Newest piece at the Philadelphia Inquirer: "Soccer may be 'in,' but it's not an injury-free sport"

My newest piece at the Philadelphia Inquirer starts this way:

With all the recent coverage given to the World Cup, interest in soccer is frequently described as reaching a "tipping point." Even President Obama has done his part to popularize the sport: taking time out from his busy schedule to watch the U.S.-Germany match, playing soccer against a robot on his recent trip to Japan, and chatting with foreign leaders about the game's finer points.  

But the president appears unaware of the health risks. He has strongly warned Americans about the risks of playing football, going so far this year as saying, "I would not let my son play pro football." He hasn't offered such similar warnings about soccer.  

Obama is not alone in apparently believing that soccer is less dangerous than American football. Surely the media have been all over how dangerous football is for concussions. And the lawsuits filed by NFL players have received much attention.  

Unfortunately, soccer is not the benign alternative it is often portrayed as being. 

Take concussions.  

In college, women's soccer has a higher rate of concussions than men's football or soccer: 6.3 per 10,000 times women participate in soccer practice or a game versus 4.9 for men's soccer and 6.1 for men's football. Indeed, among college sports, women's soccer has the highest rate of concussions.  

But concussions aren't the only problem. In total injuries, both men's and women's soccer exceed those of men's football. Total injuries for men's soccer are 11.14 per 10,000 practices or games and 9.7 for women's soccer. For football, the number is 9.5. . . .

The rest of the piece is available here. 

Serious problem of concussions in professional soccer

Striking one's head against a hard ball over and over again never seemed like a good idea.  But of course there are also all the accidental falls and hits to the head.  Here is an interesting article in the journal Neurology entitled: "Chronic traumatic brain injury in professional soccer players."

Methods: Fifty-three active professional soccer players from several professional Dutch soccer clubs were compared with a control group of 27 elite noncontact sport athletes. All participants underwent neuropsychological examination. The main outcome measures were neuropsychological tests proven to be sensitive to cognitive changes incurred during contact and collision sports.
Results: The professional soccer players exhibited impaired performances in memory, planning, and visuoperceptual processing when compared with control subjects. Among professional soccer players, performance on memory, planning, and visuoperceptual tasks were inversely related to the number of concussions incurred in soccer and the frequency of "heading" the ball. Performance on neuropsychological testing also varied according to field position, with forward and defensive players exhibiting more impairment.
Conclusion: Participation in professional soccer may affect adversely some aspects of cognitive functioning (i.e., memory, planning, and visuoperceptual processing).

For college, women's soccer appears to have a higher rate of concussions than men's football or soccer: 6.3 per 10,000 exposures in women’s soccer versus 4.9 for men’s soccer and 6.1 per 10,000 for men’s football.   Indeed, for college sports, women's soccer has the highest rate of concussions.  

For high school, girls' soccer has the second highest rate of concussions behind football, but when concussions do occur girls and boys' high school soccer have worst concussions than do football (click on figure to make it larger).



Girls' high school basketball might not have a lot of concussions, but their concussions tend to be pretty bad.  The most severe concussions requiring 22+ days to recuperate from appear to be twice the percentage for both boys and girls' soccer.  More is available here.

There is another study on college players, but the survey method used here is fairly problematic.  The survey indicates that soccer players are much less likely than football players to even realize that they have had a concussion.  If the rate of perceived concussions is related to the rate that people answer the survey, you will get relatively more underreporting of concussions among soccer players.  The questionnaires indicated that "70.4% of the football playersand 62.7% of the soccer players had experienced symptoms of a concussion during theprevious year."  But much of that difference could be explained by differences in reporting rates. 

Here is another academic article of interest:
British Journal of Sports Medicine: The Effect of Protective Headgear on Head Injuries and Concussions in Adolescent Football (Soccer) Players: "In the population studied, 47.8% had experienced symptoms of a concussion during the current football year. 26.9% of athletes who wore headgear (HG) and 52.8% of those who did not wear headgear (No-HG) had concussions."

Here is something else that a reader sent me.

SOCCER CONCUSSIONS: GET THE FACTS
-- 92,505 Concussions in High School Soccer

National High School Sports-Related Injury Surveillance Study 2011/2012. http://www.nationwidechildrens.org/cirp-rio
-- Players NOT wearing protective soccer headgear are 2.65 times more likely to suffer a concussion than those who did wear headgear
Al-Kashmiti, Delaney, et al “The Effect of Protective Headgear on Head Injuries and Concussions in Adolescent Football (Soccer) Players,” British Journal of Sports Medicine (2007). http://bjsm.bmj.com/content/early/2007/07/05/bjsm.2007.037689 .abstract - Dr. J. Scott Delaney, jscott.delaney@mcgill.ca
-- Concussions in soccer are not commonly caused by heading the ball
Boden, Kirkendall et al, “Concussion Incidence in Elite College Soccer Players,” American Journal of Sports Medicine (1998), 26:238-41. http://ajs.sagepub.com/content/26/2/238.short
-- “Head to head impacts posed high concussion risk”
Withnall, Shewchenko et al., “Effectiveness of Headgear in Soccer,” British Journal of Sports Medicine (2005), 39(supp1):i40-i48. http://bjsm.bmj.com/content/39/suppl_1/i40.full
-- In a peer-reviewed study, 62.7% of college-level soccer players had concussion symptoms in a single year
Delaney, Lacroix et al., “Concussions Among University Football and Soccer Players,” Clinical Journal of Sports Medicine (2002), 12(6):331-38. http://www.ncbi.nlm.nih.gov/pubmed/12466687
-- The number of sports concussions is believed to be under-reported by 90%
NIH Consensus Development Panel, “Rehabilitation of Persons with Traumatic Brain Injury,” Journal of the American Medical Association (1999), 282:974-83. http://jama.jamanetwork.com/article.aspx?articleid=191465 mediarelations@jamanetwork.org
-- The concussion rate in soccer is similar to that in American football
Baroff, “Is Heading a Soccer Ball Injurious to Brain Function?” Journal of Head Trauma Rehabilitation (1998), 13(2):45-52. http://journals.lww.com/headtraumarehab/Abstract/1998/04000/I s_Heading_a_Soccer_Ball_Injurious_to_Brain.7.aspx

-- After the first concussion, the risk of a second one increases by a factor of four
Gerberich, Priest et al., “Concussion Incidences and Severity in Secondary School Varsity Football Players,” American Journal of Public Health (1973), 73:1370-75. http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.73.12.13 70
-- Subsequent concussions are usually more serious than the first one, even if the impacts are similar
Collins, Lovell et al., “Cumulative Effects of Concussion in High School Athletes,” Neurosurgery (2002), 51(5):1175-81. http://journals.lww.com/neurosurgery/Abstract/2002/11000/Cum ulative_Effects_of_Concussion_in_High_School.11.aspx
-- Second Impact Syndrome (rapid swelling of the brain, potentially catastrophic outcome) may occur if the head is impacted before the brain has recovered from a concussion
Cantu, “Recurrent Athletic Head Injury: Risks and When to Retire,” Clinics in Sports Medicine (2003), 22(3):593-603. http://www.sportsmed.theclinics.com/article/S0278- 5919(02)00095-9/fulltext
-- Younger players require more time to recover from a concussion than older players
Field, Collins et al., “Does Age Play a Role in Recovery from Sports-Related Concussion? A Comparison of High School and Collegiate Athletes,” Journal of Pediatrics (2003), 142(5):546- 53. http://www.jpeds.com/article/S0022-3476(03)00116- 1/abstract - journal.pediatrics@cchmc.org
-- Girls are more likely to be concussed than boys
Fuller, Junge et al., “A Six Year Prospective Study of the Incidence and Causes of Head and Neck Injuries in International Football,” British Journal of Sports Medicine (2005), 39(supp1):i3-i8. http://bjsm.bmj.com/content/39/suppl_1/i3.full.pdf 

Here is an interesting blog on soccer concussions.

Very dark days: 'Kickalicious' cut by Lions

I assume that everyone has seen the above video that went viral earlier this year, but if you haven't, I strongly recommend you watch it.  From USA Today:

. . . A 28-year-old native of Norway, Rugland had been the subject of intense interest this preseason with outlets from Sports Illustrated to GQ to Norwegian television stations and newspapers descending upon the Lions' Allen Park, Mich., facility to chronicle his long-shot bid for an NFL roster spot.

Rugland, who had no football experience before his video caught the eye of a New York Jets personnel man last year, showed marked improvement during his time in Detroit.

He made all three of his field goal attempts in the preseason, from 49, 50 and 33 yards, handled kickoffs in the second half of most games and was popular in the locker room.

But the Lions always intended to use six-time Pro Bowl pick David Akers, if healthy, as their replacement for Jason Hanson, who retired this spring. . . .

Unbelievable: Obama and Congress wants to tell College Football how to run playoffs

This is too bizarre. Are they next going to start running other sports?

House lawmakers are gearing up for a vote as soon as next week on a bill aimed at forcing a national college-football playoff.

Approval of the legislation by an Energy and Commerce subcommittee would represent the most significant action yet by Congress in its oversight of college football. The plans for a markup next week – still tentative as of late Friday – appeared to signal growing congressional support for the idea, which President Barack Obama also backed during the 2008 campaign.

For the last decade or so, the process of picking a national champion has been run by the Bowl Championship Series, a group that began with six major college conferences and has since expanded somewhat. The BCS runs a complex ranking system that picks the two teams that play for the national championship each year.

Prior to the BCS, the national champion was effectively chosen by polls following year-end bowl games. The BCS was designed to eliminate some of the controversy that inevitably swirled around that process.

But the BCS system's congressional critics charge that the system frequently is unfair to college teams that aren't traditional powerhouses. . . .

Drugs and sports for the elderly

Given all the discussion about drugs in sports, this seems like the perfect counterpoint. I especially like the line: “Who’s 75 years old and not taking medications?” The NY Times has this piece.

In his apartment outside Philadelphia, Frank Levine pulled a list of prescription medications from his refrigerator, his hands shaking slightly. There was metformin HCl and glipizide for his diabetes; lisinopril for his blood pressure; and Viagra.

“I need it,” he said recently.

Mr. Levine, who is 95 and has had operations on both knees, in June set the American record in the 400-meter dash for men ages 95 to 99, only to see it broken at the U.S.A. Masters Outdoor Track & Field Championships a few weeks later. “Nothing counts unless you’re first,” he said.

Mr. Levine belongs to a generation of track and field athletes who are breaking records for speed, distance and endurance at ages once considered too old for competition. In a sport tarnished by doping scandals, the older athletes raise anew the question of what constitutes a natural body for people who are at an age when drugs are a part of life.

“Who’s 75 years old and not taking medications?” asked Gary Snyder, national chairman of U.S.A. Track & Field’s masters committee, which will oversee more than 100 competitions this year for athletes over age 30. . . . .

Should Students be encouraged to take brainpower boosting drugs?

I have a lot of pieces on this issue here. It seems to me like a simple cost benefit analysis. There is no more a moral question than whether people should drink coffee to wake up or have surgery to repair joints. This article below is from the Times of London:

Students should be allowed to take “smart drugs”, such as Ritalin, to help boost their academic performance, a leading academic has suggested.

John Harris, professor of bioethics and director of the Institute for Science, Ethics and Innovation at the University of Manchester, said the government and medical profession should “seriously consider” making cognition-enhancing drugs available to students without prescription, or allowing them to be prescribed for non-therapeutic purposes, such as studying.

Students have long used drugs to boost their study performance. Caffeine and ginseng are traditional favourites. But recently the use of more powerful, restricted drugs, particularly the anti-hyperactivity medicine Ritalin, has spread from campuses in the US.

Currently such drugs are available only on prescription. Although many students buy them on the internet, their use without a prescription is a criminal offence.

But Professor Harris, joint Editor-in-Chief of The Journal of Medical Ethics, said that serious consideration should now be given to making some of them available on prescription for non-medical reasons, specifically for the purpose of enhancing cognitive performance.

There was now a sizeable body of evidence to show that stimulants such as Ritalin, Provigil and Adderall significantly improve concentration and performance and their side effects were proportional to their benefits, he said. . . . .

Even the NY Times recognizes that Women will never run as fast as Men

Testosterone is apparently the key difference.

BEIJING — No matter what happens in the men’s marathon here Sunday, one thing is all but certain. The winner will run the 26.2-mile course faster than the winner of the women’s marathon last Sunday.

The woman who won, Constantina Tomescu of Romania, was fast, of course, finishing the race in 2 hours 26 minutes 44 seconds — more than a minute ahead of the second-place finisher. But for a variety of intrinsic biological reasons, the best women can never run as fast as the best men, exercise researchers say.

Women are slower than men in running, in swimming, in cycling. Whether it is a 100-meter race on the track or a marathon, a 200-meter butterfly swim or a 10-kilometer marathon swim, the pattern holds.

And even though some scientists once predicted that women would eventually close the gender gap in elite performances — it was proposed that all they needed was more experience, better training and stronger coaching — that idea is now largely discredited, at least for Olympic events. Researchers say there is no one physiological reason for the gap, although there is a common biological thread.

“To a large extent, it’s a matter of testosterone,” said Dr. Benjamin Levine, director of the Institute for Exercise and Environmental Medicine at Presbyterian Hospital and the University of Texas Southwestern Medical Center in Dallas. “That’s why systematic doping of women is even more effective than systematic doping of men. That’s why the East German women were so much more successful than the East German men.”

The hormone affects everything from muscle size and strength to the size of the heart to the amount of oxygen-carrying blood cells in the body to the percentage of fat on an athlete’s body. Every one of those effects gives men a performance advantage.

Testosterone, Levine said, gives men what he calls a bigger and better-fueled engine. Their skeletal muscles, which do the work during exercise, are bigger. And their hearts, which provide fuel for the work, are bigger, too.

It is not that every man is inherently better than every woman.

“A very lean, well-trained woman will be faster than a less lean, less fit man,” he said. But that is not the issue in the Olympics, where the men and women are among the world’s best. . . .

Did Mitchell Steroid Report Tarnish Other Players' Images to Protect Barry Bonds?

By putting together a long list of players who had used steroids, the Mitchell Report made it difficult for MLB to do anything to Barry Bonds. The vast majority of the 80 names listed were essentially unknowns, but there were enough names a few well known ones to make punishing people seem impossible. Many of those attacked where attacked based on virtually no evidence. Simply having one person mention their name was enough to get them included in the list. Well, some are fighting back.

NEW YORK — Roger Clemens posted a video Sunday repeating his denials of the steroids use alleged against him in the Mitchell Report and plans to be interviewed for a future episode of "60 Minutes."

The seven-time Cy Young Award winner was accused in the report of using steroids, an allegation made by his former trainer.

In October last year, the Los Angeles Times reported Clemens was linked to steroids in the May 2006 sworn statement of a federal agent who cited former big league pitcher Jason Grimsley. At the time, the names of players in the public version had been blacked out. When the full affidavit was unsealed Thursday, Clemens' name was not in it, and the paper issued a correction and an apology.

"I faced this last year when the L.A. Times reported that I used steroids. I said it was not true then, and now the whole world knows it's not true, now that that's come out," Clemens said in the video, which was posted Sunday on the Web site of his foundation and on You Tube.

His youtube response can be seen here.

Steroids for the brain?

If we are going to ban steroids from sports, when are we going to begin banning treatments that improve people's performance in school? Of course, you might also have to ban caffeine and other drugs. But why is it worse for people to do well in sports by taking steroids than someone to do better on the SATs and thus beating out someone else for a place at a top school?

A rise in healthy people popping pills to boost performance in exams or work, raises long-term ethical and safety concerns about the effects of such treatments, British doctors said on Thursday.

The British Medical Association (BMA) wants a public debate about the risks and benefits of using drugs to improve memory and concentration, sometimes called "cognitive enhancement". . . . .

Even amphetamines banned from baseball. Is coffee next?

The military gives amphetamines to pilots, people in a huge number of jobs rely on them, but no longer are they allowed in baseball. Why is this so bad? Selig's statement that he doesn't hope that it has any effect on the quality of the game seems like wishful thinking.

Last week, the baseball season passed the three-quarters pole in its grueling schedule of 162 games spread out over 183 days. With the late-summer heat and the accumulated fatigue taking their toll on players' bodies, it is the time of year when in past seasons the use of amphetamines, long considered an integral part of the major league experience, would typically be at its peak.

However, this being the first year of baseball's ban on amphetamines -- also known as "greenies," "beans" and several other nicknames -- players no longer have that option, a reality that some observers believe has had a subtle effect on the game.

"I definitely know there are some guys who get to a Sunday day game, after a Saturday night game, and say, 'Man, I wish I had a greenie.' I've heard guys say that," Cincinnati Reds pitcher Bronson Arroyo said. "So there's probably been some small effect. But I don't think it's been as noticeable as people thought it would be."

Baseball's steroid-testing program is now in its fourth season and its third incarnation, having been strengthened twice under pressure from the federal government. However, until last November baseball had resisted banning amphetamines, synthetic stimulants that, some within the game argued, were not true performance-enhancers -- an assertion that is contradicted by leading authorities on the use of drugs in sports.. . . .

Commissioner of Baseball Bud Selig was asked during the all-star break last month about the belief that the quality of play would decline this summer because of the amphetamine ban. "I know there are some people who feel that way," he said. "I hope the quality of play does not change. You can do a lot of other things -- [such as] get a good night's rest." . . . .

A history of amphetamines is provided here. The interesting note is the use of amphetamines in mountain climbing (may be auto racing also) where I would think that there is a strong argument that amphetamines are possible life saving drugs. For that matter, this could be true for more than a few of the sports that they list.