Is soccer heading for trouble?
For 20 minutes after he had sustained what he believes was a concussion, Alex Smith – then a senior defender for an Olympia high school team – remained on the soccer field.
Dazed, he got up and continued running, though he was so disoriented, he could only sprint in circles, he said.
Smith, 21, now a junior studying political science and history at Washington State University, said he felt as if he had "an instant hangover."
But his team, he said, didn’t notice.
"I hid it pretty well," Smith said.
Last year, high school soccer players suffered more concussions nationally than athletes in basketball, baseball, wrestling and softball combined, according to estimates from the Center for Injury Research and Policy (CIRP) in Columbus, Ohio. Although the media has focused on concussions in football, little has been written about the effects of concussions on soccer players.
"The injury rate [for soccer] probably is lower in the youth sports, but when you get up to a higher skill level, especially high school, the gap between football and soccer narrows significantly," explained Dr. Jeff Radakovich, a team physician for Washington State University athletics.
Last year, women soccer players suffered 25,953 concussions, and men suffered 20,247 concussions, according to CIRP. By comparison, boys’ basketball players recorded 11,013 concussions. Those numbers are likely higher, experts say: The American Academy of Pediatrics estimates that less than one-tenth of the 3.8 million sports-related concussions each year in the United States are reported.
Researchers say they have found a common cause for the injuries: The practice of heading, or advancing the ball by hitting it off a player’s head.
"You see it a lot when two players are going for the same ball," explained Dr. Kasee Hildenbrand, director of the athletic training education program at Washington State University and an assistant professor in the Educational Leadership and Counseling Psychology department. "It’s not so much the ball coming at your head [that causes a concussion]. It’s someone else’s head."
Nearly 40 percent of concussions in high school soccer resulted from heading, according to a 2008 report in the American Journal of Sports Medicine.
"I don’t know if they would ever just get rid of heading to begin with, or if they’re just going to get rid of when you can head it," said Hildenbrand. "I don’t think it’s out of the question to assume at some point in soccer in the future, there will be rule changes."
The Washington Interscholastic Activities Association (WIAA), the governing body of high school sports in the state, said there are no plans to remove heading from soccer. Each year, the National Federation of State High School Associations meets to discuss possible rule changes to improve safety.
"I’ve not heard any talk of eliminating heading at the high school level," said WIAA assistant executive director John Miller. "It doesn’t mean it couldn’t happen…. As more and more data comes in, then obviously if there are things that the rules governing body can do to make the game safer, they will certainly look at that."
Is heading the problem?
Not everyone agrees that heading leads to concussions.
"Those people who don’t understand our sport believe concussions are caused by heading. Concussions are caused by head-to-shoulder, head-to-elbow, head-to-ground [collisions]," said Doug Andreassen, president of the Washington State Youth Soccer Association. "Those are the type of injuries that cause concussions. Not necessarily heading the ball."
Doug Winchell, a longtime Pullman High School soccer coach, also questioned whether the act of heading is related to the number of concussions.
"I’ve never seen the act of heading cause a concussion," Winchell said in an e-mail. "I’ve seen more than a dozen concussions in girls’ soccer during my time at Pullman High School and of all the various reasons, heading in and of itself was never the sole cause."
When done correctly, researchers say, the play rarely results in an injury. But the attempt can also lead to head-to-head and head-to-elbow collisions, which account for more than 40 percent of concussions in college soccer, according to a 1998 study by Duke University researchers.
As Hildenbrand points out, players can do everything right – contact the ball with their foreheads, keep their mouths closed – and still end up with a concussion if someone else goes for the same ball.
"There is more give to a ball, so I don’t think heading in itself will cause a concussion," Hildenbrand said. "But going up and hitting someone else’s head, those [are the] g-forces that you need [for a concussion].
"I don’t really know if there’s anything you can do to truly prevent it from happening," she added. "The biggest thing, I think, is just not putting your head in situations where there’s a risk of concussion. But that’s sort of hard in the sport of soccer."
Should soccer ban heading?
A decade ago, the American Youth Soccer Organization considered a ban on heading for younger players. It discourages youth players from heading before age 10.
"We don’t teach kids to head at a young age because of risk of concussions," said Andreassen. "We also don’t teach soccer so it becomes an aerial game. We say we want to keep the ball on the ground."
Heading is an integral part of the game, he said.
"I don’t see heading being outlawed by [Washington Youth Soccer]," he said. "If it’s going to be changed, it would have to be changed from the world-wide body called FIFA."
Dr. Donald Kirkendall, who co-authored the Duke University study and wrote "The Complete Guide to Soccer Fitness and Injury Prevention," also argues against a ban on heading.
"Head injuries are the result of accidents," he said, "and the best way to reduce accidental injury is education about the causes of accidents."
The most common opportunity for concussions in soccer, said Kirkendall, is in the middle of the field, after a goalie punts the ball, after a goal kick, or after a clearing play.
"If you watch the game closely, you can see the set-up seconds before it happens," said Kirkendall. "The ball’s in the air. There’s a lot of green space. Two players are approaching from opposite directions; both are focused on the ball."
In those situations, he said, the safest play is to let the other player head the ball.
"That first touch is little more than a rebound," said Kirkendall, a former college soccer player. "The game won’t be won or lost on the initial touch, so just back off. It’s the second touch, to gain control once the ball’s hit the ground, that matters, so why put yourself at risk?"
Quitting soccer to avoid concussions
Mike Minick, a 27-year-old former high school soccer player, believes he suffered multiple concussions in games. At one point in a game, a referee asked him how many fingers he was holding up; Minick answered incorrectly but later returned to the game.
"The concussion was usually just accidental – two people going up to head the ball and hitting heads, or a ball just coming straight at your face," said Minick, now the director of business development at Health Resources Northwest in Seattle. "I had a lot of concussions, so it was easy for me to get more. My family always joked around – still do – that I should permanently have a helmet on."
Minick quit playing soccer after suffering a concussion in college that he believes led to an episode of mood swings.
"When that happened, that’s when we decided to head to the ER because that was not normal," said Minick, who said he averaged two concussions per high school season. "I talked with the doctor, and he told me I probably shouldn’t play soccer anymore."
One of Winchell’s former players, who had sustained a number of concussions, quit in the fall of 2008 after her doctor prohibited her from heading the ball, he said.
"[In high school soccer], you really have to [head] the ball," Winchell said. "There were a couple situations where she really should’ve headed the ball, which really hurt the team… If it’s a legitimate medical concern, than I’m not sure playing is the best thing."
Casey Curtis, varsity soccer coach at Lewis and Clark High School in Spokane, said he also knows of a prep player who quit soccer because of concern over concussions. The number of concussions, he said, varies from season to season.
"This fall, I had three girl teams, and none of them had any concussions," said Curtis. "Last fall, we had five concussions."
Does soccer have a problem with concussions?
Robin Crain, the boys soccer coach at Ferris High School in Spokane, said he’s seen just one concussion in 24 years coaching boys and girls soccer.
"I’m always a little bit of a skeptic," Crain said when informed about CIRP’s concussion figures. "I teach science, so when people talk about data and statistics, I kind of wonder where they’ve gathered it from, is it biased?"
The average number of concussions per team at the college level is about one per season, according to Kirkendall.
"So it isn’t happening constantly," he said, "but it happens enough that we should try to educate people about it."
Concussions occur most often in the open-field, he added, when several players are focusing on the ball in the air, and approaching from opposite directions.
"You rarely see concussions from players jumping side-by-side," he said.
Curtis said players just need to be more alert.
"If you’re not aware of your surroundings, then that’s when you’re vulnerable," Curtis said. "It’s like texting when you’re driving. If you’re not paying attention to your driving, but paying attention to texting, that’s when accidents happen."
Smith, who played at Tumwater High School near Olympia, said he feels heading is fine, but "diving headers should be illegal at the high school level." Smith’s lone concussion playing high school soccer came attempting a diving header.
At the youth level, the ball isn’t in the air very much, but in high school, Winchell said, the ball is in the air "30 to 40 percent of the game."
"[In high school], you really have to [head] the ball," he said. "If player A can’t head the ball, that limits player A’s ability to contribute."
Hildenbrand agrees that the high school game has become increasingly aerial.
"If you want to go on to college, and you want to be competitive in soccer, you’re going to have to learn to use your head," she said. "Twenty years ago, heading wasn’t really that important, but as it becomes more a part of the [high school] game, the incidence of concussions is going to rise."
Is headgear the answer?
With rising concerns about concussions in soccer, entrepreneurs have begun marketing head guards designed to protect athletes. ("Don’t kick yourself for playing unprotected," reads one website).
But the helmets may do little to prevent concussions, Radakovich said.
"On the surface, first of all, it seems like a good idea, anything that would protect the head seems like a good thing to do. But there’s no evidence that they actually reduce the risk of concussions," he said.
He worries head guards could actually make the game more dangerous.
"If we put a piece of equipment on people, [it might] actually make them more aggressive … now that they feel this sense of protection or invulnerability," he said.
A helmet – no matter how thick – won’t prevent concussions in any sport, Hildenbrand said.
As an analogy, Hildenbrand compared the human head to an egg.
"Our brains are basically the yolk floating around in the fluid," she said. "You can pad the head all you want, but you’re not preventing concussions. The only thing you’re doing is preventing skull fractures."
---
The Murrow News Service provides local, regional and statewide stories reported and written by journalism students at the Edward R. Murrow College of Communication at Washington State University. Byron Edelman is a senior journalism student at WSU.
Dazed, he got up and continued running, though he was so disoriented, he could only sprint in circles, he said.
Smith, 21, now a junior studying political science and history at Washington State University, said he felt as if he had "an instant hangover."
But his team, he said, didn’t notice.
"I hid it pretty well," Smith said.
Last year, high school soccer players suffered more concussions nationally than athletes in basketball, baseball, wrestling and softball combined, according to estimates from the Center for Injury Research and Policy (CIRP) in Columbus, Ohio. Although the media has focused on concussions in football, little has been written about the effects of concussions on soccer players.
"The injury rate [for soccer] probably is lower in the youth sports, but when you get up to a higher skill level, especially high school, the gap between football and soccer narrows significantly," explained Dr. Jeff Radakovich, a team physician for Washington State University athletics.
Last year, women soccer players suffered 25,953 concussions, and men suffered 20,247 concussions, according to CIRP. By comparison, boys’ basketball players recorded 11,013 concussions. Those numbers are likely higher, experts say: The American Academy of Pediatrics estimates that less than one-tenth of the 3.8 million sports-related concussions each year in the United States are reported.
Researchers say they have found a common cause for the injuries: The practice of heading, or advancing the ball by hitting it off a player’s head.
"You see it a lot when two players are going for the same ball," explained Dr. Kasee Hildenbrand, director of the athletic training education program at Washington State University and an assistant professor in the Educational Leadership and Counseling Psychology department. "It’s not so much the ball coming at your head [that causes a concussion]. It’s someone else’s head."
Nearly 40 percent of concussions in high school soccer resulted from heading, according to a 2008 report in the American Journal of Sports Medicine.
"I don’t know if they would ever just get rid of heading to begin with, or if they’re just going to get rid of when you can head it," said Hildenbrand. "I don’t think it’s out of the question to assume at some point in soccer in the future, there will be rule changes."
The Washington Interscholastic Activities Association (WIAA), the governing body of high school sports in the state, said there are no plans to remove heading from soccer. Each year, the National Federation of State High School Associations meets to discuss possible rule changes to improve safety.
"I’ve not heard any talk of eliminating heading at the high school level," said WIAA assistant executive director John Miller. "It doesn’t mean it couldn’t happen…. As more and more data comes in, then obviously if there are things that the rules governing body can do to make the game safer, they will certainly look at that."
Is heading the problem?
Not everyone agrees that heading leads to concussions.
"Those people who don’t understand our sport believe concussions are caused by heading. Concussions are caused by head-to-shoulder, head-to-elbow, head-to-ground [collisions]," said Doug Andreassen, president of the Washington State Youth Soccer Association. "Those are the type of injuries that cause concussions. Not necessarily heading the ball."
Doug Winchell, a longtime Pullman High School soccer coach, also questioned whether the act of heading is related to the number of concussions.
"I’ve never seen the act of heading cause a concussion," Winchell said in an e-mail. "I’ve seen more than a dozen concussions in girls’ soccer during my time at Pullman High School and of all the various reasons, heading in and of itself was never the sole cause."
When done correctly, researchers say, the play rarely results in an injury. But the attempt can also lead to head-to-head and head-to-elbow collisions, which account for more than 40 percent of concussions in college soccer, according to a 1998 study by Duke University researchers.
As Hildenbrand points out, players can do everything right – contact the ball with their foreheads, keep their mouths closed – and still end up with a concussion if someone else goes for the same ball.
"There is more give to a ball, so I don’t think heading in itself will cause a concussion," Hildenbrand said. "But going up and hitting someone else’s head, those [are the] g-forces that you need [for a concussion].
"I don’t really know if there’s anything you can do to truly prevent it from happening," she added. "The biggest thing, I think, is just not putting your head in situations where there’s a risk of concussion. But that’s sort of hard in the sport of soccer."
Should soccer ban heading?
A decade ago, the American Youth Soccer Organization considered a ban on heading for younger players. It discourages youth players from heading before age 10.
"We don’t teach kids to head at a young age because of risk of concussions," said Andreassen. "We also don’t teach soccer so it becomes an aerial game. We say we want to keep the ball on the ground."
Heading is an integral part of the game, he said.
"I don’t see heading being outlawed by [Washington Youth Soccer]," he said. "If it’s going to be changed, it would have to be changed from the world-wide body called FIFA."
Dr. Donald Kirkendall, who co-authored the Duke University study and wrote "The Complete Guide to Soccer Fitness and Injury Prevention," also argues against a ban on heading.
"Head injuries are the result of accidents," he said, "and the best way to reduce accidental injury is education about the causes of accidents."
The most common opportunity for concussions in soccer, said Kirkendall, is in the middle of the field, after a goalie punts the ball, after a goal kick, or after a clearing play.
"If you watch the game closely, you can see the set-up seconds before it happens," said Kirkendall. "The ball’s in the air. There’s a lot of green space. Two players are approaching from opposite directions; both are focused on the ball."
In those situations, he said, the safest play is to let the other player head the ball.
"That first touch is little more than a rebound," said Kirkendall, a former college soccer player. "The game won’t be won or lost on the initial touch, so just back off. It’s the second touch, to gain control once the ball’s hit the ground, that matters, so why put yourself at risk?"
Quitting soccer to avoid concussions
Mike Minick, a 27-year-old former high school soccer player, believes he suffered multiple concussions in games. At one point in a game, a referee asked him how many fingers he was holding up; Minick answered incorrectly but later returned to the game.
"The concussion was usually just accidental – two people going up to head the ball and hitting heads, or a ball just coming straight at your face," said Minick, now the director of business development at Health Resources Northwest in Seattle. "I had a lot of concussions, so it was easy for me to get more. My family always joked around – still do – that I should permanently have a helmet on."
Minick quit playing soccer after suffering a concussion in college that he believes led to an episode of mood swings.
"When that happened, that’s when we decided to head to the ER because that was not normal," said Minick, who said he averaged two concussions per high school season. "I talked with the doctor, and he told me I probably shouldn’t play soccer anymore."
One of Winchell’s former players, who had sustained a number of concussions, quit in the fall of 2008 after her doctor prohibited her from heading the ball, he said.
"[In high school soccer], you really have to [head] the ball," Winchell said. "There were a couple situations where she really should’ve headed the ball, which really hurt the team… If it’s a legitimate medical concern, than I’m not sure playing is the best thing."
Casey Curtis, varsity soccer coach at Lewis and Clark High School in Spokane, said he also knows of a prep player who quit soccer because of concern over concussions. The number of concussions, he said, varies from season to season.
"This fall, I had three girl teams, and none of them had any concussions," said Curtis. "Last fall, we had five concussions."
Does soccer have a problem with concussions?
Robin Crain, the boys soccer coach at Ferris High School in Spokane, said he’s seen just one concussion in 24 years coaching boys and girls soccer.
"I’m always a little bit of a skeptic," Crain said when informed about CIRP’s concussion figures. "I teach science, so when people talk about data and statistics, I kind of wonder where they’ve gathered it from, is it biased?"
The average number of concussions per team at the college level is about one per season, according to Kirkendall.
"So it isn’t happening constantly," he said, "but it happens enough that we should try to educate people about it."
Concussions occur most often in the open-field, he added, when several players are focusing on the ball in the air, and approaching from opposite directions.
"You rarely see concussions from players jumping side-by-side," he said.
Curtis said players just need to be more alert.
"If you’re not aware of your surroundings, then that’s when you’re vulnerable," Curtis said. "It’s like texting when you’re driving. If you’re not paying attention to your driving, but paying attention to texting, that’s when accidents happen."
Smith, who played at Tumwater High School near Olympia, said he feels heading is fine, but "diving headers should be illegal at the high school level." Smith’s lone concussion playing high school soccer came attempting a diving header.
At the youth level, the ball isn’t in the air very much, but in high school, Winchell said, the ball is in the air "30 to 40 percent of the game."
"[In high school], you really have to [head] the ball," he said. "If player A can’t head the ball, that limits player A’s ability to contribute."
Hildenbrand agrees that the high school game has become increasingly aerial.
"If you want to go on to college, and you want to be competitive in soccer, you’re going to have to learn to use your head," she said. "Twenty years ago, heading wasn’t really that important, but as it becomes more a part of the [high school] game, the incidence of concussions is going to rise."
Is headgear the answer?
With rising concerns about concussions in soccer, entrepreneurs have begun marketing head guards designed to protect athletes. ("Don’t kick yourself for playing unprotected," reads one website).
But the helmets may do little to prevent concussions, Radakovich said.
"On the surface, first of all, it seems like a good idea, anything that would protect the head seems like a good thing to do. But there’s no evidence that they actually reduce the risk of concussions," he said.
He worries head guards could actually make the game more dangerous.
"If we put a piece of equipment on people, [it might] actually make them more aggressive … now that they feel this sense of protection or invulnerability," he said.
A helmet – no matter how thick – won’t prevent concussions in any sport, Hildenbrand said.
As an analogy, Hildenbrand compared the human head to an egg.
"Our brains are basically the yolk floating around in the fluid," she said. "You can pad the head all you want, but you’re not preventing concussions. The only thing you’re doing is preventing skull fractures."
---
The Murrow News Service provides local, regional and statewide stories reported and written by journalism students at the Edward R. Murrow College of Communication at Washington State University. Byron Edelman is a senior journalism student at WSU.
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