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Soccer Safety

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Heading Safely
Solid "heading" skills in soccer are crucial for both defensive and offensive game strategies. Players that possess good positioning and timing skills combined with an effective heading technique are invaluable to soccer coaches. The importance of heading skills to the game of soccer is a universally agreed upon fact. Heading is good for the game. Does "good for the game," however, also automatically translate to "good for game participants?" The answer to this question is not as clear. Here are some facts:

Based on available research on long- term effects of repetitive cumulative head injuries, Pediatrician Bernard Griesemer, M.D. (member of The American Academy of Pediatrics Sports Medicine Committee), stated that "Less is better..." when addressing the practice of heading skills in youth soccer leagues. It is important to note that Pediatricians caution that heading drills, that create numerous opportunities for head/ball contact, might be more conducive to a child's head injury than occasional contacts during a soccer game.

Research probing progressive neurological impairment in adult as well as teenage boxers prompted the American medical Association to call for the elimination of both professional and amateur boxing. Despite the obvious differences between the frequency of head trauma in all forms of boxing as compared to soccer, trauma resulting from heading in soccer may turn to become a major health issue. The reason for that may lie in the shear numbers. Every youngster that boxes in the United States has roughly 265 counterparts that play soccer.

The renewed and growing concern among Pediatricians and Physical Educators stems from the findings of two separate yet related research projects conducted in Norway and the United States. Both studies focus on head injuries in soccer players that started playing and practicing heading as young children. The results of these studies indicate that the severity of attentional, concentrational, judgmental and memory based deficits is positively related to reported amounts of heading during practice and games. More information regarding head injury in soccer is available on the "Physician Chat" Web Site.

A final note: A society that allows its children to play football may not be inclined to get too alarmed by yet unclear cummulative head injuries resulting from heading in soccer. Football, at least utilizes protective gear. It may be wise to consider some head protection gear for soccer too. Of the currently available head protection products the Soccer Head Band ( this URL is no longer active) and the are designed to allow skillful heading performance while providing a significant reduction in the risk of cummulative head trauma. Better yet, since the greatest concern seems to stem from heading practice, why not practice with very soft balls (e.g., volley or nerf balls). A softer, gentler ball for the game would also be a positive move toward head safety.

More about Head Injury and Safe Heading in
Competitive Youth Soccer Leagues

The American Academy of Pediatrics Policy Statement (1988) defined soccer as a "contact/collision" sport, and thus added it to the already contact classified sports of football and hockey. This "upgrade" was no surprise to those familiar with hospital emergency room statistics that reveal soccer's high concussion rate per 1000 athlete exposures–a rate that equals football statistics (Tysvaer, Storli, & Bachen, 1989). A number of published studies in professional journals, such as, "American Journal of Sports Medicine," "A Pediatric Perspective," "British Journal of Sports Medicine," "Journal of the American Medical Association," "Medicine and Science in Sports and Exercise," "Neurology," "Neuroradiology," and "Sports Medicine," highlight the risks of head trauma in competitive soccer and point out the need to "develop and adopt methods of surveillance and prevention" to maximize player safety (Matser, J. T., et. al., 1998).

Causes of head injuries in soccer include collisions with goal posts, head butting between two or more players, blows to the head (resulting from illegal high kicking and/or low heading, elbows, knees, and other body parts), and last but not least, the game strategy of heading the ball. Tysvaer (1992) reported that head injuries account for 4 to up to 22 percent of all soccer related injuries. Extrapolating from available statistics on fatal soccer head injuries in the United States, one yearly death caused by trauma to the head in soccer may occur (Demarco & Reeves, 1994). Traumatic head injuries that result in severe damage or death cannot be dismissed because it presents an undeniable bad outcome. Since fatal accidents in soccer are relatively rare (statistics are available regarding highschool, college, and professional levels of competition), the relevant question to the youth soccer parent/coach is "whether the act of heading during league practice and games presents a considerable risk for brain injury?" The available data on soccer related head injuries was mostly derived from studies on highly competitive and very skilled amateur and professional adult soccer players (e.g., Jordan, et. al., 1996; Master, J. T., et. al., 1998; Muellar & Cantu, 1990). Studies and reports that address the relationship between heading and brain trauma in youth sports have so far received little attention (Briscoe, 1985). To the skeptic, the answer to the question regarding the inherent risk in youth sport heading may not be as clear-cut and straight forward as it is to concerned athletic trainers, coaches, educators, neurologists, orthopaedic surgeons, pediatricians, and parents.

Highly skilled players play longer during single games, play more games in any given season, and use their heading skills more often than less skilled players. As the level of competition increases so does the size, weight, pressure, and velocity of the game ball. Advanced soccer players are often faced with a hard, fast moving ball when heading. It would be reasonable to assume that when compared to the pros, youth play fewer and shorter games, are faced with a lighter, softer, slower moving ball, and head less frequently during practice and games. Developmentally, however, children are quite different from their adult counterparts. From birth to the age of 10 a child's body weight represent 5 percent and 50 percent, respectively, of an young adult's weight (Gabbard, 1992). The same child's brain, however, reaches 90 percent of its adult size by the age of three (Trevarthen, 1983), and reaches its full adult size at the age of six (Kessen, Haith, & Salapatek, 1970). A child's head is thus disproportionately heavy and large when contrasted with a child's total body weight. Does the above description mean "less risk" or should it be interpreted as "same risk" to brain injury resulting from heading in youth soccer leagues? Since the risk of brain damage resulting from heading at the professional level is well documented (Jordan, et. al.; 1996; Master, J. T., et. al.), the recent and on-going trends in youth soccer need to be examined.

As youth leagues are becoming more competitive, coaches tend to increase the number of weekly practices. Practice pre-season games are common place, as are post-season all-star games and various additional tournaments. Many little league participants also play soccer at school, and attend special soccer camp sessions throughout the school year and over the summer break. A logical conclusion based on the above presented scenario is that the more serious a child is about her/his soccer participation the more he/she is at risk of cumulative damage to the brain from heading and other soccer related trauma to the head. Instituting a requirement for some form of protective head gear or for the wearing of a mouth guard for competitive youth soccer should therefore be considered as a logical and sensible action. Our children's well-being is at stake here. Let us not wait for the perfectly conclusive data or for costly head injury litigation before we take preventive action. The old cliche "better safe than sorry" is a very appropriate one for addressing this issue. A possible positive side effect of head and/or mouth protection gear would be the curbing of the current trend of increase in sports injury litigation (Davis & McKelvey, 1998).

Should future data establish beyond reasonable doubt that heading in youth soccer is safe, still protection from head contact with goal posts, contact with ground, and contact with other players' heads, elbows, knees, enough reason to require head protection gear and/or the wearing of a mouth guard while playing this otherwise great game.

  • American Academy of Pediatrics Policy Statement. (1988). Recommendations for participation in competitive sports. Physician and Sports Medicine, 16, 65-167.
  • Briscoe, J. H. D. (1985). Sports injuries in adolescent boarding school boys. British Journal of Sports Medicine, 19(2), 67-70.
  • Davis, P. M., & McKelvey, M. K. (1998). Medicolegal aspects of athletic head injury. Clinics in Sports Medicine, 17(1), 71-82.
  • Demarco, J., and Reeves, C. (1994). Injuries associated with soccer goalposts, United States, 1979-1993. Journal of American Medical Association, 271, 1233.
  • Gabbard, C. (1992). Lifelong motor development. Dubuque, IA: Wm. C. Brown.
  • Kessen, W., Haith, M. M., & Salapatek, P. H. (1970). Human infancy. A bibliography and guide. In P. H. Mussen (Ed.), Carmichael's manual of child psychology (Vol. 1, 3rd ed.). New York, NY: Wiley.
  • Matser, J. T., Kessels, A. G. H., Jordan, B. D., Lezak, M. D., and Troost, J. (1998). Chronic traumatic brain injury in professional soccer players. Neurology, 51, 791-796.
  • Muellar, F. O., and Cantu, R. C. (1990). Catastrophic injuries and fatalities in high school and college sports, 1982-1988. Medicine and Science in Sports and Exercise, 737-741.
  • Sortland, O., and Tysvaer, A. T. (1989). Brain damage in former association football players: An evaluation by cerebral computer tomography. Neuroradiology, 31, 44-48.
  • Trevarthen, C. (1983). Development of the cerebral mechanisms for language. In V. Kirk (Ed.), Neuropsychology of language, reading and spelling. New York, NY: Academic Press.
  • Tysvaer, A. T. (1992, Sept.). Head and neck injuries in soccer: Impact of minor trauma. Sports Medicine, 14(3), 200-213.
  • Tysvaer, A. T., and Lochen, E. A. (1991). Soccer injuries to the brain: A neuropsychological study of former soccer players. American Journal of Sports Medicine, 19, 56-60.
  • Tysvaer, A. T., and Storli, O. (1982). Association football injuries to the brain: A preliminary report. British Journal of Sports Medicine, 15, 163-166.

  • We organize the league, administer practice, supervise the games, etc...because the kids are too young to do it on their own. They need our guidance, help, and protection.

    So PLEASE let's protect the kids!
Copyright© 1996-2009, Daniel Frankl, Ph.D.

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Last Modified: January 4, 2009