Heading taking a lot of blame as concussions increase in soccer

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.”

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.”

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?”

Casey Curtis, varsity soccer coach at Lewis and Clark High School, said the number of concussions varies from season to season.

“This fall, I had three girls teams, and none of the (players) had any concussions,” said Curtis. “Last fall, we had five concussions.”

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.

“I don’t really know if there’s anything you can do to truly prevent it from happening,” Hildenbrand said. “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.”

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.”

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.”

That changes at the high school level. Winchell said the ball is in the air “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.”