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Head games: Soccer injuries not limited to legs

Photo by Christine Troyke

Photo by Christine Troyke

An Atlanta Fire United teammate passed the soccer ball ahead into open space, close enough that Avery Neel could give it a serious chase but a little too long for her to make a play on it.

Instead, the opposing goalkeeper, just outside her own penalty box, got there first and rocketed a clearance as the 11-year-old Neel turned away to protect her face. The ball struck her cleanly in the back of the head with a thud, ricocheting so hard that it went into the net for an amazing goal.

"I didn't know it went in but I heard everybody yelling and I turned around and saw it went in," said Neel, a rising sixth-grader at Hull Middle School. "I was laughing at first because it went in the goal."

The initial reward was pretty sweet. Players and parents couldn't stop talking about the crazy goal. It didn't appear to bother the youngster that Saturday, aside from the initial shock of a kick to the head that was quickly forgotten amid a celebration.

By Sunday, her condition had changed. She experienced vomiting, bad headaches and blurred vision. All of the classic symptoms of a concussion, a traumatic head injury that can appear immediately or in delayed fashion, as it did with Neel.

"She stumbled a little bit but only for a second (after the hit)," said Kathy Neel, the youngster's mother. "She was fine that Saturday and she didn't show any visible symptoms until Sunday."

The concussion is a common injury in soccer, though it doesn't get the hype in the Deep South, where American football rules. The frequency of concussions is well-documented in that sport, but soccer players also are regular victims of head injuries as TV audiences may have noticed as they watched this year's World Cup matches.

Heads hit heads. Elbows and knees hit heads. Heads hit the post. Heads hit the ground.

Contact up top is more prevalent in a sport that is known predominantly for injuries to the legs.

"We had two (soccer concussions) this year, one boy and one girl," said Steve Stepp, director of sports medicine at Wesleyan. "It's an aggressive, physical sport. People use their heads a lot and they're really banging into each other."

"We see just as many kids in what are considered non-contact sports, like soccer, as we do in football," said Dr. Mark Cullen of Georgia Sports Medicine.

The most violent of those collisions can make the concussion diagnosis much more obvious. That was the case when Brookwood took on Harrison earlier this year.

Junior Joy Pianka went up for a header and the girl in front of her snapped her head back toward Pianka to flick the ball ahead. What followed was a gruesome scene as the Harrison player's head hit Pianka with force just below the eye.

"It swelled up like a golf ball," said Pianka, who felt so much pressure she thought her eyeball was out of the socket. "Then I saw blood. I was freaking out, like oh my gosh, oh my gosh. I finally calmed down. But when I got up I was all dizzy. I don't really remember much about what happened. Everybody had to tell me what happened."

That's where the cases of Neel and Pianka begin following the same path.

Both had the nausea, the headaches, the dizziness and the memory loss. It was tough to focus on schoolwork and books, or even TVs or computer screens. Neel missed all or part of school four of the next five days. Pianka said she didn't feel well for a week.

The injury was a surprise to some of Pianka's friends, who didn't think concussions were much of an issue in soccer.

"They don't think much about concussions in soccer," Pianka said. "They're like, soccer? You don't get hit in the head."

Yes, they do. Just ask some of the Brookwood girls players.

Lauren King also suffered a concussion last season and Ashley Gray's six concussions over a five-year span earned her the nickname "Crashley." Even Bronco head coach Sarah Crawford, a former goalkeeper, was knocked out during one of her college games at Florida State.

"I went out (to stop) a header one time at the 18 (-yard line) and the girl just cleaned out my legs and I came down hard," Crawford said. "When I woke up, the trainer was standing over me. I was like, 'What are you doing here?'"

Crawford's injury happened in the late 1990s, before recent advancements in the diagnosis and recovery from concussions. One of the most important tools, the ImPACT Test, is available to athletes in Gwinnett like Neel and Pianka, who both took the test while doctors monitored their recoveries.

The test involves a series of memory exercises and tasks, designed to gauge the brain's response. Athletes are encouraged to take the test while healthy -- Gwinnett Medical Center offers the test free to local youngsters -- so that their responses can be compared to their results after a head injury.

Pianka had ImPACT baseline data from a week before her concussion, and her test numbers were way off after her collision. Neel's reaction time composite score on May 17, two days after her concussion, put her in the 20th percentile. A week later, she was back up to the 42nd percentile. By June 3, she scored in the 80th percentile.

"(The ImPACT test) tells you on some of the questions whether you're correct or incorrect, so I kind of knew I wasn't doing too well," Neel said.

Both Neel and Pianka then prescribed to their doctors' orders for the only method of curing a concussion -- rest. Athletes generally miss two weeks with standard concussion, though more serious ones can put the healing time closer to a month. And that's not just recuperating enough to play sports, it's getting the brain back to normal for regular activities, like schoolwork.

Unlike football or baseball, sports where head injuries lead to the constant evolution of protective helmets, there is no such remedy in soccer. Doctors and trainers stress mouth guards for soccer players to lessen the blow of hard hits, and some post-concussion players, as Pianka did this spring, wear cushioned headgear upon their return.

She finished the season without further troubles, as did Neel. But they're examples of the problems with soccer concussions, injuries that are debilitating, even when they result in a goal.

"Even with that hit (from the ball), I wouldn't have thought concussion," Kathy Neel said of her daughter.

"That's the thing about concussions, you see a child or older athlete get hit a thousand times the same way and for some reason, this particular time caused a concussion," said Dr. Steve Kroll, a sports medicine trained pediatrician for Georgia Sports Medicine. "Sometimes the big, dramatic hits don't cause concussions. Sometimes the wrong twist or hit in the wrong place can cause a concussion. They're highly unpredictable."