Clinicians are acutely aware of the increased visibility and concern about concussive injury during sport, especially during soccer. Soccer is unique because of the purposeful use of the head to control and advance the ball and because this skill places the player in a vulnerable situation that exposes the head to potential injury, especially during heading duels.
Players, coaches, parents, and clinicians have one important task when a suspected injury happens and that is to identify that a concussive injury might have occurred. The problem with concussion is there are few signs that help everyone involved make that determination. Thus, the evaluation must rely on subjective responses by the player and that the player is being honest about reporting any symptoms. When a player is less than truthful about their symptoms, the player might be returned to play without sufficient time for the brain to recover. So, why might a player not be forthcoming with their symptoms either on the day of the injury or during the recovery period after injury?
Chrisma et al. sought to determine the barriers that prevent a player from revealing their symptoms by performing a qualitative study of 50 high school athletes (Seattle, Washington area; football, boys soccer, girls soccer divided into 9 groups). Professional focus group moderators followed a standard script that discussed concussion knowledge and the athlete’s responses to four hypothetical scenarios. The players were able to describe multiple signs and symptoms of concussion, understood the dangers of concussions, and players from all focus groups were aware of the possibility of death or long term disability. When challenged with situations involving concussive symptoms, however, athletes said they would not stop playing. Instead, they would either continue playing (6 of the 9 groups) or would take a short break and then return to the game (3 of the 9 groups).
There were a number of barriers that explained the athlete’s replies. For example, the athletes wanted to remain in the game and reporting symptoms might lead to their removal from the game. Or, because concussive symptoms are nonspecific, they could be mistaken to have been caused by some other reason. Finally, athletes did not want to report symptoms to coaches unless there was some obvious pain or disability. Based on the responses, it appears that athletes have adequate concussion knowledge and lack of understanding of the injury is not a barrier. Coach approachability, however, may be an issue behind players not reporting their symptoms. The authors though that improving player-coach communication regarding concussion might remove this barrier and improve the reporting of symptom by athletes.