Scientific Article

Concussions in Soccer

7 December 2022

Research Article:

Avoiding a red card: recommendations for a consistent standard of concussion management in professional football (soccer) 

Article Breakdown

The authors of this scientific paper highlight a number of recommendations for professional football (soccer) with the goal of creating a consistent standardization of concussion management, protocols, education, and surveillance. The authors acknowledge that each recommendation has achieved some level of acceptance and adoption across the sport, although systematic cohesion among the professional ranks has not been achieved yet. This paper is a call to action with the goal of creating a new, holistic approach to concussion management in professional football. The core concepts presented aim to serve as a basic foundation for FIFA and sport organizations alike to build more comprehensive concussion management protocols that address each area. 

Recommendations for Soccer

  1. Mandatory Education 

Educating all sport stakeholders on concussion is proven overtime to improve concussion recognition and management. This practice has been implemented in a handful of professional football (soccer) leagues including, but not limited to the Major Soccer League (MLS) and for the FIFA Women’s World Cup 2019. This recommendation aims to help reduce concussion misconceptions, misrepresentations and create strides in relation to player welfare prioritization.

  1. Application of ‘If in doubt, sit them out’

This recommendation is a widely adopted concept that prompts sport staff, trainers, coaches, players and other sport stakeholders to withdraw from the field of play if a concussion is suspected. This recommendation seems simple in principle but often is hard to navigate unless an unassociated party is making the decision. 

  1. Access to video footages and independent spotter 

At the professional level, all teams have access to match footage. As a result, this level of access can help the training staff and unassociated concussion spotters to identify contact that may have resulted in a concussion. Surveillance of sport injuries is a growing area related to concussion prevention and has a lot of value for several aspects of concussion management.

  1. Time window for concussion assessment and related alteration of the laws of the game

For this measure, the authors recommend that professional football (soccer) leagues allow a specific, standardized window of time (3 minutes) to assess an athlete on the field of play for a concussion. In addition to this new rule, they also advocate for the use of a “concussion substitution” to minimize disruption of game flow and to maintain competitive equity during matches when a player has a suspected concussion. 

  1. Time window for return to football competition 

As per the recommendations put forth by the latest consensus statement on concussion and its graduated return-to-sport protocol, a concussed professional football player must remain sidelined for a minimum 6 days, undergo serial clinical evaluation and may only return if asymptomatic. If an athlete sustained a concussion on the weekend, they are unable to return to competition for a midweek match.

  1. Documented clearance by team physician 

A team doctor should document the entire process of return and it is recommended that a multidisciplinary approach to recovery might prove helpful if accessible.

Main Takeaway Message

This call to action inspires responsibility to create a holistic approach when creating a concussion policy in professional football and provides tangible solutions to help create a safer sporting environment. 

Study Reference and Access

Gouttebarge V, Goedhart EA, Orhant E, et al. Avoiding a red card: recommendations for a consistent standard of concussion management in professional football (soccer) British Journal of Sports Medicine 2022; 56:308-309.

Activity Trackers

25 October 2022

Research Paper:

Effectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analyses

Article Breakdown

This study examined the effectiveness of activity trackers for improving physical activity and other health measures. The shines a positive light on the use of activity trackers and their ability to inspire physical activity and positive health outcomes across some physiological measures. The review noted a meaningful benefit of activity trackers and noted areas for further research on this topic to establish additional insights in relation to other health measures (physiological and psychosocial).

Main Findings

  • The meta-analyses suggested activity trackers improved physical activity, body composition (, and fitness, equating to approximately 1800 extra steps per day, 40 min per day more walking, and reductions of approximately 1 kg in bodyweight.
  • Effects for other physiological (blood pressure, cholesterol, and glycosylated haemoglobin) and psychosocial (quality of life and pain) outcomes were typically small and often non-significant.


  • Although the sample chosen was comprehensive and incorporated elements related to the title, the authors acknowledge the exclusion of systematic reviews related to activity tracker-based interventions in populations with mental illness.

Main Takeaway Message

Activity trackers appear to be effective at increasing physical activity in a variety of age groups and clinical and non-clinical populations. 

Study Reference and Access

Ferguson T, Olds T, Curtis R, Blake H, Crozier AJ, Dankiw K, Dumuid D, Kasai D, O’Connor E, Virgara R, Maher C. Effectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analyses. Lancet Digit Health. 2022 Aug;4(8):e615-e626. doi: 10.1016/S2589-7500(22)00111-X. PMID: 35868813.

Physical Interventions

26 September 2022

Research Paper:

Do physical interventions improve outcomes following concussion: a systematic review and meta-analysis?

Article Breakdown

Reid, Farbenblum & McLeod (2022) conducted a systematic review and meta-analysis examining the effect of physical interventions (ie., subthreshold aerobic exercise, cervical, vestibular and/or oculomotor therapies) on days to recovery and symptom scores for concussion management. 

The authors reviewed randomized controlled trials (RCT) for interventions of subthreshold aerobic exercise, cervical, vestibular and/or oculomotor therapies. Twelve RCTs met their inclusion criteria: 7 on subthreshold aerobic exercise, 1 on vestibular therapy, 1 on cervical therapy and 3 on individually tailored multimodal interventions.

Main Findings

  • Of the 12 trials reviewed in this study, four of them included participants with acute concussion symptoms and eight included those with persistent symptoms.
  • Their analysis found subthreshold aerobic exercise had only a small effect in reducing symptoms, but more importantly it shows that subthreshold aerobic exercise does not make symptoms worse in both acute and persistent concussion, which to date has been somewhat unknown (Reid, Farbenblum & McLeod, 2022, pg. 296).
  • Additionally, individually tailored multimodal intervention can help facilitate a faster return to sport while decreasing symptoms with those with persistent symptoms.
  • They also found limited evidence for stand-alone cervical, vestibular and oculomotor therapies.
  • Although there was limited evidence for stand-alone cervical or vestibular therapy, when it was incorporated into multi-modal collaborative care, including cervical, oculomotor and vestibular rehabilitation tailored to the patient’s presentation, there is evidence of a positive outcome.


  • A limitation of the review was the small number of studies for certain interventions and the inclusion of trials with small sample sizes (Reid, Farbenblum & McLeod, 2022, pg. 297). With these limitations, there is a possibility of skewed or biassed data, please interpret the results with caution. 

Main Takeaway Message

This study provides reassurance to the Rhea Active Recovery approach of subthreshold aerobic exercise and its potential benefits in both the acute phase or those with persistent symptoms. The research highlights aerobic exercise in reducing symptoms, as well as no negative implications to using this approach. While this approach does not lead to a faster recovery, other evidence brought forth in this review suggests that a multi-modal approach to recovery can lead to a faster return to sport for those with persistent symptoms.

Study Reference and Access

Reid SA, Farbenblum J, McLeod S. Do physical interventions improve outcomes following concussion: a systematic review and meta-analysis? Br J Sports Med. 2022 Mar;56(5):292-298. doi: 10.1136/bjsports-2020-103470. Epub 2021 Sep 30. PMID: 34593371.