Sport safety research opportunity

D L Nordstrom

doi:10.1136/ip.2004.005975

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Sport safety research opportunity

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Meeting sports safety research challenges
David L Nordstrom
Published on: 13 May 2016
Sports safety research is not without its challenges
Caroline F Finch
Published on: 13 May 2016
Soccer injuries and headgear
Calvin W. Williams
Published on: 13 May 2016

Published on: 13 May 2016
Meeting sports safety research challenges
- David L Nordstrom, Epidemiologist
Dear Editor
I am grateful to Caroline Finch for responding[1] to my letter suggesting research on soccer headgear.[2] Because there has been little research on risk factors for sports injury,[3] Finch is correct that headgear use in soccer is only one opportunity for sport safety research. However, certain factors make soccer headgear an especially attractive topic. The population at risk of soccer inj...
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Dear Editor
I am grateful to Caroline Finch for responding[1] to my letter suggesting research on soccer headgear.[2] Because there has been little research on risk factors for sports injury,[3] Finch is correct that headgear use in soccer is only one opportunity for sport safety research. However, certain factors make soccer headgear an especially attractive topic. The population at risk of soccer injury includes 240 million people in the world who play soccer,[4] head injury can lead to disabling cognitive deficits, and Fédération Internationale de Football Association (FIFA), which governs soccer throughout the world, in 2003 modified its rules to allow all soccer players to wear padded headgear.[5]
In her intervention study of headgear in Australian rules football, Finch found that most participants declined to wear the headgear.[6] By the way, her paper is only the 5th English-language article found from 1966 through October 2004 by a Medline search combining “Head Protective Devices” and “Soccer” as exploded subject headings, including all subheadings. Finch notes that randomized controlled trials can be difficult to conduct, which I accept. However, sport safety investigations need not be limited to experiments because other study approaches--including quasi-experimental and observational methods—can be just as valid.[7] Some potential study topics include headgear prevalence over time, place, age, and gender; the role of soccer leagues, clubs, and coaches in the adoption of protective equipment; players’ attitudes and beliefs about headgear; frequency and type of head injury in players with and without headgear; and headgear efficacy vs. effectiveness.
Some clinicians have called for soccer headgear,[8] even though engineering testimony at a US Institute of Medicine workshop stated that no protective headgear currently on the market is designed to protect against concussion.[9] Soccer players experience head collisions with the ball, another player’s head, another player’s other body part, the ground, and the goalposts. Because the best time to evaluate preventive measures is before they are widely practiced,[10] now is the best time to research soccer headgear.
References
1. Finch CF. Sports safety research is not without its challenges [electronic response to Nordstrom D L. Sport safety research opportunity] Injuryprevention.com 2004 URL direct link to eLetter
2. Nordstrom DL. Sport safety research opportunity. Inj Prev 2004;10:255
3. Weaver NL, Marshall SW, Miller MD. Preventing sports injuries: opportunities for intervention in youth athletics. Patient Educ Couns 2002;46:199-204.
4. Fédération Internationale de Football Association. Approximately 250 million footballers worldwide: result of a large-scale survey by FIFA. FIFA News 2001 May;14.
5. Hiestand M. Protective soccer headgear to debut in crowning event. USA Today 2003 September 4;C2.
6. Braham R, Finch C. Do community football players wear allocated protective equipment? Results from a randomised controlled trial. J Sci Med Sport 2004;7(2):216-220.
7. Thompson NJ, McClintock HO. Demonstrating your program’s worth: a primer on evaluation for programs to prevent unintentional injury. Atlanta: Centers for Disease Control and Prevention, 2000.
8. Delaney JS, Drummond R. Guest editorial: Has the time come for protective headgear for soccer? Clin J Sport Med 1999;9:121-123.
9. Patlak M, Joy JE. Is soccer bad for children’s heads? Summary of the IOM workshop on neuropsychological consequences of head impact in youth soccer. Washington, DC: National Academy Press 2002:11.
10. Chalmers DJ. Injury prevention in sport: not yet part of the game? Inj Prev 2002;8(suppl IV):iv22-iv25.
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Conflict of Interest:
None declared.
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Published on: 13 May 2016
Sports safety research is not without its challenges
- Caroline F Finch, Sports injury epidemiologist
Dear Editor
Whilst I agree with Nordstrom[1] about the clear research opportunities in relation to headgear effectiveness for soccer players, I would like to make a few comments.
Firstly, the issues raised are not just restricted to headgear use in soccer – they apply equally well to many other sports, particularly other football codes – and nor do they only apply to headgear use. Much of sports safet...
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Dear Editor
Whilst I agree with Nordstrom[1] about the clear research opportunities in relation to headgear effectiveness for soccer players, I would like to make a few comments.
Firstly, the issues raised are not just restricted to headgear use in soccer – they apply equally well to many other sports, particularly other football codes – and nor do they only apply to headgear use. Much of sports safety practice, including protective equipment (PE) use, is based on common practice or best intent, and there are very few interventions at all that have been formally evaluated through a randomised controlled trial (RCT) design.[2]
Having said this, conducting RCTs for improving the evidence base for sport PE effectiveness, is a major challenge in itself, particularly when working with community-level or broad-based participation levels of play, rather than highly competitive players. We attempted this sort of study in Australian rules football. Headgear use is not widespread in this sport, nor is there is evidence for its effectiveness yet there is increasing pressure from parents and others to require junior players to wear headgear. We attempted an RCT and randomised about 150 players to wear headgear provided specifically for the purpose of the study. However, fewer than seven players even attempted to wear the headgear throughout the study, thereby negating any possibility of us assessing its effectiveness in the field.[3] This was despite close monitoring and the offering of significant incentives to players and teams who did wear the headgear.
Finally, intervention studies in the sports injury context must work within the culture of the sport and adopt strategies for maximising desirable player behaviours. In the absence of high level support for an item of protective equipment,[4] even the best designed evaluation trial of the most optimally designed PE is due to fail. It is often stated, but rarely substantiated, that players may believe that they tackle harder because they feel safer when wearing PE,[5] and this adverse behaviour change could increase overall injury rates. Those of us who work in the sports injury area, will need to give very careful consideration towards developing methodologies that will enable us to assess the effectiveness of our interventions whilst still adjusting for, and working within, the behavioural and social aspects of sports delivery. We will also need to develop strategies to monitor any adverse changes in real on-field behaviours as a result of this use.
References
1. Nordstrom DL. Sport safety research opportunity. Inj Prev 2004;10:255
2. Parkkari J, Mujala U, Kannus P. Is it possible to prevent sports injuries? Review of controlled cinical trials and recommendations for future work. Sports Medicine 2001;31(14):985-995.
3. Braham R, Finch C. Do community football players wear allocated protective equipment? Results from a randomised controlled trial. Journal of Science & Medicine in Sport 2004;7(2):216-220.
4. Braham R, Finch C, McIntosh A, McCrory P. Community football players' attitudes towards protective equipment - a pre-season measure. British Journal of Sports Medicine 2004;38:426-430.
5. Finch C, McIntosh A, McCrory P. What do under 15 year old schoolboy rugby union players think about protective headgear? British Journal of Sports Medicine 2001;35:89-94.
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Conflict of Interest:
None declared.
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Published on: 13 May 2016
Soccer injuries and headgear
- Calvin W. Williams, mfg.Kangaroo soccer headgear
Dear Editor,
Anyone who is in doubt about the need for protective headgear should request a computer print-out of hospital admitted (or treated) cases from the U.S. Consumer Products Safety division. With less than 10% of soccer head injuries being reported, the long, detailed list of injuries would shock even those who are against soccer headgear. These figures leave very little room for any one to deny the need...
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Dear Editor,
Anyone who is in doubt about the need for protective headgear should request a computer print-out of hospital admitted (or treated) cases from the U.S. Consumer Products Safety division. With less than 10% of soccer head injuries being reported, the long, detailed list of injuries would shock even those who are against soccer headgear. These figures leave very little room for any one to deny the need for soccer headgear.
It is true soccer headgear needs to be improved to the point it covers not only full head protection but should also give some protection for heading of a soccer ball. Heading is still the unknown to some, but with the death of a professional English soccer player (Jeff Astell), the coroner's report states that his death was from long-term heading of a soccer ball. A soccer ball fully inflated weighs 16oz and can travel at a speed of 0 to 70+ mph. In soccer there are only two ways to advance a ball: kicking and with the head. It is up to the rule makers of soccer (FIFA) and the parents of young players to make the decision to protect the players - it is not a decision to be made by young players or those who have not researched the issue of soccer head injuries.
Kangaroo soccer headgear does provide full head protection and is now introducing a helmet with an impact disbursement plate in the header pad for forehead protection in heading, and continue to improve the helmet as new materials and research presents themselves.
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Conflict of Interest:
None declared.
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