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Youth Boys Jul 13, 2012

Concussion conundrum: referees’ role in preventing head injuries

By Dr. Wendy Lebolt

[Editor’s note: This is the latest column from Dr. Wendy Lebolt, a longtime coach and physiologist who is the founder of Fit2Finish, a Northern Virginia-based training, fitness and rehabilitation company which works with teams and individual players to maximize health and performance.

The Soccer Wire is excited to present Wendy’s learned perspectives on the mental, physical and psychological aspects of the beautiful game. Learn more about her background here. This week Dr. Lebolt presents a follow-up to her previous discussion of concussions, a thought-provoking piece which can be found here.]

Everyone agrees: We don’t want our young players suffering concussions. The difficulty comes in figuring out how to minimize them. There is a lot to this conversation; I only just scratched the surface in a two-part article. In the first, we looked at the nature of the injury and in the second, how to return them to safer play.

Much of the commentary on concussions – both on The Soccer Wire’s forum and in reply to my blog posts – has expressed alarm at the physicality of play. Fingers started pointing at (and vilifying) the referees. Anecdotally, the game seems to have taken a brutal turn and folks figure it is the referee’s job to stem this tide.

Disclaimer: I have been a soccer parent and a soccer coach and something of a soccer player for quite some time, but I am not a certified soccer referee. What I do know for sure is that I don’t know all the laws of the game or their proper application. I have been on soccer sidelines enough to know that many, perhaps most, of the parents (and many coaches) on the sidelines are, let’s just say, “poorly informed” when it comes to reffing, even more so than me, though I am probably not completely objective here.

For instance, they will holler when a foul occurs, but the ref signals for the teams to “play on” so that the fouled player can keep his advantage. They will yell “hand ball!” all day even though the law refers to handling the ball and must result in advantage to the offending player in order to be whistled. Don’t get me started on “dangerous play” or “offside.” I have been cautioned against making that plural.

But a long time on the sidelines does not qualify me as a referee. State referee instructor Ted Longworth told me what does.

“To receive their basic certification referees are required to take and pass a 16-hour basic course which includes on-field training and a written test,” explained Longworth. “Each certified referee must take and pass a recertification class each year and also pass another written test. This means a minimum of 6 hours classroom of additional training each year. During these sessions instructors cover topics of concern to USSF [the United States Soccer Federation] and the soccer community, which lately has included concussion.

“Additionally, USSF asks all referees to read papers from their web site as part of our continuing training program. In addition to certification and continuing education, local groups and clubs pay for higher level referees – instructors and assessors – to operate a mentor program to provide referees with advice and support in real game situations.”

Recognizing the dedication of the referees I know, when online replies to the issue started screaming “Foul!” on the ref squad, I headed (pardon the pun) straight to an authoritative source: Alan Liotta, who has been the director of referees for Chantilly Youth Association since 1995 and served as State Youth Referee Administrator for the state of Virginia from 2004 to 2008. I posed some of our questions:

Wendy Lebolt: What is the role of the ref in maintaining safety as well as fair play?

Alan Liotta: What we teach our refs is that soccer is a contact sport — it was created, designed, and artfully played to be that way. Two players fairly challenging fiercely for a 50-50 head ball is a critical part of the sport’s beauty. Such instances, however, very often will result in physical contact – one player is just a beat behind the other player. In soccer, unlike most sports, the laws of the game require intent — did the player intend to smash his head into his opponent? Or was he so reckless in his attempt to play the ball that he knowingly endangered the other player?

If those elements aren’t met, the referee is not going to call a foul simply because contact was made, even if it means one player goes down injured. Very important note here: I am not diminishing the need for safety in my comment, merely noting what constitutes (or does not constitute) a foul in soccer. In such an instance, the referee should of course be concerned about injury and, if required, stop the game for the player to be treated. But in a day and age when players are increasingly “going to the ground” and “feigning injury,” particularly if they just lost the ball in that challenge, referees must determine whether the injured player is attempting to disrupt play as a tactical advantage or in actual need of immediate medical attention

Experienced CYA (Va.) referee Tim Gorgos adds to this discussion: “It’s important to note that referees do not necessarily have authority to remove players from the field of play after head contact, unless play must be stopped to attend to the player or blood is visibly present. However, a referee can suggest to a coach that a youth player may need evaluation, such as, “Coach, from my viewpoint, player no. 11 took a strong hit to the head and you may want to substitute the player to make sure they are ok.”

Alan again: “Now, does that mean every ref gets it right all the time? Absolutely not. Even the best refs have bad days – witness one of the top referees in the world giving three cautions to the same player [referring to Graham Poll in the 2006 World Cup] in the same match! Referees are like players — some are at the top of their game all the time, some are top-flight but just have a bad day, some are at a level below top flight, but pushing to improve and work at it every day, some just show up to play.

“In games where you have a three-man ref team, we teach our center refs to watch play ‘behind you,’ i.e. in the case cited by some of your commentary, to watch what happens after the head ball to see if heads collide. And good ARs [assistant referees] are essential to helping an official with that.’”

Do referees have special training with regard to managing collisions that may result injuries, especially head injury? Concussions have been a point of emphasis for referee training for the past several years, even before the NFL made it a popular topic. We started addressing it as part of the head gear players began to wear several years ago.

What about the difference between the style and aggressiveness of men’s and the women’s game? Particularly with the travel refs, we frequently discuss the differences between the women’s game and the men’s game. It isn’t that female players just barrel into play because they lack “touch” on the ball. Men use their shoulders, arms, and upper body to leverage opponents and gain position.  Women players almost always come in with their hips to leverage opponents and gain position. When a man gets “brutally fouled” or “taken down,” his teammates tend to retaliate quickly in the same match against the aggressor. When a female player receives the same tackle, her teammates tend to never retaliate in the same match, but to wait for a later match — even if it is years later. Alan noted that this ‘retaliatory behavior’ has been documented by the USSF using Landon Donovan and Mia Hamm several years ago.

Is there a difference in how referees are assigned? Assignors do not assign less qualified officials or younger officials to girls games because they are “easier.” I don’t know a single assignor who would tell you that a competitive girls’ game is any less demanding than a boys’ game.

Some have suggested it would be better just to prohibit heading, or delay allowing it until players are older, perhaps using more caution on the girls’ side. Experienced State Cup referee and former player Cassy Gorgos says no.

“At the youth level, it is the responsibility of the coach to help teach and take preventive easures for his or her players, girls or boys,” Gorgos told me. “Everyone acknowledges that girls are made and develop differently from boys. So they need to be taught the more advanced skills and tasks, — including heading – correctly but differently. Heading techniques should be introduced at a young age and taught and corrected throughout the following years. Heading shouldn’t be eliminated, but youth coaches should be trained in proper heading techniques, as well as exercises to increase shoulder and neck strength.”

[ +See a Fit2Finish video on strengthening against head injury here ]

Alan Liotta was particularly poignant in describing the challenge to today’s referee with regard to maintaining both the safety of play and the integrity of the game. He reminded me of what we all know but sometimes forget: in a given game a ref may have 15 to 20 split-second decisions to make as to whether a collision was the result of fair physical contact committed within the laws of the game, injury or not. The need for safety, any referee will tell you, is paramount. But they are charged with deciding what does or does not constitute a foul in soccer.

Upholding the law is difficult business. Just ask Supreme Court Chief Justice John Roberts about ‘Obamacare.’ There is necessarily room for interpretation. I couldn’t follow the arguments there either.

So I disqualify myself from speaking authoritatively into this issue. I am learning and remain part of the conversation. This even happens around my dinner table where, on a good evening, my three soccer-playing kids, who are all certified referees, will illuminate me on the fine points. Getting our players to become certified referees is a great way for them to learn the game and to see it from a different point of view. And I’ll be honest, sometimes the stories they tell of the ‘parental play’ from the sidelines is even more dangerous than what they officiate on the field.

The only tidbit of expertise I can offer is the play-by-play of a blow delivered to my 20-year-old head by an opposing player intending to head the ball. I had a goose egg over my right eye before I hit the ground. The venue was the College of William and Mary, in the days of club soccer before a varsity team was formed. No refs. Not even a scoreboard. Legendary W&M coach John Daly still remembers the moment. That ended my competitive playing days, as well it should have. I was on scholarship for another sport and had a terrible time hiding that shiner from my coach – and concentrating on my school work for a few days, although at the time I didn’t know why.

It does qualify me to be one of the increasingly non-exclusive club of women who compare head injury “war stories.” Here’s to the effort to reduce the membership of that group.

I offer my thanks to Alan, Tim and Cassy, who do a yeoman’s job trying to maintain the fairness and safety of our beautiful game. Without their good play, it’d just be an ugly scrimmage.