Vision training could mitigate soccer-related concussions

'Keep your eyes on the ball' is fairly ubiquitous sports wisdom, though now it may take on a particularly pertinent connotation as it relates to concussion mitigation in women's soccer.

Published in the online version of Medical Hypothesis, a new study from the University of Cincinnati College of Medicine tackles the peculiar incidence of concussion rates in women's soccer, a sport that experiences nearly double the rate of concussions than men's soccer and one of the highest rates among all high school athletes, short of football and ice hockey. The distinction may come down to how athletes see the field of play—or don't.  

Researchers looked to how both male and female players performed 'headers,' paying particular attention to circumstances where more than one player tried for the ball, also known as a '50-50 ball.' In analyzing a series of in-game images, researchers noticed that while 79% of male players closed their eyes during a header, a whopping 90.6% of females did the same.  

The study posits that closing their eyes when going to head the ball may increase women's risk of concussion by decreasing visual awareness of their surroundings. It also goes one step further and suggests vision training, such as tactics employed by football players to be spatially aware prior to a hit, may help women athletes play safer.  

"In other studies, vision training has successfully reduced the rates of concussion in college football athletes; overall lack of visual awareness in a contact sport may increase the risks of concussion," a University of Cincinnati news release reads.

"Therefore, vision training and better eye discipline may decrease concussion rates."  

Little more than a year ago, the U.S. Soccer Federation made international headlines for announcing an outright ban on headers among youth athletes under 11, and encouraged reduced headers among 11 to 13-year-olds during practice. Although headers took center stage, a JAMA Pediatrics study suggested the problem wasn't necessarily headers alone, but these 50-50 balls that increased risk of athlete-athlete contact. Could an act as simple as keeping the eyes open make a difference?  

"The startle reflex, or blinking or closing one's eyes upon a perceived risk, can be suppressed through training and coaching," notes Joe Clark, Ph.D., professor in the Department of Neurology and Rehabilitation Medicine at the University of Cincinnati, in the release. "So it is possible that training to improve eye discipline and maintain control of ball handling may help mitigate concussions in soccer players heading the ball."  

Optometry in play: Sports vision and concussions  

Doctors of optometry can play a proactive role in helping prevent and provide early assessment and treatment of concussions. Additionally, the study's assessment that vision training may hold potential for averting concussions or head injuries is one that's already catching on with professional and collegiate teams.  

Keith Smithson, O.D., who works with Washington, D.C.-based professional franchises, including the Washington Spirit women's soccer team and DC United men's soccer, says a component of sports vision training that's increasingly catching is this potential for injury mitigation.  

"Performance vision enhancement was the basis for most discussions regarding visual training and sport—how we can help you get more goals, throw more touchdowns—but in today's world of concussions and injuries, it's all about how we can keep these athletes healthy and on the field," Dr. Smithson says.  

Increasingly, sports teams' interest in concussion avoidance and rehabilitation has grown alongside their interest in gaining a competitive edge through visual enhancement. Dr. Smithson hopes that performance vision training, in this way, also will become as common as stretching before competing.  

"This is a huge change that we've seen in the past few years," he notes.  

More than 20 different visual skills can be affected by traumatic brain injury (TBI), and vision tests are good indicators of brain health following a blow to the head. That's why knowing how to properly diagnose and manage TBI is increasingly important for doctors of optometry.  

The AOA offers the Brain Injury Electronic Resource Manual (BIERM), Volume 1A, Traumatic Brain Injury Visual Dysfunction Diagnosis, and Volume 1B, Traumatic Brain Injury Visual Dysfunction: Optometric Management and Advanced Topics, to help guide doctors' clinical responsibilities and address optometry's overall involvement in the management and rehabilitation of patients.  

Read five things doctors should know about concussions.