By Jessica Wells, Dr. Anthony Rosselli, & Dr. Samantha Roberts — Texas A&M University — Commerce; Anthony.Rosselli@tamuc.edu
There is an inherent risk of injury associated with any physical activity. From minimal contact sports (e.g., tennis) to high contact sports (e.g., ice hockey), injuries and accidents happen. The problem arises when a manager, coach, supervisor, or governing body owes a duty of care for the participants of a sport or activity, fails to provide said care, and an injury occurs as a direct result of that failure. Such is the accusation brought against the U.S. Soccer Federation (USSF, also referred to herein as U.S. Soccer) and its largest member, the U.S. Youth Soccer Association (USYSA), by attorneys for two girls (Aliva Sherman and Adiah Siler). The lawyers claim that recent studies demonstrate that modern headgear could reduce concussions (Ove, 2018), and that these governing bodies have been negligent in their duty to minimize the risk of injury to its players and properly inform participants of the risks associated with concussions (Sherman et al. v. The United States Soccer Federation et al., 2018). This class action suit is relevant as concussions are a leading point of emphasis for contact sports and preventative measures have taken a front stage position as of late. High profile cases in the National Football League concerning concussions have brought the issue into focus for otherwise unaffected individuals.
Concussions in female soccer in the U.S.—The American Academy of Pediatrics claims that “up to 3.8 million recreation-and sport-related concussions occur annually in the United States” (as cited in Halstead & Walter, 2010, p. 599). For reasons unknown, girls’ soccer shows higher rates of concussions than boys’ soccer (Halstead, Walter, & The Council on Sports Medicine and Fitness, 2010; Lincoln, Caswell, Almquist, Dunn, Norris, & Hinton, 2011; Marar, McIlvain, Fields, & Comstock, 2012). Girls’ soccer results in the most concussions second only to American football (Marar et al., 2012). As such, there is justification for increased awareness and emphasis placed on preventing concussions in female soccer (overall) and youth girls’ soccer (specifically, as relevant to the current discussion).
USSF and USYSA concussion prevention strategies—The Sherman suit claims that the USSF and the USYSA have failed to provide the duty of care owed to its participants concerning prevention and education of concussions. Of particular emphasis is the use of headgear to prevent said injury. Namely, the plaintiffs claim that USSF soccer has failed to mandate/require the use of protective headgear known to reduce concussive symptoms and/or injuries. Furthermore, they claim that USSF has failed to educate the parents and players concerning the severity of concussions and concussion safety and prevention. As this negligence and fraudulent concealment are points of emphasis in this suit, an examination of these governing bodies’ concussion prevention and education strategies is warranted.
History—The Sherman class-action suit is not the first of its kind to be filed against a national soccer governing body. In 2014, a class-action suit was filed against the Fèdèration Internationale de Football Association and affiliated soccer organizations (including USSF and USYSA) that resulted in this jointly agreed upon sweeping safety initiative (i.e., Recognize to Recover). This suit sought only rule changes and was viewed as a victory by the plaintiffs (Torncello, 2015). USSF claims that this lawsuit did not prompt the increased emphasis on concussion management and education, and that, “Work on this campaign…was started long before the lawsuit” (“Player Safety Campaign FAQs — U.S. Soccer,” n.d.). The concussion guidelines were created by U.S. Soccer with the collaboration of 12 experts in the field of concussions. After reviewing current scientific data, rule changes and best practices were developed (“Recognize to Recover,” 2016).
Education—The USSF website has webpages dedicated to the recognition and recovery of a variety of injuries and ailments that could be experienced by its participants. Concerning head and brain conditions, concussions begin the webpage with an informational video discussing the signs and symptoms of concussions. Furthermore, there are written signs and symptoms on the web page as well as informational pdfs provided for download (e.g., fact sheets for players, coaches, and parents; CDC webpages with information for parents on concussions, etc.). According to the guidelines, all new players to Youth National Teams must participate in baseline concussion testing. Furthermore, any player who complains of a head injury or sustains a blow to the head will be immediately removed from play and evaluated by a licensed health care provider on the sidelines using approved concussion evaluation procedures. Specific rules and procedures for the certification of all referees and coaches are also outlined. Worthy of note is the mandate that all non-U.S. Soccer-licensed referees and coaches must demonstrate that have reviewed the concussion videos and information/protocols available on the U.S. Soccer sport medicine page. Finally, U.S. Soccer and each of the implementing members are instructed to direct players and parents to the concussion video, informational links, and respective websites (“U.S. Soccer Recognize 2 Recover Concussion Initiative Guidelines,” 2015).
Prevention strategies related to heading—The Recognize to Recover initiative has also strongly recommended the reduction of allowed heading time for the various age groups. According to the guidelines, U11 and under athletes should not be allowed to head the ball in practice and games. U12 and U13 players are only allowed to practice heading for a maximum of 30 minute per week, with no more than 15-20 headers per player per week (“Recognize to Recover,” 2016). It is important to note that these are strongly urged recommendations for all USSF Youth members, and are only required for the Youth National Teams.
Perspectives from coaches and athletes – Methods
The first author chose the topic of concussions in youth female soccer for her honors thesis project. Interviews were conducted with 15 current and former collegiate female soccer players (from all positions) with an average of 14.7 years of playing experience and three collegiate female soccer coaches with an average of 24 years of coaching experience. Participants were asked a variety of questions on the topic of concussions in youth female soccer, their position on the aforementioned Recognize to Recover Guidelines, and heading restrictions for U11 soccer and below. The interviews were transcribed and analyzed for common themes. In the interest of space, findings are condensed to the most relevant points for this article.
Findings
Inherent Risk in Sport and alternate causes—Both coaches and athletes discussed the inherent risk associated with sport (regardless of how many rules are implemented). One player stated that playing soccer is “no different from getting behind a wheel [and risking] getting in a car wreck.” Another player emphasized that a soccer player can be hit in the head in a variety of ways not related to heading during a match. For example, a ball that is kicked hard towards a player can strike them in the head, resulting in a concussion. One player has a younger brother who currently plays under the no heading rule. In order to compensate for the lack of ability to head, these young players are now utilizing more high kicks to get to the ball before their opponent (thus introducing another potential cause for concussions).
Lack of practice can lead to improper technique—When asked about the implications of these rule changes on the development of future soccer athletes, players and coaches discussed the negative impact of not properly learning this key skill at a young age. Coaches and athletes emphasized the importance of teaching proper heading technique early in an athlete’s career, such that injuries can be prevented (similar to the USA Football’s ‘Heads Up initiative’). One athlete mentioned that had she grown up under these guidelines that she would be more scared to head the ball and would have headed incorrectly as a result (thus opening the possibility of injury). Rather than eliminate or minimize the practice of heading in youth soccer, coaches and athletes recommended alterations to the current method of teaching headers. Worthy of note was ensuring the proper inflation of the ball and practicing extensively in a controlled environment, where athletes can focus on technique prior to implementation during game speed scenarios.
Discussion
Given the inherent risk associated with sport, the history of the USSF’s implementation of the Recognize to Recover guidelines and the measures taken to educate, prevent, and treat concussions in youth soccer, it is unclear how the Sherman suit will unfold. Negligence cases in sport are difficult to prove, and given the USSF’s educational stance, information available on its website, requirement of coaches and referees to view their concussion information, and emphasis that multiple parties (e.g., coaches, trainers, etc.) inform players and parents of the signs, symptoms, and consequences of concussions, it appears to be an uphill battle to demonstrate negligence and fraudulent concealment on these counts. Concerning the mandated use of protective headgear, research has demonstrated that 61.9% of heading-related concussions are caused by player to player contact. If players were required to wear protective headgear, this may have an impact on the rate of heading-related concussions. However, American football players wear full helmets and still experience concussions. Some research has demonstrated the usefulness of headgear in youth soccer. For example, Delaney, Al-Kashmiri, Drummond, and Correa (2007) demonstrated that youth soccer players who wore protective headgear suffered less concussions (26.9% or 14/52) than those who did not (52.8% or 114/216). Another study showed that headgear has the potential to decrease concussions during head to head impact on average 32.6% within controlled laboratory tests (Withnall, Shewchenko, Wonnacott, Dvorak, & Delaney, 2005). This may be the strongest evidence that the plaintiffs have in the case. More research on the use of headgear in the soccer setting is warranted to determine the usefulness of this strategy in concussion prevention and may be key in future litigation on this topic.
References
Delaney, J. S., Al-Kashmiri, A., Drummond, R., & Correa, J. A. (2007). The effect of protective headgear on head injuries and concussions in adolescent football (soccer) players. Br. J. Sports Med., 42, 110-115.
Halstead, M., & Walter, K. (2010). American Academy of Pediatrics. Clinical report—
sport-related concussion in children and adolescents. Pediatrics, 126(3), 597-615. doi:10.1542/peds.2010-2005
Lincoln, A. E., Caswell, S. V., Almquist, J. L., Dunn, R. E., Norris, J. B., & Hinton, R. Y.
(2011). Trends in concussion incidence in high school sports: A prospective 11-year study. American Journal Of Sports Medicine, 39(5), 958-963.
Marar, M., McIlvain, N. M., Fields, S. K., & Comstock, R. D. (2012). Epidemiology of
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Ove, T. (2018, May 29). Pa. families sue U.S. Soccer, claiming negligence in preventing concussions among girls. Pittsburgh Post-Gazette. Retrieved from http://www.post-gazette.com/news/crime-courts/2018/05/29/Pennsylvania-class-action-lawsuit-US-Soccer-concussions-girls-federal-court-protective-gear/stories/201805290137
Player Safety Campaign FAQs — U.S. Soccer. (n.d.). Retrieved from https://www.ussoccer.com/about/recognize-to-recover/concussion-guidelines/player-safety-campaign-faqs
Recognize to Recover (2016). U.S. Soccer presentation.
Torncello, P. M. (2015, November 15). U.S. Soccer Federation settles youth concussion lawsuit. Retrieved from https://www.collegeandprosportslaw.com/uncategorized/u-s-soccer-federation-settles-youth-concussion-lawsuit/
U.S. Soccer Recognize 2 Recover Concussion Initiative Guidelines. (2015). Retrieved from file:///C:/Users/RosselliAnthony/Downloads/Concussion%20Initiative%20Guidelines%20151125.pdf
Withnall, C., Shewchenko, N., Wonnacott, M., Dvorak, J., & Delaney, J. S. (2005). Effectiveness of headgear in football. Br. J. sports Med, 39, 40-48. doi:10.1136/bjsm.2005.019174
