Banning headers in soccer won't prevent concussions

A study shows that banning headers in soccer won't solve the concussion problem.

While many experts have called for a ban on "heading" the ball in youth soccer because they believe it is a leading cause of concussions, a new study suggests the body contact that often occurs during such play is to blame for most brain injuries.

So banning headers among high school players would not reduce concussion rates as much as enforcing existing rules on rough play would, the researchers added.

Heading the ball "is very much at the heart of soccer culture," explained study author R. Dawn Comstock, a faculty member in the department of epidemiology with the Colorado School of Public Health at the University of Colorado in Aurora. "And, yes, we found that heading is the activity in soccer during which most concussions occur among both boys and girls," she added.

"But if you look closely, it's not generally the impact of the ball to the head that leads to concussion. The vast majority of the time it's the athlete-to-athlete contact that happens during [heading] that causes the concussion. One player's head hitting another player's head, or a shoulder-to-head [collision]. That's the problem. Not the ball," Comstock explained.

"So, yes, if you eliminate heading in soccer you would definitely reduce concussions," Comstock acknowledged. "But soccer is not actually a full-contact sport. And there are rules of the game that already exist that penalize the kind of dangerous out-of-position contested heading that results in athlete-to-athlete contact."

So, she suggested, "if you just enforce these rules you would dramatically reduce aggressive body contact, and dramatically lower the concussion rate, without having to change the culture of the sport by eliminating heading itself."

The findings are published in the July 13 online edition of the journal JAMA Pediatrics.

Soccer's popularity among U.S. high school students has grown enormously in recent years. Today, almost 800,000 teens play the sport in the United States, compared with the mere 50,000 (exclusively male) students who played back in 1970, according to the report.

An analysis of data collected between 2005 and 2014 showed that today, girls actually face a higher risk for soccer concussions than boys: 4.5 concussions for every 10,000 practice or game exposures, compared with just 2.8 concussions per 10,000 exposures among boys.

Heading is the most concussion-prone activity, accounting for more than 30 percent of all concussions among boys, and more than 25 percent among girls, the investigators reported.

However, 78 percent and 62 percent of heading-related concussions among boys and girls, respectively, were attributed to body-on-body contact between players, rather than head contact with the ball, the study said.

"Based on this evidence, I would say that if soccer officials are going to allow the sport to become increasingly aggressive then, yes, please ban heading," said Comstock. "But be clear that what's causing concussions is not the ball. It's athlete contact."

But Robert Stern, a professor of neurology, and neurosurgery and anatomy and neurobiology at Boston University School of Medicine, argued that the current study "really misses the point."

"I'm a soccer fan and a major supporter of youth athletics of all different types," he said. "And we must keep in mind the incredible benefits of youth sports, including sports that result in a lot of injuries. But I do completely support those who want to eliminate heading in soccer at a young age, because the intense focus we've been having on the so-called 'concussion crisis' in recent years misses the much bigger issue: What happens to brains when they are exposed to repetitive hits to the head?" Stern said.

"I don't expect there to be a lot of concussions caused directly by heading a ball," stressed Stern, who also serves as the clinical core director of the university's Alzheimer's disease and CTE Center.

"But I'm talking about all the long-term consequences that come from 'sub-concussive' hits, absent any concussive symptoms. The repetitive brain trauma that comes with hitting the ball frequently with the head, causing changes to the white matter integrity of the brain, cognitive [mental] changes, and other alterations to brain functioning," he explained.

"And I would say that parents who struggle with trying to understand this issue need to ask one very important question: Does it make sense for us to allow for our young kids to participate in an activity that results in repetitive brain trauma?" he said. "Personally, I think children deserve to have adults protect their developing brains."

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Study claims concussions are common in middle school-aged girls playing soccer

A recent study claims that girls who are middle school-aged and play soccer commonly have concussions.

Girls who play soccer in middle school are vulnerable to concussions, new research shows.

And despite medical advice to the contrary, many play through their injury, increasing the risk of a second concussion, the study found.

Although awareness has increased about sports concussions, little research has been done on middle school athletes, especially girls, noted study co-author Dr. Melissa Schiff, a professor of epidemiology at the University of Washington School of Public Health in Seattle.

In the study, which evaluated 351 soccer players between the ages of 11 and 14, Schiff and her colleagues found 59 concussions. A concussion is defined as a traumatic injury to the brain after a blow, shaking or spinning. In the study, the girls' symptoms included headache, dizziness, drowsiness and concentration problems.

That rate of injuries, Schiff said, is higher than what has been reported at either high school or college level of women's soccer.

Heading the ball was to blame for about 30 percent of the injuries. This involves hitting the ball with your forehead to redirect the ball in play. More than half of the concussions were from contact with another player.

Experts recommend those who have a concussion be evaluated by a doctor or other health care professional trained in the injury, but Schiff found that ''56 percent were never evaluated." Experts also advise that players not return to practice or games until symptoms disappear, but 58 percent of the players in the study continued to play even with symptoms persisting, she said.

The study was published online Jan. 20 in the journal JAMA Pediatrics.

Awareness about the dangers of concussions has increased, Schiff said, beginning with the National Football League's attention to the problem. Research about the problem has slowly increased to encompass college-level, high school, and now middle school players, she said.

In this study, the researchers randomly selected 33 of 72 elite teams from four youth soccer clubs in the Puget Sound region of Washington state. The study continued from 2008 to 2012. Players reported injuries and symptoms.

With so many injuries blamed on heading the ball, should it be banned?

Schiff thinks that is unrealistic. "It's part of the soccer sport," she said. However, it was found to result in concussion 23 times more often in a game than in practice. One suggestion, she said, is to teach middle school athletes heading in practice but tell them not to do it in games until they are older. The researchers speculate that younger players' less mature brains and weaker neck muscles, along with poorer heading technique, may contribute to the number of concussions.

The new study ''calls attention to the high incidence of concussion in this age group," said Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children's Hospital.

The number of injuries blamed on heading the ball, 30 percent, is not surprising, he said. "I see it all the time," Kuluz explained. Often, he noted, a heading injury occurs along with colliding with another player.

Kuluz advises young athletes who have had a concussion to avoid heading the ball.

Parents need to pay attention to their child during and after soccer, he suggested. "In the event of an injury, pay attention to symptoms," Kuluz said. He added that if a concussion is suspected, a young athlete must be evaluated by a doctor or trainer who has experience with concussions.

"Soccer can be done safely," he said, but parents and coaches need to be aware of concussion symptoms and obtain good medical evaluation and care.

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Heading Soccer Balls and Brain Injury

A study shows that heading a soccer ball can result in brain injury resembling a concussion.

Researchers at Albert Einstein College of Medicine of Yeshiva University have shown that soccer players who frequently head the ball have brain abnormalities resembling those found in patients with concussion (mild traumatic brain injury). The study, which used advanced imaging techniques and cognitive tests that assessed memory, published online today in the journalRadiology.

"We studied soccer players because soccer is the world's most popular sport," said Michael L. Lipton, M.D., Ph.D., associate director of Einstein's Gruss Magnetic Resonance Research Center and medical director of MRI services at Montefiore, the University Hospital and academic medical center for Einstein. "Soccer is widely played by people of all ages and there is concern that heading the ball -- a key component of the sport -- might damage the brain." Dr. Lipton is also associate professor of radiology, of psychiatry and behavioral sciences and in the Dominick P. Purpura Department of Neuroscience at Einstein.

On average, soccer players head the ball six to 12 times during games, where balls can travel at speeds of more than 50 miles per hour. During practice drills, players commonly head the ball 30 or more times. The impact from a single heading is unlikely to cause traumatic brain damage such as laceration of nerve fibers. But scientists have worried that cumulative damage from heading's repeated subconcussive impacts might be clinically significant. "Repetitive heading could set off a cascade of responses that leads to degeneration of brain cells over time," noted Dr. Lipton.

To study possible brain injury from heading, the researchers used diffusion tensor imaging (DTI), an advanced MRI-based imaging technique, on 37 amateur adult soccer players (median age 31 years) who had all played the sport since childhood. Participants reported playing soccer for an average of 22 years and had played an average of 10 months over the previous year. Researchers ranked the players based on heading frequency and then compared the DTI brain images of the most frequent headers with those of the remaining players. All participants also underwent cognitive testing.

DTI "sees" the movement of water molecules within and along axons, the nerve fibers that constitute the brain's white matter. This imaging technique allows researchers to measure the uniformity of water movement (called fractional anisotropy, or FA) throughout the brain. Abnormally low FA within white matter indicates axon damage and has previously been associated with cognitive impairment in patients with traumatic brain injury.

"The DTI findings pertaining to the most frequent headers in our study showed white-matter abnormalities similar to what we've seen in patients with concussion," said Dr. Lipton. "Soccer players who headed the ball above a threshold between 885 to 1,550 times a year had significantly lower FA in three areas of the temporal-occipital white matter." Dr. Lipton noted that players with more than 1,800 headings per year were also more likely to demonstrate poorer memory scores compared to participants with fewer yearly headings.

"Our study provides compelling preliminary evidence that brain changes resembling mild traumatic brain injury are associated with frequently heading a soccer ball over many years," said Dr. Lipton. "While further research is clearly needed, our findings suggest that controlling the amount of heading that people do may help prevent brain injury that frequent heading appears to cause."

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How Cognitive Performance is Affected by Heading a Soccer Ball

This article discusses the results of a study on the changed in cognitive tasks after high school female soccer players headed a soccer ball.

Sports-related head injuries are a growing concern, and new research suggests that even less forceful actions like 'heading' a soccer ball may cause changes in performance on certain cognitive tasks, according to a paper published February 27 in the open access journal PLOS ONEby Anne Sereno and colleagues from the University of Texas Health Science Center at Houston.

The researchers tested the effects of non-injurious head-to-ball impacts on cognitive function using a tablet-based app. They found that high school female soccer players were significantly slower than non-players on a task that required pointing away from a target on the screen, but showed no difference in performance when pointing to the on-screen visual target.

According to the study, tasks that involve pointing away from a target require specific voluntary responses, whereas moving toward a target is a more reflexive response. Based on their observations, the authors conclude that sub-concussive blows to the head may cause changes specifically linked to certain cognitive functions.

The authors say that the app used in their research may be a quick and effective way to screen for and track cognitive changes in athletes. They add that a tablet-based application for such quick screens may also have broader applications in the clinic or the field.

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