This article caught my interest due to the amount of trauma I see in my practice as it relates to heading a soccer ball. Enjoy! Dr. Maj

Soccer players who use their head to work the ball may be at risk for white matter abnormalities similar to those seen in traumatic brain injury (TBI) — but only beyond a certain threshold, researchers said here.

In a small study of amateur soccer players, those who headed the ball more than 1,320 times per year had a greater likelihood of tiny changes in white matter as measured on diffusion tensor imaging, Michael Lipton, MD, PhD, of the Albert Einstein College of Medicine in Bronx, N.Y., reported at the Radiological Society of North America meeting here.

“These are changes in the brain that are similar to those we see with a concussion or TBI,” Lipton said during a press briefing. “I’m not advocating banning heading, but there may be a threshold level, which we defined, that indicates a safe range of heading.”

Lipton explained that after heading the ball, patients have reported symptoms such as headache and feeling dazed or confused, and some studies have shown that cognitive performance may also be affected.

Still, there have not been many imaging studies of its potential neurological consequences, he said.

So he and his colleagues used diffusion tensor MRI to look at tiny changes in white matter — the fibers that make up the brain’s network wiring, he said — in 38 amateur soccer players in the New York City area who’ve been playing the game their whole lives.

Over the preceding year, the number of times the patients headed the ball ranged from none to 5,600, and Lipton said the upper quartile was 1,320.

Compared with the other soccer players, those in the upper quartile of heading had lower fractional anisotropy — uniform diffusion of water across white matter — in six regions of the brain.

That included five regions in temporooccipital white matter and one in frontal white matter.

The researchers noted that the relationship between heading and fractional anisotropy followed a reverse “S” shape, indicating that white matter abnormalities rise as the frequency of heading rises.

Although further study is needed — particularly to assess whether these changes in white matter correspond with changes in cognitive performance — Lipton said the findings suggest there may be room for public health intervention, given that more than 250 million people worldwide play soccer regularly. In the U.S. alone, that estimate is 18 million people, he said.

Lipton noted that more soccer players need to be assessed over a longer period of time to see if their threshold stands up, but still, he said, players should try to minimize heading, especially during practice drills, when balls are repeatedly headed back and forth.

According to guidelines from the American Academy of Pediatrics, there are not enough data to recommend against heading altogether, but the organization similarly encourages children to minimize the number of times they do so.

Max Wintermark, MD, of the University of Virginia in Charlottesville, who was not involved in the study, cautioned that the results are preliminary and that given the small number of participants, “we have to be careful not to generalize findings that have been obtained in just a few patients.”

Still, he said it’s “worth more study,” particularly among children — although such a study would involve practical limitations, such as the need for sedation.

Primary source: Radiological Society of North America

Source reference:

Kim N, et al “Making soccer safer for the brain: DTI-defined exposure thresholds for white matter injury due to soccer heading” RSNA 2011; Abstract SSK12-04.

Dr. Stephanie Maj has a thriving family practice in the heart of Chicago. Her clinic is located at 1442 W. Belmont Ave., 1E, Chicago, IL 60657. 773.528.8485. www.communitychiropractic.net

Does my kid have a concussion or not? How does a concussion affect the brain?  The next tool in the campaign against concussions might be your smartphone.

As a chiropractor, I am interested in the Nervous System and the MASTER controller of it all is the BRAIN! It is hard for me to help with the flow on this system if the Master is injured.

What is a concussion? Well, in 2001, the first International Symposium on Concussion in Sport was organized by the International Olympic Committee Medical Commission and other sports federations. A group of experts called the Concussion in Sport Group met there and defined concussion as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.” They agreed that concussion typically involves temporary impairment of neurological function that heals by itself within time, and that neuroimaging normally shows no gross structural changes to the brain as the result of the condition.

There is new evidence linking brain damage to concussions.  This condition is called Post-Concussion Syndrome is a set of symptoms that a person may experience for weeks, months, or occasionally up to a year or more after a concussion – a mild form of traumatic brain injury.  The condition can cause a variety of symptoms: physical, such as headache; cognitive, such as difficulty concentrating; and emotional and behavioral, such as depression.

There is now help for parents and coaches in the diagnosing of concussion!  A doctor at the University of North Carolina teamed with other head-trauma researchers to develop an application for mobile devices that helps determine whether someone may have suffered a concussion.

Jason Mihalik of UNC’s brain injury research center joined Justin Smith of Psychological Assessment Resources Inc. and the Children’s National Medical Center in developing the program.

Smith says it’s the first observer-based concussion app. After the user answers a series of questions, the app determines the likelihood of a concussion and can email information to a doctor. Mihalik said Thursday that the basis for the app’s question flow comes from materials provided by the Centers for Disease Control.

The introduction of the app is just one way to speed the response to possible concussions. One of the key issues discussed during the National Sports Concussion Cooperative’s daylong seminar was how to most effectively bridge the communication gap between team doctors and the team athletic trainers, who often are the first to act when players suffer concussion-like symptoms.

“The documentation (of immediate symptoms) is very important, from, ‘How did they get hurt?’ to the mechanism of injury through those initial signs and symptoms, to ‘How did they progress over time?’” said Bill Griffin of the National Athletic Trainers’ Association. “It’s not only what happens at the time of the injury, but how things change.”

The cooperative consists of coaches, doctors, equipment manufacturers and parents, and the group was formed in March to study concussions and brain trauma injuries in an attempt to make sports safer.

“We’re trying to do more. We think there is an opportunity to do more,” said Art Chou, Rawlings’ vice president of research and development. “The caution that we have as manufacturers is, are we ready to draw definitive conclusions? … There’s a balance there, and I think it’s up to the research community to determine whether it is ready for prime time or not, because the issue is going to be one of public perception.

“The issue is, have we confused the public? … I would like to see more consensus from the research community that supports that, because we need more data. We need to move the needle. … The last thing we need, I think now, as a whole football community, is going back and forth and confusing the issue any more.”

Mike Oliver, the executive director of the National Operating Committee on Standards for Athletic Equipment, continued to express a longstanding desire to come up with a safety standard for youth helmets.

But he cautioned that it’s dangerous to rush to a conclusion before the scientific research is complete. NOCSEA, a nonprofit corporation, formed in 1969 in response to a need for a performance test standard for helmets.

“You want to have an answer. You want to have a solution to the problem,” Oliver said. “You want to be able to say … ‘We do have a solution to the problem and you can have a level of confidence (that) you will have a level of protection. … But we can’t do that until we have the science behind it.”

Dr. Stephanie Maj has a thriving family practice in the heart of Chicago. Her clinic is located at 1442 W. Belmont Ave., 1E, Chicago, IL 60657. 773.528.8485. www.communitychiropractic.net