Why Soccer Players Are Smarter

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Frequent heading of a soccer ball isn’t good for your brain..., but it’s not all bad news for participants of the world’s most popular sport: Soccer players are significantly smarter than, well, pretty much everyone, according to a new study in PLoS ONE.

When professional soccer players were tested on “executive function”—a key aspect in memory, multitasking, and creativity—they scored significantly higher than the general population. In fact, elite players belonged to the best 2 to 5 percent of the total population...


Why? Soccer players have to adapt constantly to a rapidly changing environment to perform well, says Petrovic. That’s easily translated to tests of executive functions like changing strategies and suppressing old, outdated plans, he adds.

“People assume that if you have a gifted arm or can kick a ball that you aren’t smart, you don’t need to be smart, or both,” says Kristen Dieffenbach, Ph.D., professor at West Virgina University. “High-level sport is physically demanding and requires high-level cognitive skills.”

“There’s a saying in soccer: You’re either physically gifted, or a student of the game,” says Kerry Zavagnin, assistant coach for the Sporting Kansas City and 11-time member of the U.S. Men’s National Team. “Someone who can read situations and think about solutions instead of always relying on the physical component is a student of the game—that’s how I played...”

Why Soccer Players Are Healthier

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It’s the world’s most popular sport—and a great way to lower your blood pressure. A study published in the journal Medicine and Science in Sports and Exercise found that playing soccer 2 days a week had a bigger effect on blood pressure than moderate daily exercise.

Researchers recruited 33 men between the ages of 33 and 54 with high blood pressure and randomly divided them into two groups—one that played soccer twice a week for one hour, and one that was told to exercise daily for 30 to 45 minutes at a moderate pace. After six months, the soccer players saw their blood pressure drop twice as much as the non-players…

“Higher-intensity exercise does have a whole different impact on the body’s physiology,” says cardiologist Eric Topol, M.D., director of the Scripps Translational Science Institute and a Men’s Health expert advisor. Your heart rate is higher and your blood vessels are more dilated than with moderate exercise. This high level of stress—which moderate exercise can’t provide—forces your body into overtime to adapt. That might be why soccer lowers your blood pressure better than moderate exercise, says Dr. Topol.

“Soccer is a terrific sport in terms of overall conditioning,” says Todd Durkin, C.S.C.S., founder of Fitness Quest 10 and author of The Impact Body Plan. It combines lots of different running speeds with intense spurts of acceleration—a hard combo to beat because your body never gets the chance to fully recover before going again. That level of intensity keeps your body stressed to the point where it’s forced to adapt, says David Maron, M.D., a cardiologist at Vanderbilt University’s medical center. Your body reacts by building more blood vessels that lower your blood pressure and make your entire cardiovascular system more efficient…

Soccer scores a health hat trick for hypertensive men

Playing soccer (football) could be the best way for people with high blood pressure, known as hypertension, to improve their fitness, normalise their blood pressure and reduce their risk of stroke. Research from Universities of Exeter and Copenhagen, and Gentofte University Hospital in Denmark, published today (Monday 15 October 2012) in the journal Medicine and Science in Sports and Exercise, suggests that soccer training prevents cardiovascular disease in middle-aged men with hypertension and is more effective than healthy lifestyle advice currently prescribed by GPs.

After six months of soccer training, three out of four men in this study had blood pressure within the normal, healthy range.

Almost one third of British men have hypertension, which increases the risk of cardiovascular diseases including stroke and coronary artery disease. It has long been known that physical exercise can reduce blood pressure in patients with hypertension, but until now little evidence is available on which form of exercise is most effective.

The research team recruited 33 men aged between 33 and 54 with mild to moderate hypertension. They randomly divided them in two groups: one took part in two hour-long soccer training sessions a week while the other received usual care by a GP including advice about the importance of physical activity and a healthy diet, together with control blood pressure measurements. The effects on exercise capacity, maximal oxygen uptake, body fat and blood pressure, were monitored after three months and at the end of the six-month trial.

For the soccer-playing group, average mean blood pressure was reduced by 10 mmHg, while the reduction was only 5 mmHg in the control group receiving the usual GP advice. For the football group, maximal oxygen uptake and maximal exercise capacity was improved by10 per cent, resting heart rate decreased by eight beats per minute and body fat mass dropped by an average of two kilograms. No significant changes to these health measures were observed in the control group.

The men who had taken part in soccer training were also found to be less physically strained during moderate intensity exercise. When taking part in activities such as cycling, they had markedly lower heart rates and elevated fat burning.

Lead researcher Professor Peter Krustrup of the University of Exeter said: "Playing soccer scores a hat trick for men with hypertension: it reduces blood pressure, improves fitness and burns fat. Only two hour-long football training sessions a week for six months caused a remarkable 13/8 mmHg in arterial blood pressure, with three out of four participants normalising their blood pressure during the study period.

"The soccer training also boosted the aerobic fitness and resulted in marked improvements in both maximal and moderate exercise capacity. Playing football made it easier for previously untrained men to train even harder, and also make it easier for them to cope with everyday life activities such as cycling, walking upstairs, shopping and lawn mowing."

Professor Peter Krustrup concludes "Although our previous research has highlighted the many health benefits of playing soccer, this is the first evidence that soccer may contribute fundamentally to prevention of cardiovascular disease in hypertensive men."

Senior cardiologist from Gentofte University Hospital in Denmark, Peter Riis Hansen, also emphasised that evidence suggests that the decrease in blood pressure after football training lead to a considerable reduction in the risk of stroke, myocardial infarction and death. "He said: Our results are very exciting and we are now trying to understand the findings in more depth, for example by investigating the effects of playing football on the heart's structure and function.

"Recent studies from our research group have also shown positive effects of football training on the blood pressure and heart in premenopausal women with normal blood pressure and we are now aiming to test the effects of football in women with hypertension."

England World Cup wins and losses linked to 30 percent rise in domestic violence

Domestic violence rates rose by an average of 30 percent each time England won or lost their games during the 2010 World Cup, but draws had little impact on the statistics.

Those are the key findings of research carried out by statistician Professor Allan Brimicombe and BBC News journalist Rebecca Cafe and published in the October issue of Significance, the magazine of The Royal Statistical Society and the American Statistical Association.

As a consequence of this and previous research, Professor Brimicombe believes there is a strong case for schools to educate pupils of the dangers of domestic violence, event organisers should promote initiatives that tackle domestic violence and that police forces should prepare themselves for peaks in domestic violence around major sporting events.

"Domestic violence is widespread, accounting for 15 percent of all violent crimes and 35 percent of murders in the UK," explains Professor Brimicombe, from the Centre for Geo-Information Studies at the University of East London.

"It is a crime that is estimated to affect some 30 percent of women and 17 percent of men at some point in their lives."

The researchers based their findings on statistics provided by 33 of the 39 police forces in England, which between them cover 77 percent of the country's population.

The data, for the period covering the 2010 World Cup and the same period in 2009, was obtained under the Freedom of Information Act 2000, which enables members of the public to request official information from public bodies.

The figures showed that when England drew 1-1 against the USA, domestic violence fell by 1.9 percent and when England drew 0-0 against Algeria it rose by 0.1 percent.

However when England won its game against Slovenia 1-0, domestic violence rose by 27.7 percent. And England's exit from the World Cup, after losing 4-1 to Germany, was accompanied by a 31.5 percent rise in domestic violence.

The research aimed to test the validity of an analysis carried out by the Home Office that showed that domestic violence had risen during the 2006 World Cup. "Major sporting events do not cause domestic violence, as perpetrators are responsible for their actions," said the analysis, "but the levels of alcohol consumption linked to the highly charged emotional nature of those events seems to increase the prevalence of such incidents."

Professor Brimicombe concludes that the Home Office findings were right in some respects but fell short in their analysis in other respects.

Professor Brimicombe explains: "Our research shows that increased levels of domestic violence are associated with national football matches, but only if there is a definite win or lose result. The failing of the earlier Home Office analysis was that it ignored the outcome of the match, which as we have seen is crucial.

"The percentage differences that we found are so great that we believe we have established a strong case for linking wins and losses, but not draws, to increased domestic violence.

"I hope that the findings will encourage improved education around the links between major sporting events and peaks in domestic violence and greater awareness of the risk.



"And I would applaud initiatives like the recent beer mat campaign highlighting the dangers of domestic violence, run by the London Borough of Newham and Metropolitan Police during the 2012 Olympics."

Physical therapy, not a knee brace, aids in ACL recovery

Wearing a knee brace following anterior cruciate ligament (ACL) surgery has no effect on a person’s recovery. However, strength, range-of- motion, and functionality exercises provide significant benefits, and other new therapies may show promise.

In a new literature review recently published in the Journal of Bone and Joint Surgery (JBJS), a team of orthopaedic surgeons reviewed 29 studies regarding treatment following reconstructive ACL surgery. They found that physical therapy, begun shortly after surgery, can bring about very good outcomes for patients. Bracing, though, did not seem to improve results.

The ACL runs through the middle of the knee joint and helps to stabilize it. While the ACL can be injured through impact, it is most commonly strained or torn during non-contact injuries when a person:
- Suddenly changes direction
- Stops abruptly
- Lands incorrectly after a jump

These injuries often require reconstructive surgery, with post-surgical rehabilitative therapy. These therapies usually focus on improving the patient’s strength, range of motion, and function, and also may include some balance exercises.

Other findings include:
Physical therapy should begin early, ideally within a few days after surgery.
Therapies focusing on proprioception (awareness of movement of one’s body) may have benefits; however, the extent of their efficacy requires further research.
Balance therapies also may be promising.
Neuromuscular therapies are not harmful, but their benefits are in doubt and require more study. Neuromuscular therapies should be used to support other physical therapies, not in place of them.
Accelerated rehabilitation also does not appear to be harmful, but should be studied further.
No vitamins or other supplements have been proven to have any effect on ACL healing.

“The most important thing for ACL surgery patients is to start physical therapy early and rigorously,” says Rick W. Wright, MD, professor and co-chief of the sports medicine department at the Washington University Department of Orthopaedic Surgery, St, Louis, Mo. "It can be difficult at first, but it’s worth it in terms of returning to sports and other activities.”

Simple routine could help athletes avoid choking under pressure

Squeezing a ball before competition may improve performance, study finds

Some athletes may improve their performance under pressure simply by squeezing a ball or clenching their left hand before competition to activate certain parts of the brain, according to new research published by the American Psychological Association.

In three experiments with experienced soccer players, judo experts and badminton players, researchers in Germany tested the athletes' skills during practice and then in stressful competitions before a large crowd or video camera. Right-handed athletes who squeezed a ball in their left hand before competing were less likely to choke under pressure than right-handed players who squeezed a ball in their right hand. The study was published online in the Journal of Experimental Psychology: General.

For skilled athletes, many movements, such as kicking a soccer ball or completing a judo kick, become automatic with little conscious thought. When athletes under pressure don't perform well, they may be focusing too much on their own movements rather than relying on their motor skills developed through years of practice, said lead researcher Juergen Beckmann, PhD, chair of sport psychology at the Technical University of Munich in Germany.

"Rumination can interfere with concentration and performance of motor tasks. Athletes usually perform better when they trust their bodies rather than thinking too much about their own actions or what their coaches told them during practice," Beckmann said. "While it may seem counterintuitive, consciously trying to keep one's balance is likely to produce imbalance, as was seen in some sub-par performances by gymnasts during the Olympics in London."

Previous research has shown that rumination is associated with the brain's left hemisphere, while the right hemisphere is associated with superior performance in automated behaviors, such as those used by some athletes, the study notes. The right hemisphere controls movements of the left side of the body, and the left hemisphere controls the right side. The researchers theorized that squeezing a ball or clenching the left hand would activate the right hemisphere of the brain and reduce the likelihood of the athlete's choking under pressure. The study focused exclusively on right-handed athletes because some relationships between different parts of the brain aren't as well understood for left-handed people, according to the authors.

The research could have important implications outside athletics. Elderly people who are afraid of falling often focus too much on their movements, so right-handed elderly people may be able to improve their balance by clenching their left hand before walking or climbing stairs, Beckmann said.

"Many movements of the body can be impaired by attempts at consciously controlling them," he said. "This technique can be helpful for many situations and tasks."

In the first experiment, 30 semi-professional male soccer players took six penalty shots during a practice session. The next day, they attempted to make the same penalty shots in an auditorium packed with more than 300 university students waiting to see a televised soccer match between Germany and Austria. The players who squeezed a ball with their left hand performed as well under pressure as during practice, while players who squeezed a ball in their right hand missed more shots in the crowded auditorium.

Twenty judo experts (14 men and six women) took part in the second experiment. First, they performed a series of judo kicks into a sandbag during practice. During a second session, they were told that their kicks would be videotaped and evaluated by their coaches. The judo athletes who squeezed a ball with their left hand not only didn't choke under pressure, they performed better overall during the stressful competition than during practice, while those in the control group choked under pressure, the study found.

The final experiment featured 18 experienced badminton players (12 men and six women) who completed a series of practice serves. Then, they were divided into teams and competed against each other while being videotaped for evaluation by their coaches. Athletes who squeezed a ball in their left hand didn't choke under pressure, unlike the control group players who squeezed a ball in their right hand. A final phase of the experiment had the athletes just clench their left or right hand without a ball before competition, and players who clenched their left hand performed better than players who squeezed their right hand.

The ball-squeezing technique probably wouldn't help athletes whose performance is based on strength or stamina, such as weightlifters or marathon runners, the authors noted. The effects apply to athletes whose performance is based on accuracy and complex body movements, such as soccer players or golfers, they said.

Runners can improve health and performance with less training

The new 10-20-30 training concept can improve both a person's running performance and health, despite a significant reduction in the total amount of training. This is the conclusion of a study from University of Copenhagen researchers just published in the renowned scientific Journal of Applied of Physiology.

Over the course of seven weeks, runners were able to improve performance on a 1500-metre run by 23 seconds and almost by a minute on a 5-km run – and this despite a 50 per cent reduction in their total amount of training. These are just some of the results from a research project involving 18 moderately trained runners following the 10-20-30 training concept developed by researchers from the Department of Exercise and Sport Sciences at the University of Copenhagen.

In addition to enhancing running performance, the runners from the project also had a significant decrease in blood pressure and a reduction in cholesterol in the blood.

"We were very surprised to see such an improvement in the health profile considering that the participants have been running for several years," says Professor Jens Bangsbo, Department of Exercise and Sport Sciences, who heads the project.

"The results show that the very intense training has a great potential for improving health status of already trained individuals," says Professor Bangsbo.

PhD student Thomas Gunnarsson adds that the emotional well-being of the participants also improved over the span of the project.

"We found a reduction in emotional stress when compared to control subjects continuing their normal training based on a recovery-stress questionnaire administered before and after the 7-week training period," explains Gunnarsson.

The 10-20-30 training concept

The 10-20-30 training concept consists of a 1-km warm-up at a low intensity followed by 3-4 blocks of 5 minutes running interspersed by 2 minutes of rest. Each block consists of 5 consecutive 1-minute intervals divided into 30, 20 and 10 seconds of running at a low, moderate and near maximal intensity, respectively.

30 minutes is all you need

According to Professor Bangsbo, the 10-20-30 training concept is easily adapted in a busy daily schedule as the time needed for training is low. A total of 20-30 minutes including warm-up is all that is needed. Since the 10-20-30 concept deals with relative speeds and includes low speed running and 2-minute rest periods, individuals with different fitness levels and training backgrounds can perform the 10-20-30 training together.

"The training was very inspiring. I could not wait to get out and run together with the others. Today, I am running much faster than I ever thought possible," says Katrine Dahl, one of the participants in the study.

Psychological Testing May Predict Success in Soccer

I have always maintained that good decision making, especially with the ball, is a key to being a good soccer player. Now research supports this:

Measuring what are known as 'executive functions', which reflect the cognitive ability to deal with sudden problems, may make it possible to predict how good an elite soccer player will become in the future. This has been shown by a new study from Karolinska Institutet. Scientists believe for the first time that they have found the scientific key to what has previously been described as 'game intelligence' in successful soccer players.

It has long been known that physical ability and ball sense are not enough to become really good at soccer. A third vital component has often been mentioned: game intelligence, which is the ability to 'read' the play, to be always in the right place at the right time, and steal goals. Many people have regarded game intelligence to be almost a magical ability, something that is impossible to measure.

The scientists at Karolinska Institutet, however, claim that game intelligence is hardly mystical, and that it can be understood from a scientific perspective. It is, rather, an example of something that cognitive scientists call executive functions, which encompass the ability to be immediately creative, to be able to see new solutions to problems, to change tactics rapidly and to revise previous behaviour that has proved not to work.

"Our brains have specific systems that process information in just this manner, and we have validated methods within cognitive research to measure how well the executive functions work in an individual," says Dr Predrag Petrovic at the Department of Clinical Neuroscience.

Predrag Petrovic and his colleagues report in one study, to be published in the on-line scientific journal PLoS ONE, tests of certain executive functions in soccer players in Allsvenskan (the highest Swedish league) and in Division 1 (the league under Allsvenskan), a total of 57 elite soccer players. The scientists found that soccer players in both groups performed much better in tests of executive functions than the general population. And they found that players in Allsvenskan achieved much better results in these tests than players in Division 1.

The study then compared the test results with the performance of the players on the field. The scientists followed several of the soccer players for some years and recorded the number of goals and the number of assists each player made. In this way, each player was awarded points related to his or hers performance on the field. A clear correlation appeared between the results of the tests of executive functions and the number of points obtained on the soccer field (when corrected for such factors as a player's position and age).

It was thus shown that the best players had also performed best on the tests of executive functions. These results are unique, since they are based on scientifically standardised tests. Previously, researchers have used either specific tests from which it has not been possible to generalise the results, or studied specifically how heading the ball can cause cognitive abilities to deteriorate.

"We can imagine a situation in which cognitive tests of this type become a tool to develop new, successful soccer players. We need to study whether it is also possible to improve the executive functions through training, such that the improvement is expressed on the field. But there is probably a hereditary component, and a component that can be developed by training," says Torbjörn Vestberg, psychologist and a member of the research group that carried out the study.

Psychological testing may predict success in football

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I agree with this, a lot of success in soccer depends on good decision making , particularly when one has possession of the ball.

Measuring what are known as 'executive functions', which reflect the cognitive ability to deal with sudden problems, may make it possible to predict how good an elite football player will become in the future. This has been shown by a new study from Karolinska Institutet. Scientists believe for the first time that they have found the scientific key to what has previously been described as 'game intelligence' in successful football players.

It has long been known that physical ability and ball sense are not enough to become really good at football. A third vital component has often been mentioned: game intelligence, which is the ability to 'read' the play, to be always in the right place at the right time, and steal goals. Many people have regarded game intelligence to be almost a magical ability, something that is impossible to measure.

The scientists at Karolinska Institutet, however, claim that game intelligence is hardly mystical, and that it can be understood from a scientific perspective. It is, rather, an example of something that cognitive scientists call executive functions, which encompass the ability to be immediately creative, to be able to see new solutions to problems, to change tactics rapidly and to revise previous behaviour that has proved not to work.

"Our brains have specific systems that process information in just this manner, and we have validated methods within cognitive research to measure how well the executive functions work in an individual," says Dr Predrag Petrovic at the Department of Clinical Neuroscience.

Predrag Petrovic and his colleagues report in one study, to be published in the on-line scientific journal PLoS ONE, tests of certain executive functions in football players in Allsvenskan (the highest Swedish league) and in Division 1 (the league under Allsvenskan), a total of 57 elite footballers. The scientists found that football players in both groups performed much better in tests of executive functions than the general population. And they found that players in Allsvenskan achieved much better results in these tests than players in Division 1.

The study then compared the test results with the performance of the players on the pitch. The scientists followed several of the football players for some years and recorded the number of goals and the number of assists each player made. In this way, each player was awarded points related to his or hers performance on the pitch. A clear correlation appeared between the results of the tests of executive functions and the number of points obtained on the football pitch (when corrected for such factors as a player's position and age).

It was thus shown that the best players had also performed best on the tests of executive functions. These results are unique, since they are based on scientifically standardised tests. Previously, researchers have used either specific tests from which it has not been possible to generalise the results, or studied specifically how heading the ball can cause cognitive abilities to deteriorate.

"We can imagine a situation in which cognitive tests of this type become a tool to develop new, successful football players. We need to study whether it is also possible to improve the executive functions through training, such that the improvement is expressed on the pitch. But there is probably a hereditary component, and a component that can be developed by training," says Torbjörn Vestberg, psychologist and a member of the research group that carried out the study.

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Beanballs and the psychology of revenge

This week, as tens of millions of Americans awaited the baseball season’s first pitches, Brown University psychologist Fiery Cushman was watching more warily for the first beanballs. As someone who studies moral judgment, Cushman recognizes that the intentional targeting of an innocent player to avenge a hit batsman could be a telling exception within American culture, even if the rest of the game is a national institution.

Cushman and collaborators A.J. Durwin of Hofstra University and Chaz Lively of Boston University put the question to scores of baseball fans mingling outside Yankee Stadium and Fenway Park last season: A pitcher on the Chicago Cubs intentionally throws at and hits a batter on the St. Louis Cardinals. An inning later, the Cardinals’ pitcher retaliates by throwing at and hitting a previously uninvolved batter for the Cubs.

In their new study published in the Journal of Experimental Social Psychology, the researchers report that 44 percent of the fans they surveyed granted moral approval for the Cardinal pitcher’s beanball.

The researchers call this system of exacting revenge by targeting a teammate “vicarious punishment,” and note that it has emerged in many cultures throughout human history. In such “honor cultures” it has been acceptable to kill someone’s brother to avenge one’s own brother — as in, for example, the American blood feud between the Hatfields and McCoys.

“No one should conclude from this that ... vicarious punishment is considered acceptable widely in American culture,” Cushman said. “Quite to the contrary, what makes this striking is that it’s an exception. We’re trying to explain this exception.”

The new study examines what the revenge culture of baseball may reveal about the cultural practice of “blood feud” more broadly.

The beanball exception

In their survey questions, Cushman, Durwin, and Lively peeled back the layers of the fans’ thinking and found data that suggest vicarious punishment is more of a social norm than a product of different moral reasoning.

In the first survey of 145 fans at both ballparks, they asked half about the revenge scenario between the Cubs and Cardinals (of which 44 percent approved), and asked the other half to judge a situation where the Cardinals exacted their revenge not on the Cubs, but an entirely different team the next night. Far fewer fans (although still 19 percent) approved of that.

In a second experiment they asked 78 fans outside Yankee Stadium to judge either the original situation or the beaning of the pitcher who himself threw the malicious pitch the inning before. In that case 39 percent of fans still approved of the original vicarious method, but 70 percent approved of beaning the offending pitcher himself.

The third experiment, played out among 79 fans at Fenway Park, put the question in the context of the hometown favorite Red Sox. In one case a Red Sox pitcher was described avenging a previously beaned teammate. In the other case, a Sox batter was described as bearing the brunt of his teammates’ pitching transgression. In these cases, 43 percent of Red Sox fans acknowledged the morality of their own player being beaned out of revenge, but 67 percent approved of their pitcher exacting revenge against the other team.

In a final experiment, conducted among 131 baseball fans in an online discussion group, Cushman, Durwin, and Lively sought to assess fans’ understanding of moral responsibility, as well as their opinions about the overall morality of vengeful beaning. In this sample, 61 percent approved of beaning, such as in the Cubs and Cardinals case (the more highly they rated their affinity for baseball, the more likely they were to approve). Despite the high approval for vicarious punishment, only 18 percent of the surveyed fans held the recipient of the retaliatory beaning to be morally responsible for the original beaning. Meanwhile, 92 percent of fans held the pitcher who threw the first beanball morally responsible.

“Deserve’s got nothing to do with it”

If the vast majority of fans recognize the individual responsibility of the situation as accruing to the first pitcher who beans and not the last batter to be beaned, why do as many as two-thirds (in the hometown experiment) approve of that second batter being hit? It’s a similar question to ask why such systems of justice emerged in Iceland around the 10th century A.D. or in Montenegro more than a century ago, Cushman said. Vicarious punishment also characterizes some cases of gang- and mob-related violence. Previous researchers have seen a correlation between such systems and weak state oversight.

The cultural exception that Americans make for baseball, even as they acknowledge who is and is not really at fault, the researchers suggest, may indicate cultures that practice vicarious retribution can be understood more as driven by either contextual necessity or tradition, rather than by a fundamentally different way of assigning moral responsibility. Motivations might instead be honor or deterrence.

“It’s really beautifully captured by this quote from the Clint Eastwood movie Unforgiven: ‘Deserve’s got nothing to do with it,’” Cushman said. “The idea is we have to protect ourselves, we have to do something to respond to this act. The person we’re targeting isn’t morally responsible but the practical demands of the situation are such that we’ve got to do something and this is it.”

In that sense baseball is a game of athleticism, strategy, community, and collective punishment without an underlying theory of moral responsibility.

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Fewer Injuries for Winning Soccer Teams

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All soccer players and fans know that it is better to win than to lose. Yet the fact that victory also means less risk of injury is not as obvious. New findings from researchers in sports medicine at Linköping University have aroused great interest among Europe's elite soccer teams.

Håkan Bengtsson, a master's student in physiotherapy, has analysed data from 6272 games played by 26 of the top European clubs. The material comprises 2739 injuries and constitutes the world's largest database of its kind. The results was tabled at a regional conference on physiotherapy in Linköping March 22.

Based on information the clubs sent to the Swedish researchers once a month, Håkan Bengtsson then examined how the injury rate is influenced by three factors:

* the result
* home or away match
* type of competition

It turned out that the outcome of the match had the clearest correlation with the proportion of injuries. For teams that lost, the risk of injury was 21 percent greater than for the winning teams; in drawn games the risk was 15 percent higher.

"We have not established which is the chicken or the egg. The most likely scenario is that a player was injured during the match, which subsequently lead to a loss. The bottom line is that the clubs' medical work is vital to the results," says Håkan Bengtsson.

Bengtsson was somewhat surprised that a higher injury risk ensued for the home team than the away team. One conceivable explanation is that home teams play more aggressively coupled with longer and faster running sorties. With regard to the type of competition, Champions League matches appeared somewhat more dangerous than for the rhythm of the domestic leagues.

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Competitive Soccer Linked to Increased Injuries and Menstrual Dysfunction in Girls

Regular warm-up exercises can significantly decrease ACL injury risk

In the U.S., there are nearly three million youth soccer players, and half of them are female. New research presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that despite reporting appropriate body perception and attitudes toward eating, elite youth soccer athletes (club level or higher) face an increased risk for delayed or irregular menstruation. In addition, female soccer players are more likely to suffer a stress fracture or ligament injury. A separate study found that a consistent 15-minute warm-up substantially decreases knee injury risk.

The Female Triad (Menstrual Dysfunction, Eating Attitudes, Stress Fractures) in Soccer Athletes"

The “female athlete triad” – menstrual dysfunction, eating attitudes and stress fractures – puts female athletes at risk for diminished performance and long-term health problems.

To determine the prevalence of the female triad among soccer players, investigators recruited 220 athletes, median age 16.4, from an elite youth soccer club, an NCAA Division I university team, and a women’s professional team. The participating athletes completed questionnaires regarding age of menarche (first menstruation), menstrual history, and history of musculoskeletal injuries including stress fractures. The Eating Attitudes Test was used to assess each athlete’s body image, and attitudes toward eating.

The average age of menarche was 13 years of age among the participants. Irregular menstruation cycles, or absence of menstruation, were reported by 19 percent of the participants in the 15-17 age group, 18 percent of the college-age players, and 20 percent of the professional athletes. A history of stress fractures was reported in 14 percent of the players, with a majority of the injuries in the ankle and foot.

Only one player scored in the “high risk” range, and 16 in the “potentially high risk range,” in terms of body perception and eating attitudes.“Elite female soccer athletes are at risk for delayed onset of menarche, menstrual dysfunction and stress fractures, which may be due to an imbalance of energy intake and output,” said Robert H. Brophy, MD, co-investigator and assistant professor of orthopaedic surgery at Washington University School of Medicine in St. Louis, Mo. “The risk for soccer athletes appears to be lower than for female athletes in aesthetic (gymnastics, dancing, etc.) and endurance sports. More research is needed to identify the underlying causes, and potential remedies, for these findings in elite female soccer athletes, and whether these findings translate to female athletes participating in other team sports.”

A Randomized Trial of Anterior Cruciate Ligament Injury Prevention in Adolescent Female Soccer.

In another study, investigators studied the effects of a regular, progressive warm-up exercise program on knee injuries and health.

The study involved more than 4,500 female soccer players in Sweden, age 12-17, from 309 elite clubs. The players were randomly assigned to one of two groups: an intervention group instructed to complete a 15-minute muscular warm-up consisting of six progressively more difficult knee and core stability exercises, twice a week throughout the 2009 season, and a non warm-up “control” group. Team coaches documented player participating during the season, and acute knee injuries were examined by the physical therapist and/or physician assigned to each club.

There was a 64 percent decrease in anterior cruciate ligament (ACL) injuries in the intervention group, and an 83 percent reduction among “compliant,” fully participating players. In addition, there was a “significant” decrease in the rates of all severe knee injuries.

“We showed a statistically significant reduction – by almost two-thirds – in ACL injuries in (participating) female teenage soccer players in a coach-directed neuromuscular warm-up program,” said Markus Waldén, MD, PhD, lead investigator, and an orthopaedic surgeon at Hässeleholm-Kristianstad Hospitals in Hässeleholm, Sweden. “Interestingly, players (who complied) had a reduction in other acute knee injuries as well.

“The program is intended to replace the ordinary warm-up and thus does not steal time from soccer training,” said Dr. Waldén.

Frequent "Heading" in Soccer Can Lead to Brain Injury and Cognitive Impairment

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Using advanced imaging techniques and cognitive tests, researchers at Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, the University Hospital and academic medical center for Einstein, have shown that repeatedly heading a soccer ball increases the risk for brain injury and cognitive impairment. The imaging portion of the findings was presented today at the annual meeting of the Radiological Society of North America (RSNA) in Chicago.

The researchers used diffusion tensor imaging (DTI), an advanced MRI-based imaging technique, on 38 amateur soccer players (average age: 30.8 years) who had all played the sport since childhood. They were asked to recall the number of times they headed the ball during the past year. (Heading is when players deliberately hit or field the soccer ball with their head.) Researchers ranked the players based on heading frequency and then compared the brain images of the most frequent headers with those of the remaining players. They found that frequent headers showed brain injury similar to that seen in patients with concussion, also known as mild traumatic brain injury (TBI).

The findings are especially concerning given that soccer is the world's most popular sport with popularity growing in the U.S., especially among children. Of the 18 million Americans who play soccer, 78 percent are under the age of eighteen. Soccer balls are known to travel at speeds as high as 34 miles per hour during recreational play, and more than twice that during professional play.

After confirming the potentially damaging impact of frequent heading, "Our goal was to determine if there is a threshold level for heading frequency that, when surpassed, resulted in detectable brain injury," said lead author Michael Lipton, M.D., Ph.D., director of Einstein's Gruss Magnetic Resonance Research Center and medical director of MRI services at Montefiore. Further analysis revealed a threshold level of approximately 1,000 to 1,500 heads per year. Once players in the study exceeded that number, researchers observed significant injury.

"While heading a ball 1,000 or 1,500 times a year may seem high to those who don't participate in the sport, it only amounts to a few times a day for a regular player," observed Dr. Lipton, who is also associate professor of radiology, of psychiatry and behavioral sciences, and of the Dominick P. Purpura Department of Neuroscience at Einstein.

"Heading a soccer ball is not an impact of a magnitude that will lacerate nerve fibers in the brain," said Dr. Lipton. "But repetitive heading may set off a cascade of responses that can lead to degeneration of brain cells."

Researchers identified five areas, in the frontal lobe (behind the forehead) and in the temporo-occipital region (the bottom-rear areas) of the brain that were affected by frequent heading – areas that are responsible for attention, memory, executive functioning and higher-order visual functions. In a related study, Dr. Lipton and colleague Molly Zimmerman, Ph.D., assistant professor in the Saul R. Korey Department of Neurology at Einstein, gave the same 38 amateur soccer players tests designed to assess their neuropsychological function. Players with the highest annual heading frequency performed worse on tests of verbal memory and psychomotor speed (activities that require mind-body coordination, like throwing a ball) relative to their peers.

"These two studies present compelling evidence that brain injury and cognitive impairment can result from heading a soccer ball with high frequency," Dr. Lipton said. "These are findings that should be taken into consideration in planning future research to develop approaches to protect soccer players."

Heading is an essential part of soccer and is unlikely to be eliminated from practice or play. As there appears to be a safe range for heading frequency, additional research can help refine this number, which can then be used to establish heading guidelines. As in other sports, the frequency of potentially harmful actions in practice and games could be monitored and restricted based on confirmed unsafe exposure thresholds.

"In the past, pitchers in Little League Baseball sustained shoulder injuries at a rate that was alarming," Dr. Lipton noted. "But ongoing research has helped shape various approaches, including limits on the amount of pitching a child performs, which have substantially reduced the incidence of these injuries."

"Brain injury due to heading in children, if we confirm that it occurs, may not show up on our radar because the impairment will not be immediate and can easily be attributed to other causes like ADHD or learning disabilities," continued Dr. Lipton. "We, including the agencies that supervise and encourage soccer play, need to do the further research to precisely define the impact of excessive heading on children and adults in order to develop parameters within which soccer play will be safe over the long term."

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Heading in Soccer—Could It Lead to Brain Injury?

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Could heading the ball in soccer lead to degenerative brain disease, like that seen in athletes in other sports? That's the question addressed by a review in the January issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

As yet there's not clear evidence to link heading to short- or long-term brain injury, according to Dr Alejandro M. Spiotta of the Cleveland Clinic and colleagues. However, while research is ongoing, they stress the need for proper heading technique at all levels of organized soccer.

New Review of Evidence on Heading and Brain Injury Risk in Soccer

Soccer (called football outside the United States) is the only sport in which players use their unprotected heads to intentionally deflect, stop, or redirect the ball. Headed balls travel at high velocity both before and after impact, raising concerns about possible traumatic injury.

In 2002, English footballer Jeffrey Astle, known as a "formidable header," died with degenerative brain disease. The damage was consistent with chronic traumatic encephalopathy (CTE): a progressive neurodegenerative disease caused by repeated brain injury, seen in American football players and other athletes. Those reports have prompted concerns about similar risks in soccer players.

Although concussions are common in soccer, they more often result from the head striking another player or the goalpost, rather than heading the ball. But there's still concern about long-term injury related to repetitive trauma from heading.
Detailed biomechanical studies have been performed, showing that heading is a complex task in which significant energy is absorbed by the head. Emphasizing the importance of proper heading technique, studies have shown that anticipation and "pre-tensing" of the neck muscles play a key role in absorbing and redirecting the impact of a headed ball.

Pending Further Research, Emphasis on Proper Heading Technique

Older studies reported symptoms related to heading ("footballers' migraine"), but more recent research has not confirmed those effects. One factor may be the introduction of newer soccer balls that don't absorb moisture—unlike the leather balls used in Jeffrey Astle's day.

Soft headgear has been suggested to protect against soccer-related head injuries, although studies have questioned the protective benefits. There are even concerns that wearing headgear might even lead to increased injury risk, if players develop a false sense of security.

For now, the data on heading and brain injury "leave us somewhat in the grey zone," according to Dr Spiotta and colleagues. While it's reassuring that there's no clear link to CTE, the potential for long-term brain injury remains. "Even if the cognitive impairment were to be mild, it would still present a major medical and public health concern because of the massive volume of soccer players worldwide," the researchers write. "Any possible detrimental effect…may only become clinically evident decades in the future."

Dr Spiotta and coauthors emphasize the need for further research—including autopsy studies of players in the "light ball" era—to see if there is any similarity to the patterns of brain injury seen in CTE. Meanwhile, "Proper heading technique should continue to be stressed at all levels of play." The authors also highlight the importance of using an age-appropriate ball size for younger soccer players, as they develop the neck strength and posture control needed for proper heading technique.

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