Sport-related concussion (SRC) is a growing health concern, particularly in younger, at-risk athletic populations. These injuries commonly present with a wide range of clinical signs (i.e., poor coordination, behavioral, mood changes) and symptoms (i.e., headache, dizziness, difficulty concentrating), along with neurocognitive and vestibular/ocular impairments. This review of SRCs in youth athletes focuses on individuals 5–18 years of age and includes an overview of concussion (i.e., definition, signs/symptoms, epidemiology), as well as concussion education and awareness. This is followed by a review of SRC assessment and management strategies, along with common recovery, return-to-play, and treatment approaches. Finally, suggestions are made for future research and recommendations pertaining to SRC in youth athletes.
Tracey Covassin, Kyle M. Petit, and Morgan Anderson
Liam Anderson, Patrick Orme, Rocco Di Michele, Graeme L. Close, Jordan Milsom, Ryland Morgans, Barry Drust, and James P. Morton
To quantify the accumulative training and match load during an annual season in English Premier League soccer players classified as starters (n = 8, started ≥60% of games), fringe players (n = 7, started 30–60% of games) and nonstarters (n = 4, started <30% of games).
Players were monitored during all training sessions and games completed in the 2013–14 season with load quantified using global positioning system and Prozone technology, respectively.
When including both training and matches, total duration of activity (10,678 ± 916, 9955 ± 947, 10,136 ± 847 min; P = .50) and distance covered (816.2 ± 92.5, 733.8 ± 99.4, 691.2 ± 71.5 km; P = .16) were not different between starters, fringe players, and nonstarters, respectively. However, starters completed more (all P < .01) distance running at 14.4–19.8 km/h (91.8 ± 16.3 vs 58.0 ± 3.9 km; effect size [ES] = 2.5), high-speed running at 19.9–25.1 km/h (35.0 ± 8.2 vs 18.6 ± 4.3 km; ES = 2.3), and sprinting at >25.2 km/h (11.2 ± 4.2 vs 2.9 ± 1.2 km; ES = 2.3) than nonstarters. In addition, starters also completed more sprinting (P < .01, ES = 2.0) than fringe players, who accumulated 4.5 ± 1.8 km. Such differences in total high-intensity physical work done were reflective of differences in actual game time between playing groups as opposed to differences in high-intensity loading patterns during training sessions.
Unlike total seasonal volume of training (ie, total distance and duration), seasonal high-intensity loading patterns are dependent on players’ match starting status, thereby having potential implications for training program design.
Liam Anderson, Robert J. Naughton, Graeme L. Close, Rocco Di Michele, Ryland Morgans, Barry Drust, and James P. Morton
The daily distribution of macronutrient intake can modulate aspects of training adaptations, performance and recovery. We therefore assessed the daily distribution of macronutrient intake (as assessed using food diaries supported by the remote food photographic method and 24-hr recalls) of professional soccer players (n = 6) of the English Premier League during a 7-day period consisting of two match days and five training days. On match days, average carbohydrate (CHO) content of the prematch (<1.5 g·kg-1 body mass) and postmatch (1 g·kg-1 body mass) meals (in recovery from an evening kick-off) were similar (p > .05) though such intakes were lower than contemporary guidelines considered optimal for prematch CHO intake and postmatch recovery. On training days, we observed a skewed and hierarchical approach (p < .05 for all comparisons) to protein feeding such that dinner (0.8 g·kg-1)>lunch (0.6 g·kg-1)>breakfast (0.3 g·kg-1)>evening snacks (0.1 g·kg-1). We conclude players may benefit from consuming greater amounts of CHO in both the prematch and postmatch meals so as to increase CHO availability and maximize rates of muscle glycogen resynthesis, respectively. Furthermore, attention should also be given to ensuring even daily distribution of protein intake so as to potentially promote components of training adaptation.
Liam Anderson, Graeme L. Close, Ryland Morgans, Catherine Hambly, John Roger Speakman, Barry Drust, and James P. Morton
Purpose: To better understand the energy and carbohydrate (CHO) requirements of a professional goalkeeper (GK) in elite soccer, the authors quantified physical loading, energy expenditure (EE), and energy intake (EI) during a 2-games-per-week in-season microcycle. Methods: Daily training and match loads were assessed in a professional GK (age 26 y, height 191 cm, body mass 85.6 kg) from the English Premier League using global positioning systems (GPS) and ProZone®, respectively. Assessments of EE (using the doubly labeled water method) and EI (using food diaries supported by the remote food photographic method and 24-h recalls) were also completed. Results: Physical loading was greater on match days than training days as inferred from total distance (4574  vs 1959  m), average speed (48  vs 40  m/min), and distance completed when jogging (993  vs 645  m) and running (138  vs 21  m). Average daily energy and macronutrient intake appear reflective of a self-selected “low-CHO” diet (energy 3160  kcal, CHO 2.6 [0.6], protein 2.4 [0.4], fat 1.9 [0.3] g/kg body mass). Mean daily EE was 2894 kcal. Conclusions: The average daily EE of this professional GK was approximately 600 kcal/d lower than that previously reported in outfield players from the same team. Such data suggest that the nutritional requirements of a GK should be carefully considered depending on the required daily and weekly loading patterns.
Liam Anderson, Patrick Orme, Robert J. Naughton, Graeme L. Close, Jordan Milsom, David Rydings, Andy O’Boyle, Rocco Di Michele, Julien Louis, Catherine Hambly, John Roger Speakman, Ryland Morgans, Barry Drust, and James P. Morton
In an attempt to better identify and inform the energy requirements of elite soccer players, we quantified the energy expenditure (EE) of players from the English Premier League (n = 6) via the doubly labeled water method (DLW) over a 7-day in-season period. Energy intake (EI) was also assessed using food diaries, supported by the remote food photographic method and 24 hr recalls. The 7-day period consisted of 5 training days (TD) and 2 match days (MD). Although mean daily EI (3186 ± 367 kcals) was not different from (p > .05) daily EE (3566 ± 585 kcals), EI was greater (p < .05) on MD (3789 ± 532 kcal; 61.1 ± 11.4 kcal.kg-1 LBM) compared with TD (2956 ± 374 kcal; 45.2 ± 9.3 kcal.kg-1 LBM, respectively). Differences in EI were reflective of greater (p < .05) daily CHO intake on MD (6.4 ± 2.2 g.kg-1) compared with TD (4.2 ± 1.4 g.kg-1). Exogenous CHO intake was also different (p < .01) during training sessions (3.1 ± 4.4 g.h-1) versus matches (32.3 ± 21.9 g.h-1). In contrast, daily protein (205 ± 30 g.kg-1, p = .29) and fat intake (101 ± 20 g, p = .16) did not display any evidence of daily periodization as opposed to g.kg-1, Although players readily achieve current guidelines for daily protein and fat intake, data suggest that CHO intake on the day before and in recovery from match play was not in accordance with guidelines to promote muscle glycogen storage.