In September last year, the NFL launched a new protocol surrounding concussions. The initiative, known as “Play Smart. Play Safe,” now specifies that whenever a player is suspected to have incurred a possible concussion, he must be removed immediately from the field and analyzed by a team physician, as well as an unaffiliated neurotrauma doctor. If either doctor thinks the player may have a concussion, he will be taken to the locker room for a full medical assessment and not be allowed to play the rest of the game if that suspicion is confirmed. If the diagnosis is negative, the player will still be monitored closely for any possible symptoms throughout the rest of the game.
The new protocol also mandates that the NFL must provide two medical spotters who watch games through binoculars and with video replay in order to identify possible concussions.
Last year, in part because of the new protocol, the number of concussions in the league fell by 11.3 percent from 2015.
— Chris Giza (@griz1) June 26, 2017
[More from Excelle Sports: New study shows girls’ soccer has the highest concussion rate of high school sports]
Why bring up the NFL in women’s sports?
The National Women’s Soccer League’s (NWSL) concussion protocol, unlike that adopted by the NFL, relies on a different premise: Players must report if and when they have a possible concussion. The problem with this premise: I can speak from experience that almost no player will report a possible concussion because they want to keep playing. In addition, soccer coaches and trainers often advise players not to report concussion symptoms so they can continue to be used in match play.
In December 2015, U.S. Soccer prohibited heading in youth programs until age 11 after the NCAA reported that concussions are the second most common injury among female collegiate soccer players, affecting 9.2 percent of those who play. (The most common injuries are contusions, or bruises).
Unfortunately, the concussion percentage in soccer is based on the number of injuries that athletes actually report, not necessarily how many they sustain. If you were to ask soccer players how many concussions they have had, the answer is usually indefinite. Oftentimes, you hear, “I’ve had four diagnosed, then I want to say I have had one or two more definitely, but not diagnosed.” That means the percentage of actual concussions in pro soccer, including those undiagnosed, is likely much higher.
What’s more, women athletes are up to 2.1 times more likely than men to suffer from a concussion; they also take longer to heal. While scientists aren’t exactly sure why this is, they suspect hormones may play a role.
All these statistics highlight that the NWSL needs an effective concussion protocol. So let’s look at what the league does have.
According to the league’s current protocol, all players must take an ImPACT test, or computerized concussion-assessment exam, before the season’s starts to establish baseline data. Then, whenever a player is suspected of a concussion, she is given the imPACT test again. If the player fails the test, she must typically wait about a week (more or less, as determined by her trainer’s assessment) to retake the test. When the player finally passes, she goes onto the next phase: headers.
“Day 1, you are to head the ball 8 yards away—five times forward, five times on the right, five times on the left,” Sky Blue FC player Kelly Conheeney, who has suffered multiple concussions, told Excelle Sports of the process. “Day 2, you are now 18 yards away [from the ball], and the same procedure follows: five times forward, fives times on the right, fives times on the left. Day 3, you are to stand 30 yards away and a trainer is supposed to kick the ball for you to head it five times forward, five times left, five times right … It’s absurd—it’s way too many consecutive headers. How long can you last? Seriously.”
What this means is that a player suspected a concussion must head a soccer ball 45 times in the course of three days—a protocol that seems to induce or aggravate injury rather than prevent it. After all, when does a women’s pro soccer player ever head the ball 45 times during her entire season, let alone three days?
Conheeney isn’t the only one who recognizes some absurdity in the NWSL’s protocol. Many coaches and players feel that the league’s testing is ineffective, if not counterproductive. For this reason, some coaches tell players not to do the post-concussion header test. What’s more, last year, some players said that their clubs even deflated balls before they were asked to take the header test in order to lessen possible impact.
So if NWSL coaches and clubs can’t abide by the system, doesn’t that scream for a reevaluation?
It seems as though the plot has been lost.
[More from Excelle Sports: New study found CTE in the brains of former professional soccer players]
What the NFL has that the NWSL does not are unaffiliated doctors. The NWSL instead relies on doctors and trainers who work closely with teams and are more likely to listen primarily to what the coaches and players say rather than objectively evaluate player and match-play data. In short, team doctors are more likely to be persuaded when one of their players says they’re fine to play after a concussion, which happens more often than not.
“As a player, your adrenaline can take you through the end of the game and you don’t realize until later [that you have concussion symptoms],” Conheeney said. “That’s happened to me.”
When NWSL players hear how the NFL handles concussions, they are impressed.
“Neutral doctors would be very beneficial and not just for concussions,” Portland Thorns FC defender Kendall Johnson told Excelle Sports. “From experience, I can tell you that there are so many situations where players, especially if they’re highly valued, are pressured to come back [after sustaining a possible concussion] and the doctors, as much as they try to be neutral, get lost in translation, especially for concussions.”
But when it comes to concussions in women’s soccer, feeling “fine” is not enough.
“The hardest thing is that you don’t know where to turn,” Conheeney said. “It’s such a serious injury and it can ruin your whole life. There has to be an understanding among the coaches that if a player has a concussion, they need to be on the same page and [coaches] can’t treat them like, ‘Oh, we need you right now.’”
Manya Makoski, a former Women’s Professional Soccer and NWSL midfielder, suffered six concussions while playing professionally.
“It is the worst injury that I have had to deal with,” Makoski told Excelle Sports. “If you break a leg, you can get surgery, be put in a cast and rehab to recover—it doesn’t affect your life in a major way. But with concussions, it affects all aspects of your life—mentally, physically, emotionally. I was depressed, not feeling right with myself, couldn’t remember information that was given to me and frustrated with the way I was feeling.”
This year, Makoski had surgery on the occipital nerves in her neck to help alleviate her concussion symptoms.
“For the last [concussion], I saw a neurologist and tried steroid/nerve block injections that didn’t work, so I finally opted for surgery,” Makoski said. “I had occipital nerve decompression and occipital nerve release. Basically all of the damage from my six concussions irritated my nerves, which created the daily migraines I would have. The surgeon took care of those nerves. I am one week out of surgery and I feel great. No migraines!”
Most players I spoke with would love to see the NWSL implement a concussion protocol similar to the one adopted by the NFL. While it may be more expensive to hire unaffiliated doctors to attend every game, over the course of time, how much money would women’s soccer save in medical costs and, more importantly, how many lives would the league save?
Another possible solution that would save the league money and headaches, pun intended, would be to implement initiatives that help prevent concussions from happening in the first place.
“What would be cool is to have, as part of any concussion protocol, players pass a neck-strengthening test,” Johnson told Excelle Sports. “For me and many in women’s soccer, [getting concussions] was a lack of neck strength, which is repeatedly seen as one reason why females are more prone to concussion––our necks aren’t as strong as a guys.”
There’s a big elephant that needs to be addressed in women’s professional soccer. The personal accounts shared here are frightening and should concern players, coaches, league administrators and fans alike. Something has to change. Player health should matter more than money, every time.
Ultimately, to protect the life of players is to protect the life of the sport.