Dr. George Chiampas (Photo courtesy of U.S. Soccer by John Dorton/ISI Photos)
Chiampas is the Chief Medical Officer of U.S. Soccer, which by a long stretch took the lead among the world’s soccer governing bodies in addressing concussion prevention, management and awareness -- after new science provided clearer information on the dangers of concussions and their frequency in youth sports.
He has overseen the launch of U.S. Soccer’s Recognize to Recover health and safety program and the Federation’s rule changes to ban heading for players 10 and under and limit heading for players through age 13.
Also assistant professor of Emergency Medicine and Orthopaedic Surgery at Northwestern, the Chicago Blackhawks team physician, and the Chicago Marathon's medical director, Chiampas spoke to us before he started an evening-to-morning shift at the Northwestern Memorial Hospital emergency room.
SOCCER AMERICA: You’re a busy man …
GEORGE CHIAMPAS: Yes. It gives a lot of different perspectives, which overall is supportive for all the environments I’m in.
I work harder today than even when I was a resident. And it doesn’t feel like work. It’s a part of my life. I enjoy it. I’m fortunate. You’re fortunate when you have the ability to have an influence in protecting, and I take it very seriously, protecting players and putting best practices in place.
SA: On the subject of protecting players -- assessing head injuries. Because there’s limited subbing and no reentry in soccer, assessments are likely rushed. U.S. Soccer came up with a good solution that is used in its Development Academy, whereby a player being assessed can be replaced – and allowed to return if cleared, and that substitution does not count against the limit. Shouldn’t FIFA adopt that?
GEORGE CHIAMPAS: I am on FIFA’s Medical Committee, the representative of the United States, and also on Concacaf’s Medical Committee. These conversations are being had -- in and around substitution, an additional sub, more time for assessment, potentially a substitute while there’s an assessment.
SA: Soccer as governed by FIFA and IFAB is notoriously slow to make changes. Do you think the FIFA Medical Committee has enough influence?
GEORGE CHIAMPAS: I think they do. Obviously, there are challenges any time you want to implement change. I think you have to be clear in your message. I think you have to be consistent. I think everyone has to realize these committees only meet twice a year. What I would say is I think we’re heading in the right direction.
Look at the 2018 World Cup. There’s going to be Video Assistant Replay Medical for concussion assessment.
FURTHER READING: A video review at the World Cup that makes good sense
SA: When in November 2015 U.S. Soccer announced the new regulations on heading, you said the Federation would continue to monitor the research.
GEORGE CHIAMPAS: Right. We’re going to continue to follow the research, we’re going to continue following the science. And if we need to adapt, change, evolve, we’re willing to do that.
U.S. Soccer's four-minute "Recognize to Recover" concussion awareness video.
SA: Any significant research you’ve seen since the heading rule changes were made?
GEORGE CHIAMPAS: There’s a recent study that came out that shows that youth players who have their first concussion under the age of 10 are at increased risk of having subsequent concussions--– so there’s a greater incidence and greater risk than if you have your first concussion between 10 and 18.
Your brain at 8, 9 years old, if you suffer your first concussion at that age, your risk and incidence of concussion is substantially greater.
That’s just one component. The other thing is, if we can protect players in our game, I think parents see that, one, we’re trying to be responsible. Two is, we don’t want kids to have a head injury and then quit the game of soccer. Or quit playing sports. Or quit being active.
SA: Take us back to when U.S. Soccer decided to create the heading guidelines for youth soccer …
GEORGE CHIAMPAS: As the Chief Medical Officer, I brought in some of our concussion experts and some of our medical advisory and had a very good dialogue.
We looked at current research. Looked at what future research would look at. Brought in a pediatric concussion expert as well. And started the dialogue in and around soccer.
We asked, is there evidence that heading a ball leads to concussion? And some of the conversation we really started having is that purposeful heading -- seeing the ball, preparing yourself, heading the ball -- there’s no evidence to say or suggest that heading the ball purposefully leads to concussion.
What we do know is that in the act of heading, or aerial challenges, most concussions, 60, 70 percent, occur when you hit head-to-head, elbow-to-head, knee-to-head, head-to-ground. And that is where the vast majority of those head injuries occur.
What we also looked at is ages and the game. And said is there a specific need for someone to learn how to head the ball at 7, 8, 9 years old? Secondly, is there a developmental process at looking at the ball, tracking a ball ... is there an educational period where young kids are learning those skill sets or developing them?
And so taking all that information into place, we came to summation that we can eliminate heading 10 and under, try to play the ball at players feet, and at 11 to 13 years old there are guidelines and parameters that can allow them to develop, learn the skill of heading. Also, because we highlight the skill, hopefully coaches take it seriously and make a more conscious effort on the skill set that hopefully keeps our players safer.
Dr. George Chiampas (Photo courtesy of U.S. Soccer by John Dorton/ISI Photos)
SA: Have other federations begun to take action?
GEORGE CHIAMPAS: I think Germany is looking at this and the FAs in the UK are doing research. I actually feel even more confident in our decision than I was when we made it.
SA: I've refereed and watched many games without heading and punting, using the build-out line, and the soccer looks much better than when goalkeepers were booting the ball down field. What feedback have you gotten from U.S. coaches and the technical staff?
GEORGE CHIAMPAS: They’ve been very, very supportive. Some of the changes they made, like the build-out line, is parallel to what we’ve done. There have been coaches across the country who maybe questioned it. There’s other coaches who have come out and said that the ball was not in the air much anyways. We have done a survey post the rule changes. The vast majority of coaches have said that it’s been more positive than negative.
SA: From a player development point of view, it's often pointed out the high skill level of Latin American players comes from playing futsal, where at the youth level there's hardly any heading ...
GEORGE CHIAMPAS: Correct. And there’s something to learn from how the Latin players play.
SA: That this is about the health of players' brains would seem to be the main concern ...
GEORGE CHIAMPAS: There has to be common sense. If you look at hockey and baseball, games have evolved. Major League Baseball has taken out the sliding at home. Hockey at the youth level has taken out checking into the boards at a certain age. Why shouldn’t soccer evolve?
Some of the criticism is that the United States isn’t the country that should be making the changes, it’s not in our place. Well, we also can’t sit back. And I think Video Assistant Replay Medical at the World Cup is one example of dialogue leading to the ability to have changes.
You see MLS and them having spotters and communications with their medical staff and their physicians. FIFA and IFAB are also finally allowing us to have medical communications on the bench.
These are all things that have all come up in the last two to three years. These are very player-centric changes.
Dr. George Chiampas (Photo courtesy of U.S. Soccer by John Dorton/ISI Photos)
SA: What’s your personal soccer background?
GEORGE CHIAMPAS: I’m Greek, so soccer was a part of my life from a cultural perspective. I grew up in the city of Chicago and in the Chicago park districts, unfortunately back then, soccer wasn’t a big thing in the city. You didn’t have access to the resources or the parks. It was pretty much baseball, football, basketball, so I grew up playing all three of those sports. I played varsity high school football at Loyola Academy. But I didn’t play soccer as a kid growing up.
Now, fortunately, if you’re a young kid in United States, you do have access to the global game. Soccer is one of those sports that is great for your mind, is great from a physical perspective, emotionally. It’s a team game. It opens your mind to the world. Soccer is the greatest game in the world.
SA: What led you to a career in medicine?
GEORGE CHIAMPAS: Both my parents were immigrants from Greece who came to the United States in their mid/late 20s. As immigrants, their goal for their children is to seize the opportunities that the United States offers you.
My father as a Greek wanted his children to be either a physician or a lawyer. I kind of fought that when I was a kid. I loved sports. All I did was sports pretty much 24/7. I grew up a big Chicago Bears fan, Walter Payton fan.
But I also had a draw toward helping people, serving people. When I started working in hospitals -- as an undergrad I worked as a hospital employee at Loyola University in Chicago -- I really enjoyed that aspect and it became a passion and a dream.
SA: And in 2006 you started traveling with U.S. Soccer youth national teams?
GEORGE CHIAMPAS: I was an ER doc and I was sports medicine fellowship trained, so I had a unique skill set. Having that emergency medical background combined with a sports medicine background was something that I think has been extremely helpful for me. At that time, 2006, there were not many people who were doubled-boarded in emergency medicine and sports medicine.
In soccer, you have to make some relatively quick decisions and my background in emergency medicine is exactly that. You’re built that way. You’re wired that way. You can multi-task and be very efficient.
Another benefit is that as an ER doc you have to work a certain amount of shifts per month. And once you work them, the time is yours. So I would work a lot of my shifts back-to-back-to-back to kind of try compress them and free myself up to travel with U.S. Soccer.
Around 2008, 2009, I started traveling with the men’s national team, with Coach Bob Bradley at the time. And I’ve been with the men’s national team ever since.
SA: And then you took on a larger role with U.S. Soccer ...
GEORGE CHIAMPAS: In 2015 [U.S. Soccer CEO] Dan Flynn and I had conversation about the Chief Medical Officer role and something that Dan and the Federation thought was important: A vision of providing guidance, policy, education, in and around youth player safety. Not just around our national teams but potentially be a hub and disseminate some of those best practices across the country and maybe even be influential globally.
SA: Any important changes you've seen in American sports medicine in regards to soccer?
GEORGE CHIAMPAS: With the growth of the sport, you’re seeing more and more interest from health-care providers to have a soccer-specific focus.
What you used to see is that the game of soccer would kind of absorb policies and procedures from other sports -- from some of the sports that had a bigger media presence -- and essentially try and take those rules, policies and put them into soccer.
What we’re seeing over the last three to five years is us building a platform that is specific to our game. I think that’s what’s so exciting and I think that’s what so special. Because if you’re a soccer person in the United States, trying to have other sports dictate how you play, when you play, doesn’t sometimes correlate.
What we’re doing with, for example, Recognize to Recover, is an injury platform, an educational platform, for coaches, for players, for referees, for parents. So that we can start putting forth educational safety policies, safety guidelines, educational tools, nutrition, performance -- to protect our game.
For example, we have the first heat guidelines in the game of soccer. That never existed. I’m very proud of that. In youth sports overall, about 20 kids die a year from heat. We created heat guidelines that are specific to the game of soccer, not taking them from other sports. We have cold weather guidelines and our concussion video is one of the best. That is a tremendous testament to what U.S. Soccer in Recognize to Recover does. And we're going to put our player safety message in our coaching and refereeing licensing.
Great article and very encouraging. One comment. Safety of the players is one of the prime responsibilities of not only the officials but also the coaches. For lack of a better word I will call it the "direct attacking" of players on the field in order to inhibit their play. It happens particularly to the better players who cannot be stopped through normal defensive tactics and the attempt to control them is through direct intimidation by the players in an effort to stymie their play. Some of the tactics used such as tackling from behind. Pulling a player down from behind in order stop his progress somtimes viciously subjecting the player to injury. And the officials handle it poorly. I have been to showcases across the country at all age groups boys and girls and find these tactics used frequently with little involvement by the officials. I have to assume that the coaches are preaching this nonesense or the players wouldn't be doing it.
I agree with you R Winger. Didn’t use to be this way. Too many, evidently, grew up encouraged to get away with the lazy, physical play thereby holding the technical (beautiful game) in disdain. During my college coaching years I saw many coaches not admonish their players for similar behaviors. Referees always had my permission and encouragement to error on the side of the technical. Much of soccer has become difficult for me to watch, including our pro leagues.
Ships when this happens it is so evident of what is trying to be accomplished that there should be some type of repercussion for the coaching staff for the teams that promote this nonesense. It should be one warning when it is obvious of what is going on and then the hammer drops on the player(s) involved and the coach. In some places in the country this game has turned into a street fight with some of the fouls that take place. In my humble observations the clubs that participate in this nonesense are clubs affiliated with MLS teams. Same tactics as used in MLS play. Knock em down and drag em out. Rediculous. Ruins the game and the chances of injury is grows. I see the brawny players embarrased by a technical player and the next thing I see is the tech player on the ground. Sure this game is a contact sport but it should not be a vicious sport and in this country it is moving in that direction. I was over in Spain a couple of weeks ago for Mediterranean International Cup with teams from all over the world in all age groups and I didn't see this nonesense. Sure there were fouls that were questionable but they were immediately squlched by the officials and not allowed to go on. Respect for the players and the game. We need to see more of it here.
I resent the suggestion that misconduct is associated with body type ("brawny"). Your examples are all seen from the stands, not the field. This doesn't detract from your point that the game at all levels needs to be cleaned up.
Not only should referees enforce Law 12, but coaches and players should follow Law 12. Reckless play and misconduct don't belong in the game.
One thing I forgot to mention. US had teams there at the MIC and you know what they played the game the way it should be played. I guess when in Rome do as the Romans do and when in the US do as MLS does. Sounds reasonable to me.
"VAR Medical for concussion assessment"?? No follow up to that? That seems like a big step? I read the linked article, but no mention of that in this interview..? okayy