UPDATED: Nov. 8, 2017 at 1:15 p.m.
When Jessica Vigna began playing soccer, she played for a club team coached by her dad. She remembered running around, learning foot skills and techniques with her best friends. She also remembered her first header, and the “weird” feeling it gave her.
“A ball’s being chucked at your head…” she said. “The first time, I did feel disoriented.”
For four years, as a Syracuse defender, she may have headed the ball every day. Heading the ball is an integral aspect of the game, and a daily occurrence at Syracuse’s practices, head coach Phil Wheddon said. But fear remains that constant subconcussive blows from headers could be damaging.
Head injuries have become a mainstay in national headlines since the uncovering of Chronic Traumatic Encephalopathy in National Football League athletes in 2005 by Dr. Bennet Omalu. Soccer has remained a smaller part of the conversation and lags behind football organizations as they improve player-protection protocols.
But how much does heading the ball factor into why soccer players develop CTE? Neurologists still aren’t quite sure.
“You can consider that a $64,000 question,” said Dr. Lawrence Chin, professor and chair of neurosurgery at SUNY Upstate Medical University.
A concussion is defined as a minor brain injury that results in altered brain function, Chin said. That could include blurriness of vision, ringing in the ear, headaches and several other symptoms. A CAT scan wouldn’t show any obvious damage from the injury, but the injury is clear because the person concussed would have experienced some form of symptom.
“There are many different types of injuries that will result in a concussion,” Chin said. “It could be a fairly severe blow to the head or it can be a very minor blow to the head. Both can result in the same thing.”
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The symptoms do not need to be prevalent either. A blow to the head causing a player to be concussed could only alter brain function for a matter of seconds, allowing a player to calibrate quickly and potentially ignore it.
The disoriented feeling that Vigna experienced could have been a concussion, albeit a minor one, or it might not have been. The fear lies in the unknown.
But concussions may not be the problem. Though just a hypothesis at this point, some neurologists believe that a series of subconcussive blows could be what leads to major neurological disorders such as CTE or dementia, Chin said. As a constant source of hits to the head where, Chin said, “none of which are severe enough to call what we would define as a concussion,” headers qualify.
Although there have “definitely” been confirmed cases of CTE found posthumously in soccer players, Chin said, the dialogue around heading the ball and head injuries in soccer remains small compared to football. People around soccer, and some in Syracuse athletics, have yet to universally accept that headers could potentially cause future danger.
“Most concussions are caused by contact and not by a ball,” Wheddon said. “An elbow, head to head, but not by a ball.”
In a game earlier this season, Vigna rose and led with her head towards a ball with a nearby defender also trying for the floated pass. Vigna went straight up and cleanly got her head on the ball, knocking it away from the defender and landing safely on her feet. But the back of the defender’s head collided with Vigna’s shoulder, and she fell to the ground. For a few seconds, the defender lay motionless. The game played on.
Two players challenging for a ball with their heads is a common play in soccer. It happened multiple times in the SU men’s and women’s seasons just this year. If done on a regular enough basis, the increased likelihood for a head collision, like the player who challenged Vigna, could be another factor that links to brain injury and potentially CTE, Chin said. Wheddon feels that as long as his players are heading the ball properly, concussions and future brain injury shouldn’t be in his players worries.
“We don’t overemphasize or worry about concussions,” Wheddon said. “It’s like saying don’t kick the ball because you’ll break a toe. This is a contact sport, there’s going to be contact.”
In 2015, the U.S. Soccer Federation banned children ages 10 or younger from heading the ball in either practice or games. Those same guidelines state that children ages 11 to 13 can perform headers, but must limit them to training sessions or practices and are banned from performing them in a match. This was one of the first steps soccer has made to limit the effect of headers.
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According to the most recent data the NCAA has publicly released, only 5.5 and 9.2 percent of all injuries in men’s and women’s soccer, respectively, were concussions. That data was collected from the 2004-05 through 2008-09 seasons.
The NCAA did not respond to several inquiries from The Daily Orange on if it views headers as a concussion threat, as well as if it has ever tried to ban headers or know of any schools that has restricted headers in some form.
Dartmouth College was the first Division I school to enforce contact-free practices for their football team. The system was then adapted by many in the Ivy league, according to multiple reports.
Another option that some players are going to is headgear. But there is debate of its effectiveness as well, Chin said. When someone gets a concussion, it is related to the motion of the brain as opposed to the hit itself. Therefore, Chin said, the only way to ensure a header doesn’t cause any effect to the head would have to be a helmet that absorbs all of the energy of the ball. In which case, the ball would hit a player’s head and fall flat to the surface, which he said, “defeats the purpose.”
CTE studies, Chin reiterated, are still in the early stages, and neurologists don’t know much about what causes the disease, especially in soccer players.
Still, soccer’s threat looms large. Patrick Grange, the first former soccer player to be discovered with CTE, frequently headed the ball, his parents told The New York Times in 2014. Starting at 3, he spent extended periods of time in his backyard tossing the ball to himself just to knock it into the goal in front of him with his head.
The Daily Orange asked SU Athletics if the concussion protocol for soccer is the same throughout all sports, whether it requires a team doctor at every match and if it has ever considered creating a contact-free practice or simply ruling out headers.
“Syracuse University’s NCAA approved concussion policy is followed for all intercollegiate sports,” SU Athletics said in a statement. “Per the policy, there is a primary care physician trained in the recognition and treatment of concussions at every home event.”
SU men’s soccer head coach Ian McIntyre deferred to the same statement.
After a concussion, players are required to refrain from any contact as they ease back into play, Vigna said. The second day after the initial hit, she said, the players can then return to minor contact. Headers are among the things that qualify for minor contact.
Chin said empirical evidence of headers resulting in lasting head injury remains elusive. There are some people, he said, who never play sports at all and still develop neurological disorders, like CTE. Chin questions how much of brain injury is a result of individual susceptibility.
But, he said, it’s starting to add up: Heading is a repetitive subconcussive hit. Current CTE research suggests that something like a header causes concern. There’s no definitive answer as to why former soccer players develop CTE, Chin said, but the risk exists.
“To say something is correlated,” Chin said, “doesn’t necessarily mean it’s a cause.
“But it could be.”
CORRECTION: In a previous version of this post, the areas where Jessica Vigna and the opposing defender collided were misstated. Vigna’s shoulder collided with the back of the defender’s head. The Daily Orange regrets this error.
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