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Thursday, January 7, 2016

Can Soccer Headers Cause Brain Damage?

From Real Clear Sports

By Lawrence Robbins
January 6, 2016

Heading a soccer ball is not as innocuous as once thought. Headers sometimes result in a concussion. Thousands of headers over a career may lead to permanent brain damage.

A growing body of evidence points to the adverse effects of multiple headers. One study (conducted by Dr. Inga Koerte, published in JAMA) of 19-year-old amateur soccer players revealed serious damage to the white matter in the brain. White matter is vital for most of our brain functions. These troubling findings were not found in any of the “control” swimmers who were examined.

Another study (lead author was Dr. Michael Lipton, published in Radiology) concluded that as the number of headers increased, cognitive function (such as memory) declined. This study also discovered that with increasing numbers of headers, the brain damage grew more severe. They measured damage by assessing the white matter of the brain.

A soccer ball weighs about 1 pound. The speed of a kicked ball may easily exceed 40 mph. Our fluid filled brain cannot be compressed to any great extent, which limits how much of the blow may be safely absorbed. When struck by a soccer ball, the brain often sustains a significant “G” force.

The physics and mechanics of headers are complex. The angle of impact is important, along with the position and acceleration of neck muscles. If the ball is over-inflated and wet, a more severe impact may result. Goal kicks will result in a higher “G” force than is encountered from a simple throw-in. Many headers result in no brain damage, while others may disrupt sensitive brain pathways, at least temporarily.

Based upon available evidence, many young soccer players will travel through life with a compromised brain. Thinking, memory, and attention may be diminished. We are dealt only one delicate, sensitive brain; it must be protected.

Many years of soccer could lead to an increased chance of developing a devastating neurologic condition. These include ALS, Parkinsons, and dementia. CTE, a familiar condition among professional football players, has been identified in several professional soccer players. Frequent headaches are often experienced after multiple blows to the head. Chronic depression, anxiety, and insomnia may result from brain trauma as well.

Heading the ball occasionally causes a concussion. At least 25 percent of soccer concussions are the result of heading the ball. However, I am equally concerned about the cumulative effects of many “subconcussive” hits throughout a career.

Collegiate and professional players may head the ball from 700 to 1,400 (or more) times per season. Over a number of years, some players may have headed the ball more than 8,000 times. When I played soccer in the 1970s, the season was only three months long. Now, with many kids playing soccer eight months per year, their total number of headers has dramatically increased.

There are multiple factors that determine how one’s brain copes with head trauma. Many football and soccer players suffer long-term consequences, while others remain perfectly fine. The variables include genetics, psychiatric makeup, the position played, total number of blows to the head, strength of the neck muscles, number and severity of concussions, and other factors.

Further research is necessary. A study that may help would compare soccer players with age-matched “controls” who did not play contact sports. Memory, IQ, and attention testing for the two groups, from ages 30 through 80, would possibly reveal major differences. Another helpful study would be to compare the rates of neurologic degenerative conditions in soccer players versus controls, particularly at older ages.

There are interventions that may result in a safer game. Eliminating headers prior to age 12, 13, or 14 will help. Using a lighter ball that is slightly underinflated will minimize the “G” force. Even if the ball weighs 5 percent less, it will result in a significantly lower impact. Strengthening neck muscles, which absorb much of the blow, may certainly help to prevent injury.

Headgear research may lead to a helmet that actually protects the brain. There is scant evidence that the current soccer helmets offer any real benefit. These helmets are being sold with promises that are not backed by data.

As with football, most soccer related subconcussive brain traumas occur during practice. The number of headers should be minimized. Headers during practice should be low velocity (throw-ins, as opposed to long corner or goal kicks). The balls used during practice ideally would be smaller, lighter, and underinflated.

Even considering that headers are integral to the game, it would help if we minimize the high velocity impacts. Goalkeeper punts to midfield result in higher “G” forces. I remember playing midfield in November. The ball was wet and heavy. The goalie would kick it high in the air, crashing down on my head with an enormous force. Players should not be allowed to head the goalie’s punt. This would only marginally affect the game, as midfield play rarely leads to a goal. Players can field the high punt with their chest or feet.

Corner kicks often result in collisions between two players’ heads. The ball may travel at a high velocity. In addition, the forward may whip his head into the ball, creating an angular acceleration that increases brain trauma. Corner kicks are a vital part of soccer, and cannot be eliminated. However, there may be means by which we can lessen the danger. One possibility is to move the corner kick closer to the goalie box, minimizing the speed of the ball.

Soccer is a wonderful and universal game, accessible and inexpensive. When I played and coached, little thought was given to the cumulative effects from headers. We now realize that years of small blows to the head have consequences. It is probable that many young players progress into adulthood with a compromised brain due to soccer. We must do more to protect their brains from long-term damage.

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Lawrence Robbins, M.D. is a neurologist and headache specialist near Chicago. His articles “Stop Football Save Brains,” and “Hockey Can Stay Great Without Violence” were previously published in RealClearSports. He has written 240 articles and four books, primarily on headache.

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