November 11, 2015
Heading ban for 10-year-olds and younger makes sense, but important concussion questions remain

By Mike Woitalla

In recent years, new science has provided clearer information on
the dangers of concussions and studies have revealed their frequency
in youth soccer. It seemed that it would be only a matter of time
before the game’s governing bodies seriously addressed the

U.S. Soccer did so on Monday. It issued a joint statement with the plaintiffs of the Mehr class-action lawsuit and the American defendants, who included U.S. Soccer, U.S. Youth Soccer, AYSO and U.S. Club Soccer.

The Mehr et al v. FIFA et al lawsuit did not ask for monetary damages, but sought the establishment of a medical monitoring program for players with concussions and head injuries and the implementation of "return to play" guidelines, a change in substitution rules, and restrictions on heading by players under the age of 17.

Last May, U.S. District Judge Phyllis Hamilton in Oakland, Calif., dismissed the lawsuit, citing "fairly incomprehensible" claims. Hamilton dismissed the claims against FIFA “with prejudice,” which prevented Mehr from bringing them again against FIFA. But she ruled that claims against the U.S. defendants could be brought again if the plaintiffs showed they had standing.

But let’s be clear. Something had to be done, regardless of how this lawsuit played out -- given the information we now have on concussions and the possibility of future dangers arising from heading.

“The development of a player safety initiative was under way before the current lawsuit was filed,” said U.S. Soccer CEO/Secretary General Dan Flynn in a statement that accompanied U.S. Soccer’s announcement of its “Player Safety Campaign,” which eliminates heading for children 10 and under, and limits the amount of heading in practice for children ages of 11 to 13.

U.S. Soccer also announced it would:

* Improve concussion awareness and education among youth coaches, referees, parents and players.

* Instill uniform concussion management and return-to-play protocols for youth players.

* Modify substitution rules to allow players who may have suffered a concussion during games to be evaluated without penalty. (For example, in leagues with subbing restrictions the temporary substitution would not count against a team’s total number of allowed substitutions. Leagues with re-entry restrictions would make an exception in cases of subbing for head-injury evaluation.)

I do not see any downside to eliminating heading for players 10 and under, nor to limiting heading for teenagers.

Neurosurgeon Robert Cantu, a leading concussion expert, said this about kids and teens being more vulnerable than adults to concussions:

“They don't have fully myelinated brains, so the nerve cells and their connections don't have the coating and insulation of adult brains. In addition, they have disproportionately weak necks compared to adults, and disproportionately large, heavy heads, so they're like bobble-head dolls. This sets them up for brain injuries that are more serious than those sustained at a later age from the same amount of force.”

From a player development point of view, there’s no convincing case that heading needs to be introduced at the early ages. In fact, the heading scenarios that most frequently occur at the lower ages come from goalkeeper punts. And those should be discouraged anyway if we’re aiming to teach kids good soccer, to keep possession, and play out of the back.

Generally in youth soccer, playing long, high balls is a short cut to getting results that undermines long-term player development.

Could it be that if children don’t learn heading at the younger ages they won’t be good at it when they’re older? It might very well be the opposite. They may develop better technique if it’s introduced when their neck muscles are stronger.

One common response to this issue is that proper heading technique prevents concussions. But is there proof of that, especially when it comes to children? There have been studies that indicate the frequency of heading a ball could have a harmful effect on the brain – and for all we know, that heading was done with “proper” technique. With all the unknowns, why risk it with young children during a time in their soccer experience when heading simply isn’t necessary?

A big question about the decision from U.S. Soccer – made with input from “its medical science committee which includes experts in the field of concussion diagnosis and management” – is why it chose the age of 10.

Cantu’s recommendation for youth sports is: “No tackle football before age 14 … No body checking in youth hockey before age 14 … No heading in soccer before age 14.”

One reality of soccer is that it’s an international game. Americans play against the rest of the world. Implementing a heading ban through age 13 could, it may be argued, affect the USA in international competition. That’s a legitimate concern for the U.S. Soccer, but just because FIFA and other nations might not be responding to concussion science is no good reason for us not to take the lead.

Exceptions to subbing rules to allow effective evaluations for head injuries will eventually become something the rest of the world adopts, I would bet on. U.S. Soccer committing resources to educate youth coaches, referees, parents and players on concussions is just plain good.

U.S. Soccer’s “Safety Campaign” introduces nothing that will deter the progress of American soccer players. But it may very well be just a first step because there are important questions left unanswered.

Is there enough evidence as indicated by Dr. Cantu that heading should be delayed until age 14?

We will no doubt be getting more information as science advances and further studies are done.

Are there any other solutions to decreasing head injuries in soccer?

Referees being more vigilant on foul play. Coaches not training their goalkeepers to lift a knee at the opposing player. Field players being restricted from challenging goalkeepers. Discouraging punts or mortar goal kicks.

Should female soccer have different rules?

Studies have shown that girls suffer more concussions and suffer longer-lasting or more severe symptoms. A JAMA Pediatrics-published soccer study showed high school girls with a 60 percent higher rate of concussions than boys and that girls are nearly twice as likely than boys to suffer concussions from head-ball contact.

Heading is the most dangerous part of youth soccer, whether it’s the elbows that fly in an aerial battle or the heads that might clash regardless of what expert coaching the players may have had.

If simply heading the ball produces a significantly higher rate of concussions among girls than boys who are older than the 10-year-olds U.S. Soccer is protecting, does that mean that we should seriously consider different guidelines for the genders?



* * *

Eighteen years ago, Soccer America columnist Paul Gardner became the first American journalist to draw attention to growing problems surrounding soccer concussion injuries and the inevitability -- should the issue not be addressed -- of serious legal complications.

“There is clearly a lot more to come on this subject,” says Gardner. “U.S. Soccer’s move marks the first step in a process that must quickly reach up to the pro level, where virtually every game involves at least one ugly head clash, sometimes with blood. Yet players are hardly ever removed from the game. Excuses like ‘it’s part of the game’ are no longer acceptable. If serious head injuries resulting from heading the ball are really part of the game, then the game needs a serious rethink.”