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Experts debate safety of heading

Parents who advise their children to use their heads in making daily decisions might retract that advice once their kids step onto the soccer field.

Using one’s head in soccer – what’s known as heading – involves using one’s noggin to direct an airborne ball to another player, or to punch it toward the goal in one of the most dramatic and acrobatic plays in the game.

But heading can cause concussions, which is kicking up debate among physicians, soccer coaches and parents about whether it should be banned from youth soccer.

Now, new research seems to be shifting most of cause of concussions to injuries resulting from player-to-player contact – not heading – but not all researchers agree, including a prominent sports medicine specialist who is the team doctor for the Pittsburgh Pirates.

A University of Colorado Anschutz Medical Campus study published online last week in the journal JAMA Pediatrics found, for example, that only 30 percent of high-school soccer concussions involved heading-related injuries, with athlete-to-athlete contact causing most concussions in youth soccer.

Dusty Young, an associate director of the New Mexico Activities Association, said the NMAA has not given the issue much energy.

“There hasn’t been much discussion,” he said, adding that the NMAA would likely take its lead from the national federation “to provide us with some direction in that area.”

Young said he did not believe the national federation’s soccer rules committee has broached the subject. The federation also has a sports medicine advisory committee, although it not known if it that group has talked about the correlation between concussions and headers.

So, reining in growing levels of aggression in soccer by strictly following rules that penalize unnecessary aggression would reduce concussions while preserving soccer as a contact rather than combat sport, which describes football, ice hockey and lacrosse, its researcher said.

“Among boys, about 69 percent of concussions involved contact with other players, and for girls, 51 percent by contact with other players,” said Sarah Fields, who worked on the study as associate professor of communications at the University of Colorado Denver. “If you rein in the contact with other players, you minimize more concussions, theoretically, than you would by banning heading.”

Heading to conclusions

In all sports, where injuries often occur, risks must be weighed against the benefits of athletic activity.

But heading-related injuries can involve problems beyond merely hitting the ball with the head. Concussions also result when players try heading the ball but end up knocking heads with other players, getting struck by elbows and shoulders or losing balance and bashing heads against the ground.

Another concern is repetitive ball-to-head contact, none of which causes a concussion but has potential for long-term brain damage leading to balance, memory and cognition problems, similar to what happens more often and more severely to boxers and football players.

Adding fuel to the heading debate was HBO’s “Real Sports” episode last week that focused on girl soccer players who experienced serious concussions that left them with chronic problems of imbalance, headaches, memory and cognition. The injuries forced them to quit soccer and struggle with long-term health problems.

The University of Colorado study analyzed a nationally representative sample of concussion data from 2005-2006, through 2013-2014 for American high school soccer players. It compared concussion incidence with “athletic experiences,” or AEs, each of which indicates one player involved in one practice session or game, regardless of length. The study documented 627 concussions during about 1.4 million AEs, resulting in an average of 4.8 concussions among girls and 2.8 for boys for every 10,000 AEs.

Thirty-one percent of the male concussions and 25 percent of the female concussions were heading-related. Of those injuries, 78 percent of the boys and 62 percent of the girls suffered concussions not from heading but from contact with other players.

“Although heading is the most common activity associated with concussions,” the study concludes, “the most frequent mechanism was athlete-athlete contact.”

Banning heading from youth soccer would likely prevent some concussions, the study says, but “reducing athlete-athlete contact across all phases of play would likely be a more effective way to prevent concussions as well as other injuries.”

Heading the opposition

Edward D. Snell, a member of the Sports Advisory Committee for the Pennsylvania Interscholastic Athletic Association, the team doctor for the Pittsburgh Pirates and the director of the Sports Medicine Concussion Center at Allegheny General Hospital, criticized the Colorado study conclusions because they were based on epidemiological data.

“Soccer is the fastest-growing sport in America, and the most popular sport in the world, and young soccer players are using their heads too much,” he said. “It’s exciting when you get a goal, but with the head, the quick stop can cause a concussion. … If the study says it’s not a bad thing to head the ball, I disagree with that.”

Young soccer players can have problems successfully coordinating a successful heading maneuver, so attempts can go awry and result in head and neck injuries, he contends.

“I think it is dangerous, using the head like you use a fist, but your brain is in a floating atmosphere that if accelerated and stopped quickly, can cause injury,” Snell said.

His center treats 200 concussions a week from all causes. Most heal quickly, he said. But more serious injuries can fail to repair themselves, leading to long-term consequences.

“If you stop heading the ball, you stop incidental injuries that don’t need to happen,” Snell said.

The Journal’s James Yodice contributed to this report.