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World Cup Water Breaks Put Focus On Player Safety Issues

Mark Kolbe

While concussions are the primary player safety concern in the media, dehydration and heat stroke are now getting some much needed attention thanks to the much talked about water breaks during World Cup play.

It seems like much ado is being made about water breaks during the 2014 World Cup. Social media was abuzz on Sunday during the match between Mexico and the Netherlands, which saw the first official water break of the tournament (the US match with Portugal had it but it wasn't an official break). The opinions ranged from ridicule to welcomed surprise to jokes about the Qatar World Cup needing water breaks every five minutes due to the heat.

Liga MX (which I've watched for years) has incorporated these breaks into play as long as I can remember. Usually occurring around the 30th and 60th minute marks in a match, teams will (during a natural stoppage in play) head to the sidelines for between one and two minutes and drink water. It makes sense - in Mexico's hot climate, players get dehydrated faster which can increase the likelihood of a heat related illness such as heat stroke. Without these breaks, cramping occurs more frequently, which often delays the game. Players who are supposed to be playing at the highest level simply cannot perform at that level without the proper hydration.

In no other sport are the players expected to play as long without a break. American football has breaks after every play (usually 5-10 seconds of game play). Baseball allows players to go into the dugout and eat/drink/relieve themselves every inning. Basketball allows for breaks during timeouts, and each team gets eight timeouts per game. Hockey allows free substitution of players in shifts, who can come off of the ice and sit and drink after their one-to-two minute shift is done. Soccer has the players going for 45 minutes plus stoppage without a real break in play.

As much is made of concussions, this is a player safety issue that seems to fly far under the radar. Concussions are the hot debate in soccer, with people such as Taylor Twellman pushing hard for better screening and quicker removal of concussed players. While concussions are a very serious issue, dehydration and heat-related illnesses seem to be deadlier. According to the Epidemiology of Sudden Death in Young, Competitive Athletes Due to Blunt Trauma study:

Of 1827 deaths of athletes aged 21 years or younger, 261 (14%) were caused by trauma-related injuries

This study was conducted from 1980 through 2009. And while 1827 deaths are not an insignificant number, of these 1827 deaths, only 17 were found to be directly related to concussions.

Of the 138 football players who died as a result of head/neck blows with subdural hematoma, 17 (12%) had a reported history of concussion a few days to 4 weeks prior, which was followed by persistent symptoms that included recurring headache, dizziness, disorientation, memory loss, visual disturbances, seizures, and vomiting. This sequence of events is consistent with "second-impact syndrome."

I'm not trying to lessen the tragedy of any death. Any time a parent has to bury a child it is an unimaginable horror, one as a parent myself I hope I never have to face. But the data suggests that second-impact syndrome is the cause of only 17 of the 1827 (0.93%) deaths in the study. Compare this to the "31 high school players died of heat stroke complications between 1995 and 2009" and you realize that the heat kills faster and more regularly than concussions. In 2001, NFL offensive tackle Korey Stringer died due to complications from heat stroke during the Minnesota Vikings preseason camp. A Sporting News report in 2011 stated that:

During the practice that led to Stringer’s death, the heat index reached 110 degrees, and the Vikings practiced in full pads and helmets. Stringer fell into unconsciousness afterward as his body temperature soared over 108 degrees. He died early the next morning.

I would like to propose to MLS that any match where the heat index as measured by the National Weather Service is above 95F (35C) at kickoff be mandated a brief two minute water break between 25 and 35 minutes and between 65 and 75 minutes. Play should not be stopped unless there is a natural break in play, and the two minutes allowed for these breaks would be added into the stoppage time at the half in which it was played. This would again help players remain hydrated during matches with a minimum amount of interference. It's time to take this easily correctable player safety issue as seriously as any others before MLS has a Korey Stringer of their own.

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