All Articles by Lindsey Barton Straus, JD

Since 1999 several studies have suggested that repeated heading of a soccer ball may result in the short term in weaker mental performance. The long term effects of repeated heading are less clear. "Until further studies clarify the risks, there should be a yellow warning signal going out, say experts, who suggest in the meantime a number of safety precautions.

Mouthguards help prevent injury to the mouth, teeth, lips, cheeks and tongue, but they may also increase the number and intensity of mouth cuts and abrasions, thus exposing an athlete to an increased chance of infection due to the bacteria, yeast, and fungi that they routinely collect.  Experts recommend that mouthguards be sanitized daily and replaced after 14 days or when they develop sharp or jagged edges, whichever occurs first.

One of the signs usually but not always present with concussion is poor balance. An athlete's balance and equilibrium can be tested using low-technology, intermediate technology, and high-technology methods, but the most widely used and validated is the Balance Error Scoring System (BESS).

The emerging model of sport concussion assessment now involves the use of brief screening tools to evaluate post-concussion signs and symptoms on the sideline immediately after a concussion and neuropsychological testing to track recovery further out from the time of injury. One of the tools of value for sideline evaluation is called the Standardized Assessment of Concussion.

Teenage soccer players who wear protective headgear suffer nearly half as many concussions as those who play without soccer headgear, according to a 2008 study conducted by Canadian researchers.

Second Impact Syndrome (SIS) occurs when an athlete who sustains a head injury - often a concussion or worse injury, such as a cerebral contusion (bruised brain) - sustains a second head injury before symptoms associated with the first have cleared. Typically, the athlete suffers post-concussion signs and symptoms after the first head injury, such as headache, visual, motor or sensory changes or mental difficulty, especially with the thought and memory process. Before these symptoms have cleared, which may take minutes, hours, days or weeks, the athlete returns to competition and receives a second blow to the head.

The question of when it is safe for your child to return to the playing field after suffering a concussion is largely a matter of clinical judgment on an individualized basis, but some hard and fast rules do apply.

An athlete can experience two types of amnesia after a concussion: anterograde (reduced ability to form new memories) and/or retrograde (partial or total loss of the ability to recall events before injury). Whether anterograde amnesia is an indicator of more serious injury and slower recovery remains unclear.

Concussions don't usually show up on most magnetic resonance imaging (MRI) exams or CAT scans. As a result, conventional CT or MRI scans of the brain are usually not needed where post-concussion symptoms are mild and clear within a week to ten days. A CT or MRI is, however, recommended in some circumstances.

A multiple concussion history, especially where concussions occur with progressively less impact force, are considered modifying factors in the investigation and management of concussion under the current international consensus statement on concussions.