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Soccer players heading for trouble, study says

By KEVIN KELLY

© St. Petersburg Times, published February 22, 2000


Under most circumstances, Derrick Aguis would be troubled by a 10-ounce object slamming into the side of his head from 30 yards away.

But because it was a soccer ball, the Hudson senior midfielder considered it routine.

"I closed my eyes, and I misjudged it," he said.

Even the dizziness that came after the blow during the Cobras' recent game against Central isn't out of the ordinary, though it required a quick on-field remedy by Aguis.

He placed his hands on his knees, lowered and then raised his head, gave a few exaggerated squints, massaged the spot where the ball hit, and in 10 seconds was trotting down the muddy field.

"If it hits the wrong part of your head, you almost black out," Aguis said. "I just got a little dizzy, but it has happened before. ... If you hit the ball, it doesn't hurt. If you let the ball hit you, it hurts."

As a referee of more than 200 youth, high school, collegiate and adult league soccer games a year, Sam Velez sees hundreds play a game he used to.

He also sees dozens who take line-drive shots off their skulls and head the ball improperly -- by accident like Aguis or because they don't know the proper technique.

"I saw a girl, (the ball) almost ripped her head off and she just went flat on the ground," said Velez, who lives in Spring Hill.

"I've seen a few bad, bad hits," he said. "What happens is they lack the skills."

Research on the effects of heading a soccer ball proves what most players, referees, coaches and parents already know. It can be painful.

The hurt may last a few seconds.

It also may last a lifetime, according to a soon-to-be-published study by the Institute for Preventative Sports Medicine in Ann Arbor, Mich.

The study concludes that heading a soccer ball causes symptoms of a concussion and, over time, can permanently damage the brain.

"We're not trying to scare anybody," said Dr. David Janda, who led the IPSM's study titled "An Evaluation of the Cumulative Concussive Effect of Soccer Heading in the Youth Population.' "

* * *

Three years ago, Janda was studying goal-post injuries in Michigan when a youth soccer coach's heading drill got his attention.

The coach lined the players up, bounced the ball off each player's head until the last child completed the drill.

"After these kids came off the field we asked them what they liked best about soccer and got a myriad of responses," Janda said.

"We also asked what they liked least. They all came up with the answer, "When we do that heading drill, many times I see two of everything and I have ringing in my ears, and sometimes I feel like I'm going to throw up.' Well, those are signs of a concussion."

The children's responses prompted Janda and his colleagues to study how a soccer ball affects the brain.

"Think of the brain being a slab of Jell-O in a bowl," Janda said. "Every time the ball hits that bowl, that Jell-O bumps into the side of the bowl; therefore the brain bumping into the side of the skull."

Janda followed 57 Michigan youth soccer players (boys and girls) ages 10-14 in 1997-1998 and kept track of how many headers the children did.

The players also underwent verbal tests at the end of each season and were compared against the performance of a group of non-soccer-playing children.

In the first year of the study, 49 percent of the soccer players complained of headaches, ringing ears, double vision or nausea -- the symptoms of a concussion -- but scored no differently from the control group on the verbal tests.

The following year, Janda found the soccer players performed worse on the tests than the control group.

"What we think happens is that the kids start developing these concussive symptoms after heading," Janda said. "The next thing that starts to happen is their information processing and memory ability starts to diminish."

By the time a player reaches 19 years old, Janda believes the damage becomes permanent.

* * *

Like most coaches, Hudson coach Ron Ladimir teaches his players to head the ball in a rectangular area on the forehead -- about an inch above the eyebrows and an inch from the hair-line inside the ends of the eyebrows.

"I've been playing all my life, and I don't seem to have been affected that much," he said. "Believe me, you get headaches. Depending on how hard the ball is kicked, it does hurt. Thing is, if you go in thinking it's going to hurt, it probably will.

"Most people, when they get headaches or something happens, either they get hit on the top of the head or they let the ball hit them instead of them hitting ball."

Brain injuries such as concussions aren't limited to headers but are often brought on by collisions between players.

"Two kids going up for the ball, both kids are leaning, there's a good chance that something's going to hit and it's often the head," River Ridge boys soccer coach Dave LaRoche said.

John W. Powell, a professor of kinesiology and an athletic trainer at Michigan State University, led a study titled "Traumatic Brain Injury in High School Athletes" that was published in September in the Journal of the American Medical Association.

The study tracked injuries of athletes in 10 sports, including boys and girls soccer, at 235 high schools from 1995-97.

Of the more than 23,000 reported injuries, 1,219 were mild traumatic brain injuries -- an alteration in mental status that may or may not involve the loss of consciousness.

Girls soccer players accounted for 6.2 percent (76) and boys soccer players experienced 5.7 percent (69) of all such injuries. Football had the highest number (773 cases, 63.4 percent) while volleyball had the lowest (six cases).

Eleven of the 145 soccer players studied experienced a second concussion.

* * *

Direction, force, length of time the force is applied to the head and the nature of the object are all factors in a head injury.

But there are ways to help prevent a soccer-related head injury.

A lighter ball in drills is one way.

A youth soccer ball can weigh from 9 to 11 ounces while a professional ball weighs 14 to 16 ounces. Janda suggests coaches use a beach ball or soft-sided ball.

Helmets and protective headbands also have been developed. Neither is required in Florida and both can be difficult to find.

Dr. Donald W. Rumbaugh, a family physician in New Jersey, developed "The Protector" safety headband and sells it on the Internet (www.soccerband.net) for $14.95. He estimates he has sold 800 to 1,000 units to buyers in 30 states.

The band wraps around a player's forehead and is made of molded foam and a semi-rigid plastic shell liner.

"I sent it to a testing lab in Tennessee and there was a 44 percent decrease in impact forces," Rumbaugh said.

Powell and Janda said requiring headbands or helmets may be a rash reaction because of the rare nature of head injuries and lack of research on the effectiveness of headgear.

LaRoche and Ladimir agree.

"I think that would take a lot away from the game," LaRoche said. "It would be hard to head the ball unless the gear was built where the portion of the head you need was exposed."

Ladimir added: "A helmet isn't going to do anything."

Although protective headgear and the teaching of proper heading technique all can combat the ill-effects of repeated blows to the head by a soccer ball, nothing helps more than knowing about the potential dangers, Janda said.

"We encourage folks to get into the sport," he said. "We believe we're obligated to let the public know. If there's a problem out there, we have to let folks know and not stick our heads in the sand."


-- Information from the Journal of the American Medical Association was used in this report.

HOW A CONCUSSION OCCURS 1. Strong blow to head

2. Momentum causes brain to compress and strike the skull wall

3. Tiny nerve endings and blood vessels stretch and tear as brain rebounds

SIGNS OF CONCUSSION Player appears dazed

Player has vacant facial expressio

Confusion about assignment Athlete forgets plays

Disorientation to game, scoring, opposing tea

Inappropriate emotional reaction (laughing, crying)

Player displays lack of coordination or clumsiness

Player is slow to answer questions

Loss of consciousness

SYMPTOMS REPORTED BY ATHLET Headache

Nause

Double or fuzzy visio

Feeling slowed dow

Change in sleep patter

Irritabilit Sadness

Feeling more emotiona FOR MORE INFORMATION

www.neuroskills.co www.jama.ama-assn.org

www.ama-assn.or

The Evaluation and Treatment of Mild Traumatic Brain Injury by Nils. R. Varney (Editor), Richard J. Roberts (Editor


-- Information compiled from the Journal of the American Medical Association and Times files.

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