Concussion-Prevention Strategies Used in National Collegiate Athletic Association Divisions I and II Women's Soccer

Abstract

Context Whereas much attention has been paid to identifying mechanisms for decreasing concussion rates in women's soccer players, which strategies are currently being used is unknown. In addition, athletic trainers' (ATs') knowledge and beliefs about the efficacy of concussion-prevention practices have not been studied. Objectives To evaluate the concussion-prevention strategies being used in National Collegiate Athletic Association Division I and Division II women's soccer and identify the beliefs of certified ATs regarding mechanisms for preventing concussion. Design Cross-sectional study. Setting Online survey. Patients or Other Participants A total of 223 women's soccer team ATs employed at Division I or II universities. Main Outcome Measure(s) A survey instrument of structured questions and open-ended, follow-up questions was developed to identify the use of cervical-strengthening programs, headgear, and other techniques for preventing concussion. Questions also addressed ATs' beliefs regarding the effectiveness of cervical strengthening, headgear, and mouthguards in concussion prevention. Data were collected via questionnaire in Qualtrics survey software. Descriptive statistics of frequencies and percentages were calculated for close-ended questions. Open-ended questions were evaluated for common themes, which were then reported by response frequency. Results Cervical strengthening or stability for concussion prevention was reported by 38 (17.12%) respondents; 153 (69.86%) ATs believed that cervical strengthening would aid in concussion prevention. Seventy-eight (35.49%) reported that their players wore headgear. Nineteen (8.76%) believed that soccer headgear prevented concussions; 45 (20.74%) believed that mouthguards prevented concussions. Education in proper soccer technique was reported by 151 (69.59%) respondents. Fourteen (0.06%) respondents cited nutritional strategies for concussion prevention. Conclusions Although ATs believed that cervical strengthening could help prevent concussions, few had implemented this strategy. However, the ATs whose teams used headgear outnumbered those who believed that headgear was an effective prevention strategy. Based on our findings, we saw a disconnect among the current use of concussion-prevention strategies, ATs' beliefs, and the available evidence.

Athletes' and Coaches' Attitudes Toward Protective Headgear as Concussion and Head Injury Prevention: A Scoping Review

“…Of the 18 articles that were included in the final review: three focused on knowledge about and awareness of the risk of injuries to the head and injury prevention strategies (Lehl, 2005 ; Inness and Morgan, 2015 ; Jeffries et al, 2020 ), five examined perceptions of the risk of head injury and attitudes toward the use of protective headgear (Kahanov et al, 2005 ; Taylor et al, 2005 ; Provance et al, 2012 ; Tiryaki et al, 2017 ; Vriend et al, 2018 ), seven studies only examined athletes' attitudes toward using protective headgear in sport (Finch et al, 2001 , 2003 ; Pettersen, 2002 ; Braham et al, 2004 ; Ruedl et al, 2012a ,b; Pratt et al, 2019 ), two examined athletes' experiences of the obstacles to wearing protective headgear in training and competitions (Ross et al, 2010 ; Dean and Bundon, 2020 ) and one only examined the use of protective headgear in one single season (Braham and Finch, 2004 ). Finally, four studies did not include any measurement of the athletes' use of protective headgear, but the remaining 14 of the 18 studies did.…”

“…The reviewed studies examined a wide range of sports, including polo ( n = 1), roughstock rodeo ( n = 1), downhill skiing ( n = 4), rugby ( n = 2), surfing ( n = 2), basketball ( n = 1), Australian football ( n = 5), different recreational sports including hockey, basketball, volleyball, cricket, football and martial arts ( n = 1) and mountain biking ( n = 1). Fourteen of the studies focused on athletes, two on coaches (Lehl, 2005 ; Jeffries et al, 2020 ) and two included a sample of athletes and coaches (Pettersen, 2002 ; Tiryaki et al, 2017 ). The study populations varied in age from 6 years (Provance et al, 2012 ) to 65 years (Pratt et al, 2019 ).…”

“…In these studies the use of protective equipment among athletes was not associated with coaches' risk perceptions. In their studies, Tiryaki et al ( 2017 ) and Jeffries et al ( 2020 ) identified a disconnection between coaches' risk perceptions and the implementation of concussion-prevention strategies, such as promoting the use of protective headgear in training and competitions. For instance, Jeffries et al ( 2020 ) found that 70% of collegiate women's soccer athletic coaches believed that cervical strengthening programmes would help to prevent concussion, but that only 17% of the coaches included in the sample used such programmes in their training regimes.…”

“…In their studies, Tiryaki et al ( 2017 ) and Jeffries et al ( 2020 ) identified a disconnection between coaches' risk perceptions and the implementation of concussion-prevention strategies, such as promoting the use of protective headgear in training and competitions. For instance, Jeffries et al ( 2020 ) found that 70% of collegiate women's soccer athletic coaches believed that cervical strengthening programmes would help to prevent concussion, but that only 17% of the coaches included in the sample used such programmes in their training regimes. Jeffries et al ( 2020 ) reported that only 8.76% of the coaches believed that headgear prevented concussion, while 20.74% believed that mouthguards prevented concussion among football (soccer) players.…”

“…Similarly, only 33% of coaches in Pettersen's (2002) study of Canadian rugby players believed that wearing headgear could prevent concussion. The low percentages reported in Jeffries et al (2020) and Pettersen (2002) could be due to the phrasing used in the study designs, as there is a notable difference between believing that headgear or mouthguards can prevent concussion and that this type of protective equipment can provide some level of protection against concussion and other head injuries. Tiryaki et al (2017) surveyed 53 coaches and 351 players (aged 12-38 years) to examine the prevalence of dental injuries and awareness of mouthguards as protective equipment in basketball.…”