People @ Swiss Concussion Center: Cornelia Meier, physiotherapist

In a loose series of short video interviews, we present the people who work at the Swiss Concussion Center and contribute daily to enable athlete athletes a safe “return to sport” after concussions.

What is your job at the Swiss Concussion Center?

I am physiotherapist and specialized in vestibular and visual systems. My task is to decipher the symptoms with which the athletes come to us. With the help of additional clinical and high technology diagnostics and in an interdisciplinary team, we can then initiate a specific rehabilitation program.

What are your goals at the Swiss Concussion Center?

Various problems may arise from concussions, which may be independent but may also be linked to one another. The goal is to bring the athletes back into their everyday life and then back into their sport with a targeted therapy adapted to them and their problems, step by step.

What is your motivation to contribute to the Swiss Concussion Center?

As part of my work as a therapist, the Swiss Concussion Center offers me the opportunity to bring my specialist knowledge in vestibulo-oculomotor rehabilitation to a motivated, interdisciplinary team. Above all, the highly specific requirements for the vestibular and visual system of an athlete in his own sport are a big challenge, which I place above all else.


JIKEI Group Japan visits the Swiss Concussion Center

On 27 June 2016, a delegation from the Jikei Gakuen School Corporation and Sangyo Gijutsu Gakuen School Corporation (JIKEI Group), Japan, visited the Swiss Concussion Center and the Schulthess Clinic. JIKEI Group comprises more than 70 colleges in Japan (including approximately 35,000 students), including the Tokyo College of Medical Sport, with whom Dr. Mario Bizzini, Head of Physiotherapy at the Swiss Concussion Center, has been cooperating for several years.

Dr. Alfred Müller of the Swiss Concussion Center and Dr. Mario Bizzini guided the guests from Japan through the key areas of the Swiss Concussion Center and the Schulthess Clinic. A training week for physiotherapy students from the JIKEI Group is scheduled for 2017 at the Swiss Concussion Center and the Schulthess Clinic.

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Medscape interview with Nina Feddermann on the subject of a header ban for young players

The leading international online platform for medical topics, “Medscape“, interviewed Nina Feddermann, Head of the Swiss Concussion Center, in the run-up to the European Football Championship in France 2016 on the subject of the ban on header bans for young players. The full interview is below. The original post is under this link (free registration necessary).

Category “Opinion”

Kopfballverbot für Nachwuchsspieler: Header ban for youngsters: “The header itself is not the problem”
Author: Teresa Nauber |08. June 2016

Since headers in youth football were banned in the USA after pressure from a parent’s initiative, the uncertainty is growing here as well. Do headers have serious health consequences? Not only parents of young players, but professionals are also afraid of long-term effects – also because is this also suggested by current studies. Dr. Nina Feddermann is a neurologist specializing in head injuries. At the newly founded Swiss Concussion Center in Zurich, she and her colleagues advise athletes who have suffered a head injury.

Medscape: Dr. Feddermann, in the USA, young footballers are not allowed to head the ball during training nor in matches until the age of 11, and until 13 only during training. Are Americans overbearing?

Dr. Feddermann: To be honest, I do not know exactly how this decision came about. The American Soccer Federation has probably responded to a collective complaint by parents. From a neurological point of view, however, there is currently no scientific evidence for this. To date, it has not been proven that header per se has any negative effects on the brain’s structures or functions. The results of studies with active and former footballers are contradictory. The studies dealing specifically with football in childhood have concluded that concussions are rare in childhood. The main cause of the few concussions was not the header itself, but direct body contact or falls.

Medscape: What exactly are the pathophysiological mechanisms behind concussions?

Dr. Feddermann: A concussions is a mild form of traumatic brain injury (mTBI). The exact pathomechanism has not yet been detected. According to a common hypothesis, a so-called “neurometabolic cascade” is triggered by the trauma. This begins with an ionic disturbance, which increases the extracellular potassium. The result is a nonspecific electrical depolarization of the cells. Additionally, glutamate is released and the potassium-dependent effects increase. In affected patients, for example, loss of consciousness, memory gaps (amnesia), and cognitive impairments can be observed. The energy requirements of the affected cells increase, glycolysis and lactate production increase, and the oxidative metabolism is restricted. Basically, a vicious circle arises from various effects which are mutually dependent and lead to what is termed a cellular “energy crisis”. For example, cell-membrane damage and an increased permeability of the blood-brain barrier can occur. Overall, the brain is more vulnerable for about a week than usual.

Medscape: Does something like this happen also during a header?

Dr. Feddermann: No, in my opinion this is one of the challenges: One has to distinguish between what is called “concussions” in German, i.e. the mTBI, whose probable effects on the brain I have just explained and the sports-associated concussion. In English, this is called “concussion” and is understood as a mild subtype of mTBI. It is caused by direct or indirect trauma against the head (acceleration-deceleration mechanism or “coup” and “contre-coup” injury). It is usually a functional disorder and not a structural injury. Correspondingly, the standard imaging indicates normal results.

The “concussion” is characterized by a diffuse, mostly reversible brain damage, which can lead to neurological and neurocognitive changes occurring rapidly after the event, such as dizziness, headache, blurred vision, and concentration problems which can occur with or without a loss of consciousness. The core features of the classical mTBI (amnesia, confusion, and equilibrium disorders) are not so frequently observed in sports-associated concussions.

Additionally, you have to distinguish between this mild form of concussion, and what happens with a header. The terms ”header” and “(sport-associated) concussions” are unfortunately often mixed together. The force effect on the head during a header is usually much lower than in the trauma mechanism of a concussion. Therefore, these beats are also referred to as “subconcussive”, that is, low. Whether cumulative effects of repetitive low-intensity force effects on the brain have a negative effect on brain structures or function has not yet been determined. However, Vann Jones of the Institute for Aging and Health at Newcastle University in Great Britain has shown, for example, in a small study in 2014 that the risk of neurocognitive impairment after the end of the football career is as high as any other person.

Medscape: So headers are not dangerous at all?

Dr. Feddermann: A header is a technical skill that is learned. There is no evidence that this technique leads to lasting injuries – if it is learned and applied in a controlled manner. Headers are suspected of being a risk factor, but the main causes of head injuries in footballers are not header.

Medscape: But rather?

Dr. Feddermann: Direct body contact with an opponent or falling. There is a very recent prospective epidemiological multi-centre study on head injuries in children aged 7 to 12 years in organised football. There were 39 head injuries and a neck injury recorded in 688,045 game hours. Of these, 11 were diagnosed as concussions, and 2 of them were caused by ball contact – so one in 344,022.5 game hours. Most children had been injured by direct physical contact or, in other studies, by hitting their heads on the pitch.

Medscape: There are already studies, however, which suggest that the constant headers can have profound consequences. For example, Dr. Inga Koerte and colleagues from Munich and Harvard showed changes in the brain structure in former professionals, which were related to the exposure of the players to headers.

Dr. Feddermann: Yes, the studies have – unfortunately, in my opinion – led to much uncertainty. The problem is that results of studies are disseminated whose design is not at all appropriate to substantiate causality. In one of the studies by Dr. Koerte you mentioned, only 12 soccer players were examined. In another, the players themselves estimated retrospectively over a year how many headers they had played. We have also carried out studies with professional players. Many of them had problems remembering how many games they played last season. In addition, studies are based on newer imaging methods, such as diffusion-weighted magnetic resonance tomography (DW-MRI). Currently, it is not yet clear whether an abnormality seen in the actual state is later to be assigned to a disease value or whether it recurs. However, studies into this topic should be continued in any case.

Medscape: So, you would not be in favour of a header ban in football?

Dr. Feddermann: I do not think this is the right path for two reasons: first, we do not know enough about the effects of repetitive headers. To this end, we gave a lecture at the DFB (German Football Association) Scientific Congress in January, for which we screened 991 abstracts, and analysed the relevant studies. Here, at the Swiss Concussion Center, we have concluded that prospective combined longitudinal and cross-sectional studies are necessary to draw clear conclusions. Secondly, we wonder whether age is the right indicator for such a ban. Children develop very differently. Everyone who has ever seen football with children already notes body size.

Medscape: Does it even make sense to only enforce such a ban in childhood?

Dr. Feddermann: It is undisputed that the child’s brain is more vulnerable to injuries because it is still developing. In addition, the neck muscles are less developed and the header technique less mature. The latter in my view speaks against a ban in youth football.

Headers are an elementary part of football; you cannot simply abolish it. Eventually, footballers should be introduced to the header, preferably playfully, controlled and above all with balls adapted in size and weight. This is best done in childhood. Evidence shows that the number of synapses increases only until about age 10, after which what is not needed is reduced again. That is, you can learn certain things only to a certain age.

Medscape: So, head injuries in football are in your opinion no problem?

Dr. Feddermann: Head injuries should be paid particular attention, since in rare cases it is a potentially significant injury. Here at the Swiss Concussion Center, we look after athletes daily, including footballers, after head injuries. In football, however, these injuries are usually not caused by headers, but because, for example, two players collide during tackling.

Medscape: So does something have to be changed on the field?

Dr. Feddermann: From my point of view, one should try to reduce direct body contact on the field so that football can evolve from a physical to a more technical game. The referees must also be trained for this. In the prevention of injury, this approach has long been a common practice. Analyse what the main risk factor for an injury is and then consider whether it can be minimised. Before the 2006 FIFA World Cup, a study conducted by FIFA’s Center for Medical Evaluation and Research identified the direct elbow strike against the head as the main cause of head injury. Thereupon a new rule was laid down, after which a direct elbow strike is punished with dismissal.

Medscape: Before such rule changes enter into force – what can team physicians, coaches and supervisors do if a player shows signs of a sports-associated concussion or one of its subforms?

Dr. Feddermann: It is essential to make a correct diagnosis as early as possible, since these are often combined injuries and different diagnoses result in different therapeutic measures. An initial rest period is recommended after a concussion. If the balance system is affected, however, rapid physical activity is required, or specific therapeutic measures, to initiate central compensatory mechanisms. If the player is deprived of such measures, this can lead to long-lasting problems and it can have long-term sequences. Ten days of dizziness are a risk factor for the development of affective disorders such as anxiety or depression. To identify players with an increased risk for a prolonged course at an early stage, it is important for medical colleagues who care for players or teams should consult a specialist at an early stage. As a Center, we are happy to advise players, team physicians and coach teams.

© 2016 WebMD, LLC
The opinion stated is that of the author and does not necessarily reflect the views of WebMD or Medscape

Source: Header ban for youth players: “The header itself is not the problem”. Medscape. 8 June 2016.


The Swiss Concussion Center in the broadcast pulse of Swiss Television SRF

Are headers harmful to children’s heads?
The topic of the “Pulse” program on Swiss Television SRF was dedicated to this theme. Beitrag der Sendung “Puls” des Schweizer Fernsehen SRF. The head of the Swiss Concussion Center, Dr. Nina Feddermann, takes a position and explains the situation from a medical perspective.

The Swiss Concussion Center visits the University of Calgary

Mario Bizzini, Head of Physiotherapy at the Swiss Concussion Center, visited Dr. Kathryn Schneider at the Sports Injury Prevention Research Centre at the University of Calgary (Alberta, Canada) in May 2016 as part of a project with the Canada Soccer Association. Dr. Schneider, assistant professor at the Faculty of Kinesiology, has been researching the topic of concussions for several years and is also the author of various publications in this area. Her clinical research is dedicated to manual therapy and vestibular rehabilitation in patients with post-concussion syndromes. The studies demonstrated the effectiveness of these therapies. The Swiss Concussion Center is planning a cooperation with Dr. Kathryn Schneider and her team in Calgary as part of a research project.  


Kathryn Schneider (University of Calgary) and Mario Bizzini (Swiss Concussion Center)




People @ Swiss Concussion Center: Karin Mani, Research Assistant

In a loose series of short video interviews, we present the people who work at the Swiss Concussion Center and contribute daily to enable athlete athletes a safe “return to play” after concussion.

Interview Transcript:

What is your job at the Swiss Concussion Center?

I work at the Swiss Concussion Center in the field of research. I am mainly concerned with scientific questions around dizziness and balance problems. Furthermore, I am responsible for diagnostics in the field of postural control. That is, the athletes come to me and do various computer-based tests, and I can then use these results to make a detailed diagnosis and use this diagnosis in conjunction with their own physiotherapy team to create an individual, personalised rehabilitation for the athletes. This is all based on research results.

What are your goals at the Swiss Concussion Center?

With my research results, I would like to contribute to a more detailed diagnosis after a traumatic head injury. This also means for an athlete that they can start a specific rehabilitation therapy faster.

What is your motivation to contribute to the Swiss Concussion Center?

The people who come to the Swiss Concussion Center are my motivation. One must imagine: the athletes lose their hobby, their job, and their social environment all at the same time. They come to therapy and work incredibly hard. If I can speed up the rehabilitation process with my work, then this is enough motivation.

The Swiss Concussion Center at the 25th International Conference of Sports Rehabilitation and Traumatology in London

The 25th International Conference of Sports Rehabilitation and Traumatology, which took place at the Queen Elizabeth II Conference Center in London from April 9 to 11, 2016, focused on “Return to Play” this year. Over 2,000 physicians and physiotherapists from 89 countries took part. The Swiss Concussion Center was also represented and introduced by Prof. Jiří Dvořák, Chief Medical Officer of FIFA and member of the Swiss Concussion Center, during a presentation. Click here to go to the message.

Twitter: @footballmed oder #RTP2016

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The Swiss Concussion Center in the program “10 vor10” from Swiss Television SRF

In its episode on 1st April 2016, the well-known informative programme “10vor10” from the Swiss Television SRF reported on the work of the Swiss Concussion Center in connection with concussions in Swiss ice hockey. The focus was on the therapy using the Equitest and the rotating chair. Deny Bärtschi (SCL Tigers) and Félicien Du Bois (HC Davos) gave “10vor10” information on their treatments at the Swiss Concussion Center.

People @ Swiss Concussion Center: Mario Bizzini, Head of Physiotherapy

In a loose series of short video interviews, we present the people who work at the Swiss Concussion Center and contribute daily to enable athlete athletes a safe “return to sport” after concussion.

Interview in text form:

What is your job at the Swiss Concussion Center?

I am responsible for the physiotherapy, rehabilitation, and training departments at the Swiss Concussion Center and coordinate a team of specialised physiotherapists and sports physiotherapists who look after our athletes. In doing so, we design customised programmes from the gymnastics room to the sports field.

What are your goals at the Swiss Concussion Center?

Our goal is to provide a safe “return to sport” so that our athletes can return to their sports in the best possible condition. It is a daily challenge to design the individual support, as every athlete is different, both regarding sport and the individual problems regarding concussion.

What is your motivation to contribute to the Swiss Concussion Center?

Apart from the fact that I like to work with international athletes, the Swiss Concussion Center offers a unique opportunity to work in this important area. The topic of concussion is becoming increasingly important and taken seriously, and I am very motivated to build up a Swiss competence Center with an interdisciplinary team.

The Swiss Concussion Center at ETH Demo Week

The team of the Swiss Concussion Center led the topic “Diagnostics of Posttraumatic Dizziness” and “Therapy for Posttraumatic Dizziness” from 8th to 11th February 2016 at the ETH Demo Week, which is held annually for students studying health sciences and technology at the Schulthess Clinic. Each afternoon, about 60 students were introduced to the topic. In the field of diagnostics, the focus was on the video-head impact test, in the field of therapy on different balance tests and exercises for training balance and eye movements.