More questions about the safety of heading

By Paul Gardner

U.S. Youth Soccer’s “official” response -- if that’s what it is -- to the latest medical studies on possible brain damage resulting from heading the ball sounds dangerously complacent.

The new study, from New York's Albert Einstein College of Medicine and Montefiore Medical Center, suggests that soccer players who frequently head a soccer ball do indeed run the risk of damaging their brains.

Jim Cosgrove, executive director of USYS, has replied to these findings -- but it is impossible to read his comments without a rising sense of exasperation. Cosgrove says he has “some concerns” with the study based on variability and the number of participants. He seems more content to question the validity of the tests than to address the possibility that the sport -- his sport, our sport -- might have a serious problem with one of its basic playing techniques.

He happens to be right to throw doubt on the tests. For a start, the number of players tested is far too small to form the basis of any solid conclusions. But Cosgrove is quite wrong to leave the impression -- which he does -- that all is well and will remain so until someone does more widely based and carefully designed tests -- presumably tests with more incriminating results.

That approach is ominously similar to the one that the tobacco industry adopted when the first evidence started to come through that its product was killing people.

This is a shameful way of dealing with an extremely serious issue. Cosgrove -- and everyone else at USYS and USSF -- and FIFA for that matter -- has to be aware that the new study is not an isolated report. It is one of a growing number of such investigations. Each of them -- taken individually -- can be dismissed, by Cosgrove’s criteria, as inadequate. But taken together they add up to something rather more weighty.

Virtually all of them -- certainly the ones of which I am aware -- have found enough evidence to warrant a note of caution about heading. Most of them suggest that “further research” should be carried out.

Which means new studies, like the one carried out in New York, and a crucial feature of any new study is that it is likely to feature the use of new techniques and/or newer and more sensitive equipment than were available to previous researchers. In the New York study, the innovation was the use of an “advanced MRI-based imaging technique called diffusion tensor imaging (DTI)” to scan the players brains.

There has been a series of advances in understanding the causes of concussion. The dangers of “second impact syndrome” are now well known; within the last year or so, the dangers of CTE -- chronic traumatic encephalopathy -- have been revealed. Another comparatively recent discovery has been the long-term effects of repeated subconcussions.

It is disturbing that this growing body of research seems to be ignored by the soccer world. Not long ago. we had a Manchester United player removed from a game on a stretcher and taken straight to hospital with a head injury. But ManU coach Alex Ferguson soon announced that “It's a straightforward one. He has concussion and will miss Saturday's game."

If there’s one thing we are learning, it is that concussions are anything but straightforward. The technical details of all the new research techniques need not concern us -- but the growing sensation that something may be very seriously wrong here should. And that concern should be reflected in any and every statement from official sources. We are not talking about head colds here. The subject is brain damage.

Cosgrove’s comments -- though he surely didn’t intend this -- convey the message that, Well, OK, there may be a problem here but we’ll wait until someone comes up with a watertight case against heading before we take it seriously. In the meantime, everyone should carry on as though we don’t know about the incipient danger.

An attitude that is irresponsible, at least -- particularly coming from a top official in youth soccer. We have, after all, been warned before that youngsters’ brains are more susceptible to second impact syndrome. Very well, then, we should get a decisive answer from USYS to this question: Should young players be heading the ball at all? All we have is a suggestion that players under 10 should keep heading to a minimum.

That is one of the inescapably bizarre aspects of the new study -- that the researchers have attempted to quantify heading. Among the 38 adult players studied, it seems that damage to the “cognitive functions” of the brains was related to the number of headers, with “mild traumatic brain injury,” occurring among players who amassed more than 1,000 headers in a year.

A much lower figure would presumably apply to children - but even if a figure could be agreed on, of what use would it be? How on earth would anyone keep track of how many headers each player had performed? Would a boy lose his place on the team once he passed the threshold and was forbidden to head the ball until next season?

There is also the possibility -- something that apparently comes over as a nightmare for the soccer authorities -- that there is no such thing as “safe” heading, and that it should therefore be banished from the sport altogether.

Obviously, more research is needed. Everyone is agreed on that point. The ideal would be a massive trial involving, let’s say, at least 10,000 players, who would need to be followed and periodically tested throughout their playing careers, and then on into retirement, maybe even into old age.

If you think 10,000 subjects is an absurdly large number, take a glance at the number of men -- smokers and non-smokers - that the American Cancer Society studied for its definitive 1954 research into the effects of smoking on health: 187,766. And then be aware that the findings (of course, they incriminated tobacco) of this enormous, carefully planned study by the ACS were immediately dismissed by the tobacco industry as “biased, unscientific, and filled with shortcomings.”

A comprehensive study of heading would be a lengthy and highly expensive business. Who would conduct it? Well, FIFA has plenty of money and has a worldwide organization ... but it is also an interested party. An independent body is needed, presumably, that would have to come from the world of academia. None of which sounds too likely. We may have to go on assessing the growing series of much smaller trials. Each of which will be -- justifiably -- suspect because it is not big enough.

Uncertainty surrounds, and will continue to surround, the issue. But does that make it acceptable for the soccer authorities -- all of them, from FIFA on down -- to adopt a wait-and-see attitude towards what is, potentially, a very serious health issue? It’s worth repeating: this is brain damage we’re talking about.

10 comments about "More questions about the safety of heading".
  1. Tito Messi, December 5, 2011 at 2:24 a.m.

    can you imagine that heading the ball in soccer can cause "brain damage", what can a "study" find in playing football and getting hit head to head with tremendous "force" and helmets do protect very little, especially the neck...someone in the USA doesn't want soccer to go might as well have "every kid and grown ups" stop heading the ball, make it illegal I guess...but FIFA will automatically kick the USA from their association.

  2. tim francis, December 5, 2011 at 3:53 a.m.

    Paul is right to take the 'putting off' attitude to task and encourage further study. Players and adults need to know before they'll commit fully to heading. Otherwise we will continue to see uncontested high balls hit the ground. From preliminary reviews of lit., the most in-depth studies on heading found that repeated head to head, not head to ball, concussions yielded the significant brain damage. But several other studies noted the potential danger of heading the ball, particularly when the ball hits the head, rather than having the head moving into the ball. As Paul says, a significant study to clarify is certainly needed!

  3. Kent James, December 5, 2011 at 7:55 a.m.

    I had one concussion during a game (an inadvertent elbow to the face) and I still remember heading a waterlogged leather ball that had been punted back in the 1970s (it literally staggered me), so I understand that the potential for damage is real. And certainly, having children under 10 not be allowed to head the ball would be a reasonable safety measure (and wouldn't change the game much, since most of them don't like to head the ball anyway; maybe it's their natural instinct to protect their developing brains?). But I thought that PG's attitude towards the possibility that heading might be removed from the game was a little cavalier, since heading is an important component of the game. But then I realized that removing heading would eliminate the style of play that PG hates; long crosses to people attempting to head the ball on goal. Very subtle, Paul, well-played. While I'm sure PG is concerned about the health of the players, I'm guessing the tactical changes required by a ban on heading would not displease him, and my account for his lack of concern about the potential loss of that aspect of the game.

  4. Jack Burd, December 5, 2011 at 8:40 a.m.

    Ok, so if we remove the ability to head the ball into the net, does that mean that it is still 0-0 between Duke and Stanford women's college game? Why not just be precautionary and require high school and college to wear the soccer "helmet" now rather than later?

  5. David Mont, December 5, 2011 at 10:50 a.m.

    If someone gives me money, I will conduct a study and conclude that people walking in the street do indeed run the risk of severe bodily damage including death. And so do people who drive. And breath (who knows what kind of pollutants we're breathing in?). And, of course, swimming is quite risky as well. And don't forget the riskiest of all activities -- eating. How many people die from food poisoning? Or long term effects of obesity, diabetes, pesticides?

  6. David Flanagan, December 5, 2011 at 11:08 a.m.

    Perhaps MR. Gardner should do some research to find out that US Youth has put into place some very rigorous standards when a player exhibits concussion symptoms. Standards have been set to determine if a concussion has resulted due to injury via heading the ball or for that matter any other head injury. While research may indicate attention be directed toward injury prevention common sense will determine when a coach or parent insists on excessive heading practice. The larger problem is how do we test damage to youth players? One would have to measure speed, height and trajectory of the ball to truly determine the damage effect on a player a multiple age levels. Does an 8 yr. old player hit the ball as hard as a high school players? Is the impact the same on a player who heads the ball? Player safety is the issue and while heading can cause head injury US Youth recognizes that coaching education will help contribute to a better understanding of this situation and coaches/parents will make decisions in the best interest of the health of the players.

  7. Power Dive, December 6, 2011 at 12:58 p.m.

    I'd like to echo Jack Burd's question. Why not require the soccer helmet? I've never used one (grew up before it was introduced), but it seems like a good idea to me. We require shin guards and those are only protecting something as insignificant as a leg bone. You'd think we would be much more precationary with the brain.

    Further, no matter how good of an idea the soccer helmet is, nobody will ever start wearing them unless they are mandatory.

  8. James Gang, December 7, 2011 at 3:18 a.m.

    This is not an issue of "wait and see." centuries of history show that it does not require immediate attention. in AYSO (American Youth Soccer Organization) it is against the rules to use your head in the younger age groups. Aside from that, people know what they are getting themselves into or getting their kids into, much like boxing or football, and therefore should be a matter of choice not rule.

  9. omar touny, December 7, 2011 at 6:07 p.m.

    Mr.Paul and/or anyone who can help..i want to know if there's a soccer coaching licens taken from a school in USA?!


  10. Kent James, December 15, 2011 at 7:58 a.m.

    Omar, both the USSF and NSCAA have coaching schools. Here are some links that should help you find the information you need.



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