Heading for Disaster? A Tale of Four Concussions

US Soccer just settled a lawsuit regarding concussions and heading the ball 

The epidemic of concussions in American Youth Soccer is a real issue.  But is heading the chief culprit? Taylor Twellman certainly thinks so

Here is the concussion advocate and former USMNT player talking with Bob Ley on ESPN’s Outside The Lines

Bob Ley:  “There’s a lot… going on in the game. There’s contact.  There’s elbows.  There’s a clash of heads just going up for the ball. There’s falling down to the ground….  What percentage do you guess as a very educated layman on this, of trauma might be occurring just because simply of heading? Because there’s a lot of other stuff going on.”

Taylor Twellman: “I don’t think we have enough data that says heading a soccer ball causes concussions. The act of heading a soccer ball… that is where the majority, if not all concussions in the sport of soccer occur.”

Well, since a prominent concussion advocate sees no reason to back up his argument with data or statistics, neither do I. Instead, I will draw on 35+ years of experience as a player, coach, and (reluctant) administrator in the game.  And what my experience tells me is that the concussion problem with Youth Soccer has much less to do with heading the ball and much more with the overall culture of soccer in this country, and how the game is subsequently played, coached, and refereed.

I’ve seen plenty of concussions and head injuries. I would put heading and attempts to head the ball down to at least number five on the risk chart, especially at the younger ages and lower levels where there is a natural aversion to heading the ball anyway
I currently coach a mid level GU14 team that I took over in the summer of 2014. There have been four diagnosed concussions among my players in the past year.  Interestingly enough, our pattern of concussions fits very neatly with the overall pattern of concussions I have observed in American soccer over the years.

My team’s first concussion occurred when a girl lost her balance in a collision and hit her head on the ground while falling backwards.  I’ve seen this over and over, and had seen a carbon copy event while working at a soccer camp a month earlier.  American kids don’t learn how to fall.  Most don’t get specific agility training and most don’t get the same formative experiences that we did as kids from playing unsupervised on our own.  Unbeknownst to my parents, when I was a kid we played “train tag” on an abandoned rail spur near our neighborhood.  Slipping off a caboose on to fist sized gravel and steel rails teaches you how to fall well.  A less extreme example: in about 50 hours of playing and observing players of all ages engaged in very physical games of futsal on cement courts in Bolivia over the past two summers, I never saw one head injury, or even a serious hard fall.  It seems tht for American kids, playing Xbox is not an effective substitute for the experiences of physical play.

We can significantly reduce concussions in American soccer by teaching kids how to fall.

The second concussion occurred when a player fell to the ground after a series of two handed shoves in the back from an opponent.  She rode the first two but the third sent her tumbling to the turf.  The referee saw nothing wrong with the challenge(s) and did not award a foul. Again, I see this over and over.  Whatever a ref permits, a ref promotes. So because most referees let a lot of illegal contact and sloppy fouls go in the interest of “letting them play” and “keeping the game flowing”, I see plenty of illegal contact and sloppy fouls at all levels of the game. Many of these fouls lead to injury, including ample concussions

If referees strictly and uniformly enforce the laws of the game, there will be fewer concussions in American soccer

The third concussion occurred when one of my forwards closed down a defender in possession of the ball.  With plenty of space to dribble and passing options to both sides, the defender aimlessly smacked the ball as hard as she could, striking my player in the side of the head. Again, nothing new here. I received my own concussion this way in an Over-40 game a few years ago.  We don’t teach our kids how to play properly.  “Not across the goal”, “Send it”, and “Get rid of it” are part of the American soccer fabric.  If you condition your players to be afraid of the ball, then they are going to treat the ball like a hand grenade that has been chucked out of the foxhole as soon as possible.  The results are predictable. In American soccer, from little kids all the way to college and MLS, the ball is in the air way more than in most other countries.  Not only do you risk a smack in the head for your pressing efforts, but it also creates an environment where aerial challenges and the potential for clashes of the head become commonplace.

If coaches eschew the boot ball style of play and teach players how to play with more skill, control, and intelligence, there will be fewer concussions in American soccer
The fourth concussion occurred when an attacker recklessly charged my goalkeeper who had just smothered the ball.  With the chance to win the ball long gone, the attacker slid in anyway, kneeing the keeper in the side of the head.  In my experiences this typifies the majority of concussions I have seen at the youth level…. Simple bad, reckless, and careless challenges all over the pitch.  Bad technique, bad decision making, no attempt to control one’s body, and no regard for opponents. Coaching is the same as refereeing.  What you permit you promote.  So regardless of whether you are not teaching proper technique, are teaching violent play, or simply turning a blind eye to your player’s bad tackles and swinging elbows, the result is going to be the same… Lots of injuries.

Teaching your players to properly and legally challenge for the ball will significantly reduce concussions in American soccer.

So what about heading? Let’s address high school first.  I did my hard time.   I spent five years working in an inner city high school as head coach.  I loved working with the kids, and if the state of the High School game in my state wasn’t such a violent hack fest, I might still be there now.  During that time I observed plenty of players removed from games due to our state’s very sensible concussion protocol.  Of these, only one case that I can remember was the result of a clash during a header.  As it turns out, there was no concussion in that incident.  The athletic trainer pulled the player from the game because “he was confused and could not answer simple questions.”  He was fine.  The problem was that the boy spoke very limited English.  Are some of those 50,000 high school soccer concussions per year the result of aerial challenges for the ball? I have absolutely no doubt.  Are the majority, or as Twellman suggests “almost all of them” the result of attempted headers?  I doubt that very much.  Again, most of the concussion scares I have seen in high school ball were the same that are typical to US youth soccer: bad falls, bad refereeing, bad coaching, bad challenges, bad style of play.  Bad soccer culture.

Do not get me wrong: challenging for headers is a serious concussion risk. But for those concussions that DO involve heading the ball it’s the same story; bad technique, bad coaching, and poor enforcement of the laws of the game play a major role.  I don’t really understand how avoiding the issue of heading during the “golden age of learning” is going to provide a knock-on benefit once kids get older.  Yes, it’s cringe-inducing to see a punted ball smack off of the top of an untrained u10 player’s skull as adults cheer.  And I agree that kids don’t need to be heading the ball much at the younger ages.  But if they are going to do it, and if they are going to need to learn how to do it, wouldn’t it be safer to teach them the proper technique and decision making instead of avoiding the issue altogether?  Shouldn’t we be working in ways to systematically and methodically train young players to be ready for that day when they are allowed to head the ball?

Proper training of the techniques and decision making of heading the ball will reduce concussions in American soccer

The problem of concussions in soccer is real.  But for me, heading is being regarded as a convenient scapegoat instead of a portion of the overall issue.  The real root of the problem is deeply embedded in our current American Soccer Culture.

Unfortunately, this lawsuit resolution is also unique to our American way of problem solving.  We have 50,000 concussions per year in high school soccer, so we ban heading for little kids who are in grade school and middle school. Now they will get little or no training until they are 14.   It seems to me that if heading is the major statistical cause of concussions at the high school level, then the problem could be more effectively addressed directly at the high school level, which is known for a preponderance of rough play, inexperienced players, inexperienced coaches, and lax refereeing.

Or is that thinking too far Outside The Lines?

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