side-line diagnosis of concussion with adoption of a strict remove-from-play protocol is essential, followed by a supervised, graduated return-to-play protocol. Recent studies, however, demonstrate that adherence to these recommendations by players, coaches, clubs, and officials is insufficient, calling for stricter enforcement. In addition, future research to solidify the pathophysiological relevance of concussion for soccer athletes seems to be needed. Advanced neuroimaging and neurochemical biomarker analyses (e.g. S100β, tau and neurofilament light (NfL)) may assist in detecting concussion-related structural brain changes and selecting athletes at risk for irreversible damage.

Conclusion

Sports-related concussion represents a genuine neurosurgical field of interest. Given the high socioeconomic relevance, neurosurgeons should get involved in prevention and management of concussion in soccer.

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Abbreviations

CISG:

Concussion in Sports Group

CSF:

Cerebrospinal fluid

CT:

Computed tomography

CTE:

Chronic traumatic encephalopathy

DMN:

Default mode network

DTI:

Diffusion tensor imaging

FIFA:

Fédération Internationale de Football Association

fMRI:

Functional magnetic resonance imaging

GFAP:

Glial fibrillary acidic protein

MRI:

Magnetic resonance imaging

MRP:

Magnetic resonance perfusion

MRS:

Magnetic resonance spectroscopy

NAA:

N-acetylaspartate

NFL:

National Football League

NfL:

Neurofilament light

NSE:

Neuron specific enolase

PCS:

Post-concussion syndrome

PET:

Positron emission tomography

RTS:

Return to sport

SCAT:

Sport Concussion Assessment Tool

SIS:

Second impact syndrome

SRC:

Sports-related concussion

TBI:

Traumatic brain injury

TMS:

Transcranial magnetic stimulation

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Authors and Affiliations

  1. Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany

    Vanessa Hubertus & Peter Vajkoczy

  2. Skane University Hospital, Department of Clinical Sciences Lund, Neurosurgery, Lund University, Lund, Sweden

    Niklas Marklund

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Hubertus, V., Marklund, N. & Vajkoczy, P. Management of concussion in soccer. Acta Neurochir 161, 425–433 (2019). https://doi.org/10.1007/s00701-019-03807-6

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