FORT LAUDERDALE, Fla. -- Major League Soccer is looking to take the lead with the best protocol for handling concussions.
Team doctors, athletic trainers and trainers from outside the sport attended the MLS Medical Symposium on Saturday.
While football and soccer has its share of concussions, men's soccer ranks fifth in terms of game-related concussions, according to Dr. Ruben J. Echemendia, a clinical neuropsychologist for the MLS who led the symposium.
How concussions are sustained differs in each sport, but identifying and treating concussions should be the same across various sports, he said.
Like some other leagues, the MLS has added to each team a neuropsychologist, who specializes in the treatment of concussions.
Dr. Riley J. Williams, team doctor for the New York Red Bulls and the New Jersey Nets, emphasized the importance of being referred to a neuropsychologist.
"We think is appropriate and should be the standard of care, at least for any type of impact athletics," he said.
Echemendia implemented the concussion treatment program in the NHL and carried over the same principles to the MLS.
"The management of the injury remains basically the same," Echemendia said. "What's different are the rules as in soccer, we have rules about substitution that make it difficult to do the kinds of evaluations that we would do in the NHL or even in the NFL."
Unlike other pro leagues, MLS players don't have a union, which may make it easier to implement stricter rules around concussions.
In 2010, the MLS created a nine-member concussion committee chaired by Echemendia. Last year, the league added neuropsychological testing for all players to establish a baseline, so problems can be more easily identified when symptoms arise.
Repeated head trauma forced the retirement of New England star Taylor Twellman in 2010. Concussions forced out D.C. United defender Bryan Namoff, and Alecko Eskandarian, like Twellman a former league MVP, stopped playing after a 2009 concussion.
Last month, Seattle Sounders backup goalkeeper Terry Boss retired. He'd posted on Twitter his intention to retire because of complications from concussions.
In the MLS, a player suspected of having a concussion in a game or practice must be removed immediately and evaluated. Team physicians are the ultimate authority.
Players are evaluated and treated using three testing protocols. Players must pass cognitive tests and be symptom-free before returning to the field, which could take days or months. The team doctor and team neuropsychologist must OK the return to competition.
"Once they're symptom-free both physically and cognitively, in other words they're saying that the feel fine, then our protocol is to evaluate them using neuropsychological testing to make sure that cognitively they are fine," Echemendia said. "Because very often the physical symptoms will resolve prior to the cognitive symptoms, and we really don't know that until we test them."
Players then start low-level aerobic activity and gradually build up their exertion to the level of competition.
The system helps avoid players hiding symptoms or faking their way through some cognitive tests by memorizing some of the questions.
"It's an injury that is a little vague and a little diffuse," Williams said. "Players are often very anxious and very, very worried about their positions on teams because, after all, it is a money-making business for them. So it's really our responsibility to be cautious and act in the best long-term interests of the players in terms of not putting them back on the field prior to them being ready."
The symposium was sponsored by Hospital for Special Surgery.