If your youth coach wants to practice headers...

[dad4]

I would urge people to read the Abstract from the study. It sounds like the risk of CTE is not very high when it comes to headers. In the end, the "risk of harm falls in line with the population." This study should not be the last word on the matter. Only 92 subjects were included. But if this is the best we have right now, then the evidence does not support a claim that heading causes CTE.

Abstract
Background: Heading impairs cognition in the short and medium-terms; however, little is known about the long-term consequences. This study aimed to investigate the hypothesis that chronic low-level head trauma is associated with persistent cognitive decline.
Methods: All members of Former Player Associations (FPAs) from four professional football clubs in the UK were contacted to participate in the study. Participants were required to complete a self-assessed test of cognition, the Test Your Memory questionnaire. Further information was collected from respondents in order to analyse the potential effect of a number of variables on cognition.
Results: 10 of 92 respondents (10.87%) screened positive for possible mild cognitive impairment (MCI) or dementia. There was no association between low-risk and high-risk playing positions (HR = 0.40, p = 0.456) or length of playing career (HR = 1.051 95% CI 0.879 to 1.257, p = 0.586) and a positive screening result. Age was a risk factor (HR = 1.137 per additional year, 95% CI 1.030 to 1.255, p < 0.05), although this was not significantly different from the population prevalence across age groups.
Conclusions: These results suggest that once a player ends their playing career, their risk of harm falls in line with the population, suggesting either that changes are reversible or that heading may not be as harmful as commonly thought. Future longitudinal studies of large numbers of professional football players are needed to support the findings from this study.

Who said that one study is the best we have?

It is a self-assessment study with only 92 participants from 8 years ago. It is neither particularly recent nor particularly thorough.

However, if you start with a desire to tell yourself that headers are safe, it satisfies that particular need.

 

[espola]

1. It is the best study that has been presented here. If you got a better one, then it is incumbent upon you to show us. As I said, it should not be the last word. More research is definitely appropriate.

2. As to your second point ("if you desire to tell yourself that headers are safe, it satisfies that particular need..."), what your are really doing is accusing me of deductive reasoning, meaning that I have formed a conclusion and no contrary evidence will be admitted. As my posts show, I do not foreclose the possibility that headers might cause CTE, but the best evidence presented so far does not support that position.

3. You, however, have presented no evidence whatsoever except that one soccer player had CTE. From that shaky premise, you concluded that people should run away from coaches who teach heading. Then you went on to suggest that heading a soccer ball put soccer players in the same category as NFL players. Now, even when presented with evidence that soccer headers do not cause CTE, you accuse me of having my mind already made up.

4. I say that you are the one who has formed an opinion which "satisfies your particular need." In 10 or 15 years we will know if your opinion is correct. For right now, though, it is unsubstantiated.

5. Until then, follow your own advice. Put your child with a coach who doesn't teach headers. Or take your child out of soccer.

Good post, except I think you have the definition of "deductive reasoning" a little wrong.

 

[zebrafish]

Props to dad4 for bringing more than opinion into this conversation.

Pure and simple, there isn't any well-done scientific evidence that I've seen which convincingly shows heading the ball is actually safe. And I do look at this primary literature. Talk to neurologists/neurosurgeons, they'll tell you the same thing.

It is a historically woefully understudied topic that thankfully is getting more attention and research dollars.

What is clear is that the more carefully people look with imaging and functional studies at heading, the more they find that heading the ball *isn't* good for the brain. And this risk probably extrapolates down to a situation where there isn't a "safe" or "ok" amount of heading. The same can be said of alcohol consumption and cancer risk.

There's not firm science behind the age threshold that US Soccer set in regards to heading (12 years), but I'm glad they did... something.

Interestingly, the EPL came out last year with guidance on heading in all players (https://www.premierleague.com/heading-guidance)-- that includes adults and pros.

It is definitely clear from the science that girls' concussion risk is significantly higher than boys' in soccer, and the biomechanics behind this likely translate into headers being worse for female players than male players. The EPL link discusses that some.

I think the game should eliminate heading. We would all adapt. It would still be beautiful.

We can all talk about acceptable risk and where to set that threshold. But I think better information is needed for people to really understand the risks that they are inflicting on their kids (that many don't realize are there, especially from this conversation...).

To anyone who says you can't play at top levels without heading the ball, I say to you: Son Heung-min scored zero goals with his head last year. And, oh yeah, he tied for the golden boot in the EPL. Something like 2% or fewer of Messi's goals have come from heading the ball. I could go on. Yes, there are some very talented players in the air--- but it isn't critical for the game in all players.

I played the game for 30+ years and headed the ball many times (yes, with proper technique)-- occasionally seeing stars for a few seconds. That's not good. Do I wish I could eliminate that from my past? Absolutely. And I don't want my kids to be there either.

 

[dad4]

1. It is the best study that has been presented here. If you got a better one, then it is incumbent upon you to show us. As I said, it should not be the last word. More research is definitely appropriate.

2. As to your second point ("if you desire to tell yourself that headers are safe, it satisfies that particular need..."), what your are really doing is accusing me of deductive reasoning, meaning that I have formed a conclusion and no contrary evidence will be admitted. As my posts show, I do not foreclose the possibility that headers might cause CTE, but the best evidence presented so far does not support that position.

3. You, however, have presented no evidence whatsoever except that one soccer player had CTE. From that shaky premise, you concluded that people should run away from coaches who teach heading. Then you went on to suggest that heading a soccer ball put soccer players in the same category as NFL players. Now, even when presented with evidence that soccer headers do not cause CTE, you accuse me of having my mind already made up.

4. I say that you are the one who has formed an opinion which "satisfies your particular need." In 10 or 15 years we will know if your opinion is correct. For right now, though, it is unsubstantiated.

5. Until then, follow your own advice. Put your child with a coach who doesn't teach headers. Or take your child out of soccer.

I do follow my own advice. My kid does not head clearance balls.

There is plenty of evidence that concussions and sub-concussive impacts are a problem in soccer. The nature of that relationship is the sort of thing they write survey articles about:

https://www.futuremedicine.com/doi/10.2217/cnc-2020-0004

To present one of those 100 or so studies and say “here’s the last word“ or “this is the best study” is kind of silly.

 

[Grace T.]

My gk son and I just had a discussion about balls over the top in the boys game over dinner (other than the Uswnt, and a few games from his gf and cousin, he hasn’t seen enough of the girls game to judge)

He was very animated. He said balls over the top are probably the third toughest play he faces…after cutbacks on the ground and cutbacks in the air. Unlike a thru ball on the ground, he says it’s one he and his gk peers worry about because the ball is out of control and unlike the ground there is no really fixed routine to stop it. It makes it more dangerous for them and the two times he’s had a serious collision has been with this type of ball.

he said that the thru ball on the ground is probably a result of a defensive tactical mistake and he bears part of the responsibility for failing to see it. But the ball on the air is totally the defenders responsibility for failing to challenge the aerial. He said he’d totally go off on a teammate that put him in that situation by whincing away from the aerial (gks yell a lot), it would absolutely destroy the trust which is so important between the cb and gk (trust which he recognizes go both ways and which in the past he’s merited a loss of) and that a player that did that wouldn’t survive long in the higher level boys game. He brought up the bad experience he had with these balls on one team that led to 4-8 1v1s a game and he said it was absolutely awful (no but I’m grateful I got better on 1v1s…just it sucked).

it was a good convo so thanks for that…was surprised his feelings on the subject were stronger than mine. As to the risks he said there’s a lot riskier stuff going on in soccer and if the adults feel it isn’t safe for kids they should change the rules, but not by throwing gks under the bus.

Ps he said that if you are going to eliminate risky stuff start with goalkeepers sliding. It’s a gk wishlist fantasy but his idea is if the gk is sliding in the box the striker has to yield the ball to the gk on pain Of a yellow card. I told him to keep dreaming.

I think the game should eliminate heading. We would all adapt. It would still be beautiful.

We can all talk about acceptable risk and where to set that threshold. But I think better information is needed for people to really understand the risks that they are inflicting on their kids (that many don't realize are there, especially from this conversation...).

To anyone who says you can't play at top levels without heading the ball, I say to you: Son Heung-min scored zero goals with his head last year. And, oh yeah, he tied for the golden boot in the EPL. Something like 2% or fewer of Messi's goals have come from heading the ball. I could go on. Yes, there are some very talented players in the air--- but it isn't critical for the game in all players.

I played the game for 30+ years and headed the ball many times (yes, with proper technique)-- occasionally seeing stars for a few seconds. That's not good. Do I wish I could eliminate that from my past? Absolutely. And I don't want my kids to be there either.

The immediate impact on offense would be minimal. You just could never cross or corner the ball in the air between the penalty spot and the gl because the goalkeeper will have too much of a height advantage in grabbing it and the low cutback would become more of a go to option (an option which is harder for the crosser to properly execute than an aerial). You could also just eliminate the goalkeeper from the game.

the problem with the back line is harder. I don’t see any solution to it other than an aerial ball over the last defender will automatically be called offside and to ban the goalkeeper from punting. It would lead to much more stoppages.

Because otherwise the only thing you are going to get is goalkeepers punting and defenders long balling the ball over the top of the opposing line leading to footraces. All soccer games would look like some of the u10 games we see around town where it’s just see who is faster. These aerial balls are also ugly and require little skill to create a foot race whereas a thru ball on the ground requires some tactical creativity. They’ll also increase the number of 1v1s on goalkeepers putting them more at risk. Games would be a lot more high scoring but certainly less beautiful.

 

[Mosafie]

There is now evidence that even repetitive lighter contact with the head can cause CTE. That's all lawyers need.

America is a land of litigation. The reason there are no headers in youth soccer is because of a class action lawsuit in 2015 against US Soccer Federation which was settled and eliminated headers as part of the settlement.

Any coach that is wasting a lot of time practicing headers, which have a very small impact on the game is not only putting players at risk but also himself and his club to litigation.

Sure incidental head contact and concussion are part of soccer however accidents are different than repetitive intentional head impacts that are going to attract the wrong kind of attention.

 

[Woodwork]

I do follow my own advice. My kid does not head clearance balls.

There is plenty of evidence that concussions and sub-concussive impacts are a problem in soccer. The nature of that relationship is the sort of thing they write survey articles about:

https://www.futuremedicine.com/doi/10.2217/cnc-2020-0004

To present one of those 100 or so studies and say “here’s the last word“ or “this is the best study” is kind of silly.

I think you and I both agree that the safest thing is for some other kid to head the ball to our kids' feet. Don't argue too persuasively now.

 

[Grace T.]

There is now evidence that even repetitive lighter contact with the head can cause CTE. That's all lawyers need.

America is a land of litigation. The reason there are no headers in youth soccer is because of a class action lawsuit in 2015 against US Soccer Federation which was settled and eliminated headers as part of the settlement.

Any coach that is wasting a lot of time practicing headers, which have a very small impact on the game is not only putting players at risk but also himself and his club to litigation.

Sure incidental head contact and concussion are part of soccer however accidents are different than repetitive intentional head impacts that are going to attract the wrong kind of attention.

If litigation were to get to this point (that heading gets banned in the us youth game) it ends in one of two places. First, if the over 18 teams continue to be able to do it, the us winds up being woefully unprepared on the international stage, the dominance of the Uswnt ends and the men will largely go off to Europe at age 12 to train. Second if the 18-21 get banned too or even the pros, the us just gets redlined by fifa. The litigation probably also results in youth gridiron football getting banned in the us.

we aren’t in the drivers seat on this one. Change, if it comes, has to come from Europe.

 

[dad4]

I think you and I both agree that the safest thing is for some other kid to head the ball to our kids' feet. Don't argue too persuasively now.

I’d be perfectly happy with my kid playing for a team or league where no one heads the ball.

It’s just soccer. Maybe they lose a game or two. That’s better than finding out 20 years from now that her best friend turned to alcohol to get rid of the migraines.

 

[Grace T.]

If litigation were to get to this point (that heading gets banned in the us youth game) it ends in one of two places. First, if the over 18 teams continue to be able to do it, the us winds up being woefully unprepared on the international stage, the dominance of the Uswnt ends and the men will largely go off to Europe at age 12 to train. Second if the 18-21 get banned too or even the pros, the us just gets redlined by fifa. The litigation probably also results in youth gridiron football getting banned in the us.

we aren’t in the drivers seat on this one. Change, if it comes, has to come from Europe.

Ps one of the drivers in the us is the Latino community. Unless the rule change were imposed on Latin American and European countries I just don’t see the community caving to such a litigation settlement. They’d form their own league and try and force the insurers to say they won’t insure it. If the insurers balk they’ll either walk away or more likely go underground Latino league (like during the covid bans). You’ll have Latino soccer and white people soccer. If it’s not banned in college and the pros, the Latino leagues will have an inherent competitive advantage

 

[Mosafie]

If litigation were to get to this point (that heading gets banned in the us youth game) it ends in one of two places. First, if the over 18 teams continue to be able to do it, the us winds up being woefully unprepared on the international stage, the dominance of the Uswnt ends and the men will largely go off to Europe at age 12 to train. Second if the 18-21 get banned too or even the pros, the us just gets redlined by fifa. The litigation probably also results in youth gridiron football getting banned in the us.

we aren’t in the drivers seat on this one. Change, if it comes, has to come from Europe.

Youth football is already being impacted. The cost of insurance is getting so high because of lawsuits that some school districts are dropping tackle football.

OTL: Football facing growing insurance issue

From the NFL to rec leagues, football is facing a stark new threat: An evaporating insurance market that is fundamentally altering the sport's economics, squeezing and even killing off programs faced with higher costs and a scarcity of available coverage.

www.google.com

The big difference between Europe and the US is that most European countries have caps on lawsuit payouts just as they do on medical malpractice claims to keep cost of insurance down because most of it is government funded.

 

[dad4]

I don’t see any solution to it other than an aerial ball over the last defender will automatically be called offside and to ban the goalkeeper from punting. It would lead to much more stoppages.

a 3 line rule would solve the aerial problem. You see it in indoor soccer. There are 3 parallel lines on the field, similar to build-out lines in 7v7. The rule is you can’t kick the ball so that it crosses all 3 lines in the air. Similar to icing in hockey. Doesn’t seem to cause many stoppages. The goalie just gets good at hitting a spot instead of going for pure distance.

 

[Grace T.]

Youth football is already being impacted. The cost of insurance is getting so high because of lawsuits that some school districts are dropping tackle football.

OTL: Football facing growing insurance issue

From the NFL to rec leagues, football is facing a stark new threat: An evaporating insurance market that is fundamentally altering the sport's economics, squeezing and even killing off programs faced with higher costs and a scarcity of available coverage.

www.google.com

The big difference between Europe and the US is that most European countries have caps on lawsuit payouts just as they do on medical malpractice claims to keep cost of insurance down because most of it is government funded.

The trend though in youth football is consolidation. Not just because of some schools dropping it but because the best athletes are recruited by certain public and private schools and the coaches go to see the athletes at these schools (not necessarily bothering with the lesser ones)

if the rules change outside but not inside the academies (who have deeper pockets and would want to avoid being sanctioned by fifa) you’d have a similar thing happen.

 

[Grace T.]

a 3 line rule would solve the aerial problem. You see it in indoor soccer. There are 3 parallel lines on the field, similar to build-out lines in 7v7. The rule is you can’t kick the ball so that it crosses all 3 lines in the air. Similar to icing in hockey. Doesn’t seem to cause many stoppages. The goalie just gets good at hitting a spot instead of going for pure distance.

would only solve the problem of the gk or defenders long balling it. It’s just as much of a problem if the mids put it over the top to their strikers…it’s still a foot race (and one which has made collisions more likely between the gk and striker).

some fields like the ones at Ferraro, silverlakes or Galway would be too small for the olders so they’ll be fewer full fields

Is it really that rare in hockey? I haven’t followed since the early 2000s but I recall it having quite a few stoppages per game. Things changed?

and The higher level older boy gks already train punts for accuracy and not just distance. By 13 in the smaller fields most higher level boys can knock it to the opposing keeper (who just picks it up). They are training to put it right behind the defensive line where the opposing gk can’t sweep it and their strikers can beat the defender at the best angle for a foot race.

 

[whatithink]

A few thoughts on this

• The studies are on ex players / pros, i.e. who have played the game well into their adult life at a serious and continual level.
• As these are older, they played when the balls were different, i.e. heavier etc. which would have a very different impact than current balls
• There is a link to positions, which is only natural, as some positions head much more than others
• At youth level, imv, boys are far better at heading than girls, i.e. in execution and technique - most girls are pretty clueless from what I've seen and many will avoid it.

My kids play mid, head the ball infrequently and sometimes never in a game. I have zero recollection of any of their coaches ever running a session on heading. I, on the other hand, did teach them correct heading technique in the back yard.

Dementia: Does heading a football cause the disease? - BBC News

Football should consider eliminating heading, dementia expert says | Football | The Guardian

 

[dad4]

would only solve the problem of the gk or defenders long balling it. It’s just as much of a problem if the mids put it over the top to their strikers…it’s still a foot race (and one which has made collisions more likely between the gk and striker).

some fields like the ones at Ferraro, silverlakes or Galway would be too small for the olders so they’ll be fewer full fields

Is it really that rare in hockey? I haven’t followed since the early 2000s but I recall it having quite a few stoppages per game. Things changed?

and The higher level older boy gks already train punts for accuracy and not just distance. By 13 in the smaller fields most higher level boys can knock it to the opposing keeper (who just picks it up). They are training to put it right behind the defensive line where the opposing gk can’t sweep it and their strikers can beat the defender at the best angle for a foot race.

I was talking about a change that was short of eliminating headers entirely. Heading a 20 yard chip ball is less force than heading a 70 yard clearance ball.

It doesn‘t solve everything. You still have the problem of contested headers and head to head collisions on those midfield chips.

 

[Grace T.]

At youth level, imv, boys are far better at heading than girls, i.e. in execution and technique - most girls are pretty clueless from what I've seen and many will avoid it.

Honest question..I suspected this was true but hadn’t seen enough games to come to a firm conclusion…is it true even of the higher level girls?

if so one remedy might just be to make the boys and girls games different (the girls having a lesser game) give the difference in risk profiles. It happens in lacrosse.

 

[whatithink]

Honest question..I suspected this was true but hadn’t seen enough games to come to a firm conclusion…is it true even of the higher level girls?

if so one remedy might just be to make the boys and girls games different (the girls having a lesser game) give the difference in risk profiles. It happens in lacrosse.

I'd say that the better girl players have the best technique, same as anything else.

 

[NorCalDad]

I was talking about a change that was short of eliminating headers entirely. Heading a 20 yard chip ball is less force than heading a 70 yard clearance ball.

It doesn‘t solve everything. You still have the problem of contested headers and head to head collisions on those midfield chips.

I also think this is directly related to how we are coaching in the US. Remove boot ball and focus on decision making / possession like the rest of the world, much of this goes away. Soccer in the US is pretty abysmal even at the highest levels.

 

[NorCalDad]

What I don't get is the 80s were the peak "boot ball" era. Are we not seeing CTE cases from that time? It seems CTE is showing up for American football players pretty regularly. Can't we glean anything from that? Like I said early, I played CB and headed the ball regularly. I have no idea if I had proper form, but I certainly never saw stars.