Concussion experts say that the fears of mental impairment among
soccer athletes are largely unfounded. All the same, caution should come
into play.
By Marnell Jameson, Special to The Times
"Hey, Coach! Can we head the soccer ball?" asked one 10-year-old girl
during pre-season practice. "If the ball's coming fast, duck. If not, go
for it," the coach answered.
While the player's question echoes a hesitation many soccer parents
share, the coach's answer reflects the ambivalence surrounding the
heading worry.
Is it safe to hit soccer balls with your head? The latest word,
according to the nation's top sports concussion experts, is a qualified
yes.
The concern and confusion are understandable. In a study that sent shock
waves through soccer leagues around the world, European researchers
reported in 1999 that years of soccer playing may be associated with
reduced cognitive abilities. The study of Dutch amateur and professional
soccer players suggested that, when compared with athletes in
non-contact sports, the soccer players were, on average, slower at
learning and remembering new material.
"The authors generalized that heading was the culprit," said Mickey
Collins, assistant director of sports concussion programs at the
University of Pittsburgh Medical Center, "but the study wasn't
well-controlled for heading. It could have been lifestyle or a number of
other factors."
That study prompted American researchers to launch their own
investigations, none of which turned up a link between heading and later
cognitive problems.
When he heard the results, Kevin Guskiewicz, director of sports medicine
research at the University of North Carolina, Chapel Hill, began
analyzing data he'd been collecting on the school's athletes.
At the university, every freshman athlete is given a series of mental
ability tests, including tests for concentration, mental speed and
memory, upon admission. This serves as a baseline in case the player
later suffers a head injury. Using this data, Guskiewicz performed a
retrospective study. He looked at 91 incoming soccer players and
compared them to 96 incoming athletes who had played non-contact sports.
He also tested 53 non-athlete students as a second control group.
He found the soccer players to be no different in neuro-cognitive
abilities than the two control groups.
"We did see a higher prevalence of concussion among the soccer players,
but that made no difference in cognitive ability," Guskiewicz said. His
findings were published in the American Journal of Sports Medicine last
year.
In addition, researchers at the University of Pennsylvania studied 100
varsity collegiate soccer players before and after the players went
through a 20-minute soccer-heading practice session. They found no
decrease in mental performance scores after the heading sessions and
later published their findings in the Clinical Journal of Sports
Medicine.
But couldn't multiple impacts to the head, such as those sustained when
repeatedly heading soccer balls, have a degenerative effect on the brain
even if they don't cause concussion?
"Current scientific literature refutes that as well," said Guskiewicz,
who last year wrote a position paper on the subject for the Department
of Health and Human Services. "No published study has provided direct
evidence that the practice of heading a soccer ball causes long-term
deficits in mental function," he wrote. "Preliminary evidence suggests
that if done correctly, heading a soccer ball is safe."
The American Youth Soccer Organization agrees: "We tend to be
conservative," said Rick Davis, director of player programs for AYSO,
based in Hawthorne, "and our stand is that until there's conclusive
information that heading soccer balls is a problem, we allow it."
However, he added, "we would never force anyone to do something they
didn't feel right about."
AYSO recommends that its coaches not teach heading to kids under age 8,
said Davis, "because it's not a necessary part of the game at that
level," but suggests they introduce the skill to players age 10 to 12.
Although concussions do occur in soccer, they're unlikely to be the
result of heading a ball, Guskiewicz said. Most soccer concussions occur
in head-to-head, head-to-ground or head-to-goal-post collisions and
rarely in a head-to-ball contact. To put the risk in perspective, 64% of
all sports-related concussions among high school boys occur in football,
11% in wrestling, 6% in soccer and 4% in basketball, Collins said.
The worst thing an athlete can do after sustaining a concussion is to go
back to play too soon, Collins said. For example, if a soccer player
suffers a concussion, returns to play before fully recovered, then heads
a soccer ball, serious problems could result.
"Even if the brain is 95% recovered, a minor blow to the head before
it's completely healed can result in permanent brain damage and even
death," he said. Second impact syndrome, as it's known, is responsible
for the deaths of several U.S. high school kids each year.
Guskiewicz recommends that players wait for seven days after being
completely free of concussion symptoms before returning to play. Most
don't. In studies he has conducted of professional football players, 70%
returned to play the same day they suffered a concussion. A study he
performed on other high school and college athletes revealed they
returned to play on average four days after a mild concussion and eight
days after a moderate one.
However, if a young player has a concussion and recovers completely,
there's usually no long-term effect, Collins said. "You can hit the
reset button on most kids."
Meanwhile, manufacturers of sporting equipment are capitalizing on the
concerns and have developed headgear for soccer players that supposedly
reduces the risk of head injuries. The only people who seem to endorse
it, however, are the manufacturers. "There have been no peer-reviewed
studies published that support the use of helmets or headgear in soccer,
and no authoritative medical or sports organizations have recommended
their use," Guskiewicz said.
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(BEGIN TEXT OF INFOBOX)
How to head a soccer ball
Proper heading technique is key to minimizing head and neck injuries,
experts say. Rick Davis, AYSO director of player programs, played on the
U.S. Olympic men's soccer team during the 1984 and 1988 Games and later
played professional soccer for 13 years, seven with the Cosmos. Here are
his guidelines for heading a soccer ball.
. Strike with your forehead, at the hairline (or, for some men, where it
used to be); striking on the top of the head puts a greater load on the
spinal cord.
. Keep your eyes on the ball, though you'll naturally blink on impact.
This will help you hit with the correct part of the head.
. Keep your mouth closed, so you don't bite your tongue or lip.
. Keep chin to chest until just before the strike to help brace your
neck muscles.
. Engage your upper body and arch your back to help disperse the load
across the entire upper body, not just the head and neck.
-- Marnell Jameson
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