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Youth soccer and concussions: Should headers be banned?

An American soccer icon is leading the charge to ban heading until high school

When fans voted recently on the greatest goal in women’s World Cup history, it was Abby Wambach’s stoppage time equalizer vs. Brazil in 2011 that came out on top.

Unsurprisingly, Wambach’s weapon of choice for that goal wasn’t her boot, but her head. After all, it’s how the world’s all-time leading scorer (in both men’s and women’s international play) has scored almost half of her 182 career goals.

Another USWNT icon, Brandi Chastain, earned a reputation as a prolific header of the ball in her playing days, too. And in the summer of 1999, she accomplished what very few female athletes have in the US: become a household name.

With one penalty kick and a memorable celebration, Chastain became the face of the game for an entire generation of young girls. Her raw, emotional display after her World Cup-winning goal versus China is the sort of passion you’ll see on any given NFL Sunday. But it’s a primal show rarely afforded women in American society. The photo of a screaming, sports bra-baring Chastain, collapsed to her knees, fists pumping, has become one of the most iconic images in sports history.

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Now a mother and youth soccer coach, Chastain has made it her mission to delay the practice of Wambach’s signature scoring strike until high school. Along with former women’s national teammates, Joy Fawcett and Cindy Parlow Cone, she’s joined the Sports Legacy Institute’s (SLI) Safe Soccer Campaign. The non-profit SLI, founded in part by renowned concussion expert Dr. Robert Cantu, is focused on its mission of working towards “concussion safety without compromise”.

Headers, concussions, and the data: It’s a gray matter

The issue of headers and concussions is contentious, pitting concerns over bubble wrapping an entire generation of kids versus worries that a developing brain is just too precious to risk in absence of clear data lending an endorsement one way or another.

Studies on the topic only stir up sediment in an already murky debate pool.

US Youth Soccer cites the Centers for Disease Control (CDC) report on traumatic brain injury in soccer, which deems data on heading and concussions as inconclusive. The CDC report concludes that, while older studies from the 1990s suggested “cognitive functioning was inversely related to the number of concussions and to the frequency of heading”, more recent studies reveal no evidence of cognitive impairment.

For their part, US Youth Soccer recommends – but does not mandate – that players under 10 refrain from heading the ball.

The CDC offers free online concussion training for coaches, parents, and anybody else looking to gain a better understanding of concussion symptoms and how to respond to them.

The larger impact of subconcussive hits

Initiatives like Chastain’s Safe Soccer Initiative cite evidence from studies suggesting that many small or “subconcussive” impacts (like heading a soccer ball) may add up to mild brain trauma.

A report published last year in the Journal of the American Medical Association studied the brains of soccer players and swimmers, none with a history of symptomatic concussions. When compared to the swimmers, the soccer players showed a significant difference in white brain matter integrity (the brain’s communication wiring responsible for relaying messages between neurons), the sort typically related to concussion.

While certainly disconcerting to some, the JAMA article makes it very clear that "future studies are needed to confirm the results and elucidate the…effects of white matter alterations in soccer players".  

With much more research to be done, it's the sort of cautionary asterisk you'll find attached to any current study of the topic. 

Soccer’s riskiest play

One piece of data is not up for debate: the majority of concussions on the soccer pitch happen during the act of heading. About 50 percent result from contact with another player, the ground, or goal post while attempting a header. Only 12 percent of concussions come from head-to-ball contact, though that number does not state what percentage stems from players being accidentally struck in the head with a ball, which is an important distinction to make.

That risk becomes magnified, says the SLI’s Dr. Robert Cantu, when younger, less developed players are involved.

“They [Kids] have big heads on very weak necks and that bobblehead-doll effect means you don’t have to impact the head as hard to cause damage.”

Add to that less coordination, body awareness and technique, and youth players are more likely to hurt themselves and others attempting to head the ball, according to Cantu.

Developing skills from the bottom up

No matter what side is taken on the issue, anybody who has ever watched the ball ricochet wildly off the head of a 10-year-old can attest – heading is hardly necessary, or effectively executed, at that level. Many agree its elimination wouldn’t just decrease the chance of injury, it would increase the quality of play.

“As a coach I would prefer my players had focused solely on foot skills as they develop their love of the game,” says Chastain. “I believe this change will create better and safer soccer.”

Protecting players and improving play by eliminating certain aspects of play from the youth level is nothing new in sports. Many ask why not treat headers like the curveball in baseball or body checking in hockey, introducing it only when it’s developmentally appropriate?

Cindy Parlow Cone, Chastain’s fellow advocate and US teammate agrees. With the proper coaching, players who enter high school with a strong grasp of the game’s fundamentals will undoubtedly learn to become safer, more effective headers of the ball later in their teens.

Parlow Cone retired from soccer due to concussion related symptoms.

"With good coaching, heading skills can be learned during the high school years. Up until the high school age, the focus should be on coordination, technical skills and spatial awareness. Delaying the teaching of heading skills, while still preparing players for heading by teaching jumping and landing and strengthening the neck, not only will help make the sport safer but also is developmentally appropriate."

Coaches looking to build a proper foundation at an early age can start working on technique without a ball, then incorporate a NERF ball or soft inflatable to lessen the impact on developing brains.

“The point is to have more people play soccer,” says Cantu, “but have them play it in a safer manner at the youth level. This doesn’t mean that youngsters can’t be taught these skills. Instead of heading a soccer ball, they should practice heading with a beach ball.”

Action already being taken

Some soccer organizations, like the Soccer Shots youth program have already instituted a “no heading” policy.

"There was a time when we taught them about heading," said Jason Webb, co-founder of Soccer Shots. "But we've become aware of the dangers."

Motivated in large part to the efforts of the Sports Legacy Institute, a Pennsylvania middle school made headlines when it announced their own policy last summer.

And the issue has also made its way to the courts. Cases include a lawsuit against FIFA brought on by a group of soccer moms looking to ban headers until high school, and, most recently, a former University of Illinois soccer player suing the NCAA over claims that her concussions were mishandled.

What do you think?

Are rule changes in order for youth soccer? Or do you see the banning of headers as an over protective measure? 

Your free Key Safety Topics Guide is a great way to start a conversation on athlete safety at your organization. Download yours to read about and share info on timely issues like background screening, concussion training, cyber bullying, and safety on the road.  

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