Catastrophic brain injuries associated with full-contact football appear to be rising, especially among high school students, according to a new report. The increase is alarming and indicates more coaches and athletic trainers should change how they teach the fundamental skills of the game, according to researchers based at the University of North Carolina at Chapel Hill. Until recently, the number of football-related brain injuries with permanent disability in high school had remained in the single digits since 1984. However, the tally rose to 10 injuries in 2008 and 2009, and there were 13 in 2011, according to the latest catastrophic football injury research annual report from the UNC-based National Center for Catastrophic Sports Injury Research. “These 2011 numbers are the highest since we began collecting catastrophic brain injury data,” said Fred Mueller, Ph.D., the report’s lead author, director of the center and professor emeritus of exercise and sports science in the College of Arts and Sciences. “This is a major problem.” About 4.2 million football players compete nationwide, including 1.1 million high schoolers. The center has collected data and published annual reports on catastrophic football injuries, including fatalities, disabilities and serious injuries, for 48 years. The National Collegiate Athletic Association, National Federation of State High School Associations and the American Football Coaches Association fund the research. The center’s work is believed to be directly responsible for nearly eliminating football fatalities, as well as drastically reducing the number of cervical cord injuries to single digits, between the late 1960s and the early 1990s. Since 1977, about 67 percent of football-related catastrophic injuries have been suffered by players as they made tackles. Mueller said part of the problem is that despite being prohibited in 1976, head-to-head contact – such as butt-blocking, face tackling or spearing tackles – is still occurring. These strategies make the head the initial and primary contact point with an opposing player, and often lead to cervical spine fractures or permanent brain injuries. Some players recover fully after surgery and rehabilitation following injuries. However, many only recover partially, living with paralysis or mental deficiency, relying on intensive lifetime medical care. Since 1984, there have been 488 cervical cord and cerebral injuries with incomplete recovery, including 164 brain injuries, of which 148 were among high schoolers. Additionally, the years between 2001 to 2010 saw a 25 percent jump in football-related disability brain injuries over the previous decade, increasing to 66 from 52 incidents among all types of players. Other potential reasons for the apparent increase in brain injuries may be because of heightened awareness of the issue. Also, this year’s report updated the number of football participants. However, Mueller noted that neither of these factors likely influenced the overall figures, since the report’s definition of catastrophic injuries (defined as injuries that resulted in brain or spinal cord injury or skull or spine fracture, which involved some disability at the time of the accident) and data collection methods have remained unchanged. Mueller said reversing the https://equired several changes, which some in the football community are already implementing. Coaches must be well versed in the signs and symptoms of concussions, such as headaches, dizziness, nausea and light sensitivity, and pull players from games if they exhibit those indicators. Players should not return to play until cleared by a physician. Teams also should hold pre-season meetings to discuss concussions, conduct medical evaluations of all players and emphasize that the head should not be used in tackling or blocking. The report’s recommendations also note that schools should hire coaches who teach proper fundamental skills, and retain athletic trainers certified by the National Athletic Trainers’ Association. Referees must be vigilant about throwing flags when they see illegal tackles and parents also must be involved in meetings and discussions about concussions. “All of these measures are important if we want to continue to make a positive impact on the game,” he said. “We have to continue research in this area. Accurate data not only indicate problem spots, but they also help us offer appropriate precautions and reveal the adequacy of our preventive measures.” The report’s co-author is Dr. Robert C. Cantu, chair of surgery and chief of neurological service at Emerson Hospital in Concord, Mass. Report webpage (PDF file): https://www.unc.edu/depts/nccsi/FBCATReport2011.pdf Source: University of North Carolina at Chapel Hill Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

The first of three private screenings was held in Chicago on May 15th for "Head Games," a documentary on the sports concussion crisis. From acclaimed director Steve James (Hoop Dreams, The Interrupters) and award-winning producer Bruce Sheridan, Head Games takes a deeper look at the devastating and long-term effects of concussions in all sports. Inspired by events from the book Head Games written by Christopher Nowinski, the film offers eye-opening insight and cutting-edge science on head trauma from the nation’s leading medical experts. Additional screenings will be held June 6 at the Boston University School of Medicine Albany Street Auditorium and June 7 in Philadelphia at the Translational Research Center (TRC) Rubenstein Auditorium. Watch the trailer Questions/comments? contact Jean Rickerson at Jean@SportsConcussions.org

The Dynavision D2 ™ is an FDA cleared medical device with a long history concerning sports performance enhancement and an even longer history concerning neuro visual rehabilitation of stroke and brain injured patients. Physical medicine rehabilitation practitioners have used it to train brain injured patients to improve hand eye coordination since the 1980s. With a pedigree from the neuroscience community concerning rehab and from the sports community for improving performance it was a logical fit that the D2 ™ be applied to the management of the athlete with a concussion. The Dynavision D2 ™ is a light board with 64 lights mounted in a board along with a small screen. The primary task is to hit the red or green lights. It assesses speed and coordination. When the computer screen and lights are used together there are numerous tasks the athlete can be asked to do. Several universities and professional sports organizations have adopted the Dynavision D2 ™ as part of the concussion management program, and for good reason. The Dynavision D2 ™ can be used as part of baseline testing. The results of the baseline tests are used for comparisons should a concussion occur. These same athletes may also train their eye hand coordination using the Dynavision D2 ™ for performance enhancement. This means the device is familiar to them and true baseline and performance parameters can be obtained. After a concussion, the Dynavision D2 ™ can be used as part of a traditional neuro cognitive examination and monitoring program. The baseline Dynavision D2 ™ results can be compared to repeat tests to see if deficits are present. Further, programs designed to assess multiple brain cognitive parameters can be performed in just a few minutes. The three tests assess: eye-hand coordination while multi-tasking, memory and cognition, cognition and executive functions. Observing the subject and noting their scores allows for an assessment of their concussion status. One of the strengths of the Dynavision D2 ™ is that it has an established cadre of programs that anyone can use. These programs can be used for rehab, prehab and diagnostics. Plus it has a relatively intuitive program option that allows more experienced practitioners and ADT trained individuals to design their own programs to meet their needs. This means that the Dynavision is a highly flexible and adaptable platform. Every person who works with athletes, injured athletes and neuro patients knows that each person is different and unique; training and rehab methods need to be personalized. Fortunately the Dynavision allows us to customize the programs to address the needs of the patient. There are numerous anecdotes where a patient who expresses a deficit that he/she is having to a rehab person who can write and try a program to help that patient during that very rehab session. One of my patients at the concussion clinic in theUniversityofCincinnatiwas injured in a wind storm. During her baseline neuro exam, we utilized the tests mentioned above and additional tests based on her specific results. The D2 was able to demonstrate the patient was unable to multi-task, making numerous math errors on simple 1 digit additions. In addition, based on a general neuro exam, the patient exhibited deficiencies in ocular motor, memory and executive function. This patient specifically benefited from the D2 as part of her neuro exam because the D2 gave measurable, unbiased results. The results of the exam were utilized to incorporate D2 training into her rehab program to improve binocularity, reaction time, multi-tasking, and cognition skills. In my opinion, without using the D2, this patient’s rehab would not have been as successful and it could have been possible to overlook subtle deficiencies that D2’s measurable results are able to track. In the center of the Dynavision D2 ™ is a tachistoscope; or small computer screen. This screen is used in several of the evaluation and rehabilitation methods. It adds tremendous flexibility to the system because it can be used to add tasks to what the subject is required to do. With the tachistoscope the patient can now be required to do a hand-eye task as well as reading or other task from the screen. This allows for multitasking to be performed and adds to the flexibility and strength of the Dynavision D2 ™ as a tool to manage the concussion patient. Repeating the evaluations on the Dynavision D2 ™ can be used as part of quantitative monitoring of the subjects as they progress through concussion rehab. The Dynavision produces reliable numbers that reflect the subjects’ performance or highlights deficiencies. When the Dynavision D2 ™ is used as part of the rehab training it becomes a cornerstone in the patient’s care and the patient can see, based on their own results, how well they are doing. Rehabilitation methods can be tailored to the needs of the patient and with many years of experience from the stroke and brain injury literature there are numerous options for the Dynavision D2 ™ to aid in a concussion rehabilitation program. About the Authors: Dr. Clark is a certified athletic trainer, professor of neurology and member of the concussion management team in the University of Cincinnati. He is an expert in complications post acquired brain injury and has published several texts and over 100 scientific articles. Mrs. Umberg is a former concussion patient and the patient referred to in this Case Study. Having used Dynavision as part of her rehab program she has since become a patient advocate and team member in the concussion management team in the University of Cincinnati and Dynavision Trainer. Disclaimer; the statements made are not screened or approved by the FDA. Source: Joseph F. Clark and Jennifer A. Umberg Department of Neurology, University of Cincinnati, Cincinnati Ohio; 45267-0536. Corresponding author: Joseph F. Clark, Professor of Neurology, joseph.clark@uc.edu.

Wisconsin governor Scott Walker signed youth concussion legislation into law today at Lambeau Field in Green Bay. Support for the bill came from physicians, student-athletes, the NFL's Green Bay Packers and other organizations. NFL Commissioner Roger Goodell has exhibited an unwavering committment to the adoption of concussion legislation nationwide, starting with the Washington state concussion law named after middle school football player Zackery Lystedt, who was injured during a game in 2006. Like the Lystedt Law, Wisconsin's concussion law calls for the removal of any athlete suspected of having suffered a concussion and requires a player to obtain written medical authorization before resuming activity. The new law also requires the state Department of Public Instruction to work in conjunction with the Wisconsin Interscholastic Athletic Association to develop guidelines and education standards for parents, coaches, and athletes. Source: Walker signing bills legalizing wolf hunt, cracking down on youth concussions -- Star Tribune --April 2, 2012 Questions/comments? Contact Jean Rickerson at Jean@SportsConcussions.org

SEQUIM, Wash. -- Battle-tested and a little weary from last fall’s high school football season, Travis Anderson, an experienced EMT and paramedic John Riley, understand the nuances of concussions. Athletes who — if they are conscious – say they are ‘fine,’ coaches who may not be sure an athlete needs medical attention, and parents told by ER staff that rest is the prescription for recovery, trying to make sense of the mountain of hospital medical bills. They’ve seen it all, and it’s not easy. First responders like Anderson and Riley from Clallam County Fire District #3 in Sequim, Wash., are a luxury for school districts around the country. Part of a crew made up of paid staff and volunteers, they wait in the corners until given the signal by a coach or referee, or a player goes down and stays there. Like other on-field personnel they can’t see every impact and don’t always know if an athlete is deteriorating on the bench after a big hit. They depend on an educated coaching staff and fellow teammates for their cues. Anderson said,”We’d like to be called sooner rather than later. If there’s any question, especially with a suspected concussion, call us.” Too little care Only about 42 percent of high schools nationally employ athletic trainers, a dismal number in the eyes of many concussion experts who continue to advise against any school district or private organization offering contact sports without proper sideline medical care. Given the budget crises facing many school districts, it is not surprising so few heed this advice. But the challenges in rural areas are even greater. Long distances separate football fields from hospitals and fire stations can serve several high schools. Resources are simply too lean. Many sports-related concussions “Our fire department provides sideline staff for high school football games, and as many junior varsity games as we can. We consider it part of our community service effort and quite frankly, we feel strongly about protecting our student-athletes and their futures,” said District #3’s Fire Chief, Steve Vogel. His first responders have been on the sidelines at Sequim School District's games since 1982. Chief Vogel’s staff has a long history dealing with sports concussions. Former Sequim football player Adrien Gault suffered a catastrophic brain injury during a game in 2006 and was airlifted to a Seattle trauma center where doctors gave him a four-percent chance of survival. He continues to work through his recovery. This past fall, a Sequim student suffered a brain aneurysm during a Friday afternoon PE class and died a few days later. That same Friday there were six significant concussions on the football field a few hundred yards away, said a well-informed source, turning the field into a war zone. Fire District #3 was there for it all. “There were more concussions during that one game than I’ve seen in my entire career, including my time as a running back in high school,” said Anderson. “It was a rarity.” Neither he nor Riley, who played tight end in high school remember suffering concussions during their football careers. They believe they’re seeing so many due to increased awareness trickling down from the NFL. Anderson said, “I think the attention on the concussion issue in the NFL is having an affect on all levels of the game, all the way down to the youngest players.” Emergency Medical Services for Children (EMSC) Guidelines and training for first responders come in the form of online education modules and concussion-related drills practiced several times a year. Soon-to-be-released state protocols developed by emergency room physicians, critical care nurses, EMTs, and others who make up the state committee of the federal Emergency Medical Services for Children program include a sports-concussion guide for first responders. Upon distribution, this document will provide a handy reference for those who attend youth and high school athletic events. “The Emergency Medical Services for Children (EMSC) program works to ensure proper pediatric care is available on ambulances and in hospital emergency departments nationwide,” said Ian Weston, Co-Director of the EMSC program headquartered in suburban Wash. D.C. “Emergency care providers are integral in ensuring our children get the right care when it counts.” When to call 911 Concussion symptoms can be subtle and may not appear right away, leaving room for mistakes to be made if athletes are not properly monitored when a concussion is suspected. The following are symptoms that require a call for emergency evaluation: •headaches that worsen •seizures •neck pain •very drowsy, can't be awakened •repeated vomiting •increasing confusion or irritability •weakness, numbness in arms and legs •unable to recognize people/places, less responsive than usual For more information see Should we call 911?, signs and symptoms Photo: (L) John Riley (firefighter/paramedic); (R) Travis Anderson (firefighter/EMT) Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

Like emergency workers rushing to a disaster scene, cells called microglia speed to places where the brain has been injured, to contain the damage by ‘eating up’ any cellular debris and dead or dying neurons. Scientists at the European Molecular Biology Laboratory (EMBL) in Heidelberg, Germany, have now discovered exactly how microglia detect the site of injury, thanks to a relay of molecular signals. Their work, published May 24, 2012 in Developmental Cell, paves the way for new medical approaches to conditions where microglia’s ability to locate hazardous cells and material within the brain is compromised. “Considering that they help keep our brain healthy, we know surprisingly little about microglia,” says Francesca Peri, who led the work. “Now, for the first time, we’ve identified the mechanism that allows microglia to detect brain injury, and how that emergency call is transmitted from neuron to neuron.” When an emergency occurs, cries can alert bystanders, who will dial the emergency number. A call will go out over the radio, and ambulances, police or fire engines in the area will respond as needed. In the brain, Peri and colleagues found, injured neurons send out their own distress cry: they release a molecule called glutamate. Neighbouring neurons sense that glutamate and respond by taking up calcium. As glutamate spreads out from the injury site, this creates a wave of calcium swallowing. Along that wave, as neurons take up calcium they release a third molecule, called ATP. When the wave comes within reach, a microglia cell detects that ATP and takes it as a call to action, moving in that direction – essentially tracing the wave backwards until it reaches the injury. . Lost alert: when microglia (green) cannot detect ATP (bottom), they don’t move to the injury site as they usually would (top).Photo credit: EMBL/Peri Scientists knew already that microglia can detect ATP, but this molecule doesn’t last long outside of cells, so there were doubts about how ATP alone could be a signal that carried far enough to reach microglia located far from the site of injury. The trick, as Peri and colleagues discovered, is the long-lasting glutamate-driven calcium wave that can travel the length of the brain. Thanks to this wave, the ATP signal is not just emitted by the injured cells, but is repeatedly sent out by the neurons along the way, until it reaches microglia. Dirk Sieger and Christian Moritz in Peri’s lab took advantage of the fact that zebrafish have transparent heads, which allow scientists to peer down a microscope straight into the fish’s brain. They used a laser to injure a few of the fish’s brain cells, and watched fluorescently-labelled microglia move in on the injury. When they genetically engineered zebrafish to make neurons’ calcium levels traceable under the microscope, too, the scientists were able to confirm that when the calcium wave reached microglia, these cells immediately started moving toward the injury. Knowing all the steps in this process, and how they feed into each other, could help to design treatments to improve microglia’s detection ability, which go awry in conditions such as Alzheimer’s and Parkinson’s diseases. Source: Sieger, D, Moritz, C., Ziegenhals, T., Prykhozhij, S. & Peri, F. Long-range Ca2+ waves transmit brain damage signals to microglia.Developmental Cell, published online 24 May 2012. Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

What does it mean to have a head concussion? Much has been written in recent years about the short- and long-term consequences of concussions sustained in sports, combat, and accidents. However, there appear to be no steadfast rules guiding the definition of concussion: the characteristics associated with this type of traumatic head injury have shifted over time and across medical disciplines. Within the context of a larger longitudinal investigation of the biomechanical factors in play that correlate with concussions in collegiate helmeted contact sports, researchers in New England and Virginia used data they obtained to investigate which signs, symptoms, and clinical histories were used by athletic trainers to define concussion in individual players. The investigators found that a heterogeneous collection of acute clinical characteristics currently exists for those events diagnosed as concussion in college athletes engaged in contact sports. Together with her colleagues, Dr. Duhaime, Director of Pediatric Neurosurgery and of Neurotrauma and Intensive Care in the Neurosurgical Service of Massachusetts General Hospital, examined concussions diagnosed in athletes participating in helmeted contact sports (football and ice hockey) at three universities: Dartmouth, Brown, and Virginia Tech. Both male and female athletes participated in the study. The students' helmets were outfitted with Head Impact Telemetry (HIT) System™ technology to record and measure peak linear and angular acceleration of impacts. The helmets were worn during practice sessions and games throughout two to four seasons. The investigators did not attempt to influence how trainers and team medical personnel defined concussion operationally, but instead relied on the clinical characteristics deemed indicative of concussion by the universities' athletic departments. More than 486,000 head impacts were recorded in 450 athletes, and concussion was diagnosed in 44 of these athletes (48 concussions) by team medical staff. Unlike concussions more often diagnosed in emergency departments, where a single, identified contact event leads to a loss of consciousness or other clear alteration in consciousness, most diagnoses in this sports setting were based on self-reports by athletes, and only a few were based on changes in athletes' clinical conditions that were observed by others. Thirty-one concussions could be directly associated with a specific impact, whereas a relationship with a specific impact could not be verified in the other cases of concussion. Only half of the athletes noted symptoms immediately after a contact event; in many athletes, the onset of symptoms was delayed. The most common reported symptoms were mental clouding, headache, and dizziness; only one case involved a loss of consciousness. The diagnosis of concussion by trainers often occurred in an even more delayed fashion: the diagnosis was made immediately after the event in 6 cases and at a later time in the other cases (median 17 hours postinjury). In general, the mean peak linear and angular accelerations for specific impact events that could be directly linked to concussions tended be in the high percentiles for the sports examined; however, there was considerable variability in the ranges of these measurements (mean peak linear acceleration 86.1 ± 42.6 g [range 16.5.9 g], mean peak angular acceleration 3620 ± 2,166 rads/sec2 [range 183,589 rads/sec2]). The variety of signs and symptoms, the imprecise timing of symptom appearance and relationship to a specific contact event, the lack of externally observed findings, and the broad ranges of the linear and angular accelerations of the impacts that coalesce in a diagnosis of concussion in college sports make it difficult to identify predictors of acute, intermediate, and long-term risks of adverse consequences resulting from sports-related head impacts. By describing the heterogeneity inherent in diagnoses of concussion as a "concussion spectrum," the authors point out the need for renewed efforts to determine which factors -- clinical, mechanical, genetic, or others -- influence outcomes in patients with single as well as repeated head impacts. The authors point out that while a clinical diagnosis is important to protect players from additional and potentially more serious consequences, it is also possible that athletes who do not receive the diagnosis of "concussion" may be at similar risk. Likewise, it is possible that some players who receive a diagnosis of concussion do not fall into a high-risk category for specific consequences. The authors note that there is still much to be learned, and that the terminology in use can sometimes oversimplify a more complex set of processes that still need to be teased apart. In their response to an accompanying editorial, they state, "By carefully characterizing exactly what we are talking about and by continued investigation, which will take more time ... , neurosurgeons and others will be best positioned to offer effective treatments and to advocate knowledgeably for appropriate injury-prevention strategies." Source: ScienceDaily

CHICAGO, May 24, 2012 -- Riddell Sports and USA Football today announced a renewed commitment to educating athletes and parents about concussion awareness. Starting today every new Riddell football helmet shipped to retailers and customers will include a hangtag offering concussion education that includes information from the Centers for Disease Control and Prevention (CDC) Heads Up program. Riddell's concussion education hangtag is the first of its kind among sports helmet manufacturers. "We have a longstanding commitment to player protection and continue to look for new ways to educate athletes and parents. As the leading manufacturer of football helmets, Riddell has raised concussion awareness through on-helmet labels and informational hangtags for over a decade," said Dan Arment, President of Riddell. "The new hangtag contains valuable information from the CDC and is the latest example of how Riddell will address concussion awareness with athletes and parents." Approximately three million American children age 6-14 play organized tackle football, placing it among the country's most popular youth sports. Since May 2009, 35 states and the District of Columbia have passed legislation to strengthen concussion education across youth and high school sports. Riddell's new hangtag will be attached to each helmet through an ear hole. The tag is titled "Raise Your Concussion Awareness" and lists concussion signs and symptoms, including CDC guidelines on what to do if a concussion is suspected. "Riddell shares USA Football's commitment to player safety and concussion awareness," USA Football Executive Director Scott Hallenbeck said. "Every parent who has a child playing youth football should ask their league two questions: 'How are your coaches trained to teach my child?' and 'Are your coaches educated on the symptoms and management of concussion?' Helmet hangtags will make certain that Riddell customers have a baseline of knowledge in this area and are directed on where they can learn more online." Riddell is the official football helmet and protective equipment partner of USA Football, the sport's national governing body in the United States. USA Football has partnered with the CDC to advance concussion education since 2007, particularly in high school and youth football. About USA Football: USA Football, the sport's national governing body in the United States, hosts more than 100 football training events annually offering education for coaches, skill development for players and resources for youth football league commissioners. The independent non-profit is the official youth football development partner of the NFL, its players and each of the league's 32 teams. Indianapolis-based USA Football manages U.S. national teams within the sport for international competition and provides $1 million annually in equipment grants and subsidizes youth league volunteer background checks. Endowed by the NFL and NFL Players Association in 2002 through the NFL Youth Football Fund, USA Football is chaired by former NFL team executive Carl Peterson. About Riddell: Founded in 1929, Riddell is a premier designer and developer of protective sports equipment and a recognized leader in helmet technology and innovation. One of Easton-Bell Sports, Inc.'s most well-known brands and the Official Helmet of the NFL®, Riddell is the leading manufacturer of football helmets, shoulder pads and reconditioning services (cleaning, repairing, repainting and recertifying existing equipment). SOURCE: Riddell Questions/comments? Contact Jean Rickerson at jean@SportsConcussions.org

Collisions. Headers. Goalpost run-ins. Soccer athletes and fans can't help but wonder which elements contribute most to the frequency of concussions in the sport, particularly among young girls. Researchers have been collecting data in helmeted sports for many years using accelerometers embedded in head gear, but non-helmeted sports have presented obvious challenges. Impact data has provided some of the most critical science in the concussion field. As a result, the forces that players sustain in various contact sports are well-documented and found, in some cases, to be alarming. The latest addition to the data bank was the inclusion of an impact study on 7-and 8-year-old football players and the adult-sized forces they incurred during practices. Now the focus is turning to other sports, including soccer. A new study by researchers at Wayne State University, published in the Journal of the American College of Sports Medicine offers insight into head acceleration in girls' youth soccer (U14) during game play. HITS The Head Impact Telemetry System (HITS) used to measure the force impacts, was utilized in this study. Small accelerometers typically mounted inside helmets, transmit data wirelessly to researchers on the sideline. In this case, soccer headbands with the padding removed were outfitted with the instrumentation. Impacts over 10g, or 10x the force of gravity, were recorded and analyzed at a later time alongside corresponding video footage to determine the nature of the hit. For reference, a sneeze might be 3g, a fighter pilot might "pull" 9g during maneuvers, and high school football players regularly sustain hits ranging from 60-100g and higher, many without reporting concussion symptoms. A total of 24 girls participated in the study, conducted during scrimmages on grass fields. Scrimmages lasted 30 to 65 minutes each. None of the players suffered a concussion during the research. Results There were 47 header impacts and 20 non-header impacts observed during the study. Non-header impacts included collisions with another player, player falls, collisions with goalposts, and unintended collisions with the ball. Researchers found: - majority of non-header impacts (40%) were player-to-player collisions - most headers impacted the front of the head; the peak linear acceleration (force) recorded was 4.5g- greatest header force occurred on the right side of the head and was measured at 62.9g - most head impacts players sustained in one scrimmage was four - side headers resulted in greater forces than back headers - player collisions resulted in the highest number of nonheader impacts and had a maximum force of 56.7g - impacts from player falls measured a maximum force of 23.7g - a goalpost collision measured a maximum of 27.1g Researchers hypothesized that non-header impacts would exceed those from heading the ball, but that was not what the case. Many of the players experienced multiple impacts in a single scrimmage, the cumulative effects of such impacts within a short time frame are unknown. Conclusions Concussions can occur in any sport and amending equipment and making rule changes to decrease the frequency and severity of the injury depends on science. Soccer has emerged as the leading cause of sport-related concussions for young girls and researchers are working to unravel the reasons why. Hypotheses range from less neck strength, to hormonal differences to better reporting by females. Source: Medicine & Science in Sports & Exercise: June 2012 - Volume 44 - Issue 6 - p 1102–1108 doi: 10.1249/MSS.0b013e3182444d7d Applied Sciences Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org