Fremd High School midfielder Missy Adrian knows how to head a soccer ball with skill and power, using her forehead to send a shot screaming toward the goalkeeper. But that’s not to say she enjoys it.
“It’s something I put up with,” said Adrian, 16, who feels a little jolt of pain on most headers. “It’s not one of the best things (about soccer), but not one of the worst.”
The consequences of skull meeting ball have become the subject of intense research over the last decade as soccer, like many sports, deals with growing concern over brain injuries.
Players can head the ball dozens of times during a week of practices and games, and while a single impact is rarely enough to cause a concussion, scientists are focusing on the cumulative effects of all those blows.
Their findings, though far from definitive, are raising questions about the safety of an act that is an integral part of the sport.
Researchers have used imaging techniques to determine that players who head the ball more than 1,000 times a year sometimes display signs of brain damage. They’ve found that professionals who do the most heading perform worse on cognitive tests than those who do less. They’ve even found evidence that headers done in a single high school practice come at a neurological cost.
“Given that a lot of these questions are just starting to be looked at, we don’t really have a good idea of what the risk is,” said Anne Sereno, a professor of neurobiology and anatomy at the University of Texas Medical School at Houston who used iPad tests to gauge the impact of practice headers. “But I think the studies coming out, mine included, suggest that there are risks.”
The research has yet to produce changes in how the game is played, but a lawsuit against some of soccer’s most influential governing bodies seeks to do just that. Five parents — two of whom are from Illinois — want the organizations to ban heading for players under 14 and impose strict limits for those under 17.
“The (plaintiff’s children) are playing in a sport that’s not properly regulated to protect them,” said lead attorney Steve Berman. “They should be protected. They shouldn’t have to wait to get a concussion to sue.”
A dangerous technique
The origins of soccer go back centuries, and when the English first drafted formal rules in the mid-1800s, players could catch the ball. A few years later, though, use of the hands was forbidden for everyone but the goalkeeper — primarily, some historians believe, to differentiate soccer from rugby — and heading became part of the game.
The danger of that technique was self-evident for decades, thanks to leather balls that got considerably heavier in the rain. Veterans from that era recall players getting knocked unconscious by the ball; one of them, English striker Jeff Astle, was quoted as saying it was like banging his head against “a bag of bricks.”
Astle later developed dementia and died in 2002 at the age of 59. An inquest concluded that heading had damaged Astle’s brain and was “likely to have had a considerable effect on the cause of death.”
England’s Football Association responded by announcing a 10-year study into the consequences of heading the ball, but last year told the BBC that the study had been abandoned after its subjects failed to make it to the professional level.
The U.S. Soccer Federation made a similar pledge in 2001, asking exercise physiologist Donald Kirkendall to perform a five-year study into the effects of heading on the brains of national youth team players. But that study, too, was never published.
Kirkendall said the pencil-and-paper tests meant to track the subjects’ cognitive functions were too hard to administer in the noisy conditions of training camp. The youth teams frequently changed players, too, further complicating efforts to collect long-term data.
Kirkendall, who is on U.S. Soccer’s medical advisory committee, reviewed the scientific literature in 2001 and determined that concussions, which came primarily from players’ heads colliding or hitting the ground, were the likely cause of cognitive deficits found in some studies — not heading the ball.
“My opinion hasn’t changed,” he said this week. “I don’t think purposeful heading is an issue.”
Officials with U.S. Soccer did not return messages seeking comment.
Research finds damage
Another researcher has launched a study similar to what Kirkendall conceived 14 years ago. Dr. Michael Lipton, a radiologist with the Gruss Magnetic Resonance Research Center at Albert Einstein College of Medicine of Yeshiva University and medical director of MRI services at Montefiore Medical Center, is following 400 players over two years to see if heading causes any changes in their brains.
The project builds off an earlier study Lipton did that used imaging technology to find signs of injury in the brains of players who headed the ball an average of 432 times a year. The more they performed the maneuver, the more noticeable the damage, and the worse they performed on a memory test. The players’ concussion histories had no bearing on the results.
Lipton said there was a threshold of roughly 1,000 headers a year under which players seemed to be fine. Even those above that mark were not greatly impaired, he said, leaving the real-world effects of heading unclear.
“Are they functioning as well as they could? I don’t know,” he said. “Have they had a significant consequence because of heading? Maybe, maybe not. Depends on how you define it and measure it.”
Mechanical engineer Adam Bartsch, of the Cleveland Clinic Center for Spine Health, is coming at the question in a different way. He and his colleagues have developed a mouth guard packed with sensors designed to measure the impact of the ball striking the head.
“We have yet to collect trustworthy data points from people in the field to quantify how often and how hard they get hit in the head,” he said. “Until we do that, any rule making will be based on subjective opinions.”
The lawsuit against FIFA, U.S. Soccer, the American Youth Soccer Organization and other governing bodies says age limits on heading are justified because children have weaker necks and less myelin (a protective covering of nerve cells) than older players, leaving them vulnerable.
But Dr. John O’Kane, a University of Washington sports medicine professor who determined that heading was responsible for roughly a third of concussions suffered by female middle school players, said the current data don’t justify such a step. He said a more productive measure would be to ensure that children are using a correctly sized ball that has been inflated properly.
“The long-term ramifications of (heading) are completely unknown,” he said. “There are millions of kids who have played soccer and it’s not clear that there’s any detriment from that.”
Heading rare among kids
Practically speaking, few players under the age of 12 or 13 head the ball much, said David Richardson, president of the Palatine-based Sockers FC soccer club.
“I don’t think it goes on as much as people say it does,” he said. “The training process for (young) players is to get them better with the ball at their feet.”
Heading is commonplace by high school, though, and parents and players interviewed at a recent game between Fremd and Elk Grove said it has a rightful place in the sport.
“I think there’s a proper way of heading the ball and an improper way, and if kids are taught at a young age how to head the ball properly, it’s part of the game,” said Missy Adrian’s father, Chris. “I don’t know necessarily that litigation is going to solve any issues there.”
But Fremd junior varsity coach Chad Jonas was contemplative about the new research. He said he played at a high level for many years, and while he was never diagnosed with a concussion, he wonders if the thousands upon thousands of headers he took came at a price.
“My memory is not the greatest long-term,” he said. “I don’t know if I can attribute that to soccer, but I don’t know if I can rule it out either. When you’re a soccer player, there’s a lot of heading, a lot of impact you take on the head. I think I’d be naive to say it has no effects at all.”
Twitter @JohnKeilman
