Top U.S. Dr Says ‘Heading’ Doesn’t Cause Concussion
Top U.S. Dr Says ‘Heading’ Doesn’t Cause Concussion avatar

On a media conference call to discuss U.S. Soccer’s Framework for Player Safety campaign this afternoon U.S. Soccer Chief Medical Officer Dr. George Chiampas will have surely raised some eyebrows with his declaration that, “heading, in and of itself doesn’t cause concussions.”

Dr. George Chiampas

Dr. George Chiampas

In clarifying his statement, Chiampas said, “purposeful heading has not shown to this date scientifically to lead directly to concussions.” “We’re following the research,” Chiampas said, adding, “that as the research comes out we have the adaptability within U.S. Soccer to adjust as needed.”

Banning players 10 and under from heading the ball and limiting heading among players 11-13 was by far the most controversial part of the U.S. Soccer safety program when it was announced last month.

“The changes that we made,” Chiampas said, “are based on expert opinion at this point, realizing that science is still evolving.” “We know that the vast majority of concussions occur when there is contact between players trying to head the ball,” said Chiampas. “Whether that is head-to-head contact, elbow-to-head or their head hitting the ground while challenging for the ball in the air; by reducing the number of those aerial challenges to head the ball, we believe we will decrease the incident of concussions.”

The question of headgear was raised and Chiampas was clear in stating, “currently across all sports, football, hockey, headgear has not shown to prevent a concussion,” although the doctor conceded that headgear may prevent other head injuries.

Heading a ball alone cannot cause concussion.

Heading a ball alone cannot cause concussion.

The program announced today by the United States Soccer Federation, Recognize and Recover, is touted by the USSF as “a comprehensive player health and safety program. The federation says Recognize and Recover, a” first-of-its-kind program aims to reduce injuries in soccer players of all ages and promote safe play by those on and around the field.”

Educating coaches, players, parents and referees to prevent and better manage injuries is the primary goal of the program and according to Chiampas, “Recognize to Recover will lead to better awareness and understanding of player health and safety initiatives and strengthen the role parents, players, coaches and officials play in preventing, protecting and addressing injuries.”

More information on U.S. Soccer’s concussion guidelines and the Recognize to Recover program is available on USSoccer.com.

About Peter Nolan

Peter Nolan is a staff writer for the GotSoccer Magazine, covering MLS and other US leagues, He's GotSoccer's chief National Team Correspondent.
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33 Responses to Top U.S. Dr Says ‘Heading’ Doesn’t Cause Concussion
Top U.S. Dr Says ‘Heading’ Doesn’t Cause Concussion avatar

  1. nancy says:

    Hello,

    As a parent of a 20-year old who sustained multiple concussions in high school soccer, I am utterly dismayed by this proclamation that heading does not lead to concussions.

    Our son ended his soccer career after sustaining a concussion (not his first), after a direct head of a ball in practice.

    Enough ‘speak’ about research and please start listening to patients and parents. Young players are far better served learning to control the ball vs. heading the ball especially in their early stage of development not only on the pitch, but in the classroom.

    We have come so far in acknowledging the risks of concussions and gaining insights to post-concussion care. Please do not casually make such statements that are simply false.

    The world of youth soccer will be far better served with properly informed players, families and coaches alike.

    • Peter Nolan says:

      Are you happy with the ban on heading for 10 and under and the restrictions 11-13? The doctor did say that many concussions come from contact surrounding heading the ball, collisions, elbows, falls, etc.
      Peter Nolan

    • Maria says:

      Hi Nancy, our daughter also ended a very promising soccer career after a concussion (also not her first) caused by heading a ball (from a corner kick). I don’t know what rock this “top doctor” has been hiding under. I agree with your suggestions of listening to patients and parents – and above all making it easier for the players to speak up and not feel pressured to continue. We need to work on changing attitudes around elite sports – rather than admiring a player for toughing it out, we need to support them in sitting out when in doubt and make it socially unacceptable to take those risks. Brain health first, sports second. Best wishes to you and your son.

    • Jack Jensen says:

      As the father of a boy who has had concussions (though not related to heading), I empathize with the parents who have had kids affected. But questioning the doctor’s credentials or thinking that he’s clueless or hiding under a rock aren’t valid conclusions.
      He’s basing his statements on the legitimate research, published in JAMA. There will always be some anecdotal evidence that goes against the research, but policy must be based on the best scientific evidence.
      Unfortunately, I couldn’t find the entire study, which probably shows that some concussions resulted from heading the ball. In which case the doctor should have qualified his statement that it isn’t the predominant cause. But the conclusion was that the primary cause was head to other body part/ground contact.
      Of course, this often happens during heading, hence the decision to preclude the very young from heading. If there is no risk at all, they wouldn’t have done that. But to limit it more for older youth and adults would mean changing the game.
      http://www.ncbi.nlm.nih.gov/pubmed/26168306

    • Soccer Coach says:

      With all due respect the doctor is neither cavalier nor is he incorrect. His statement is that proper heading of the ball in and of itself does not cause concussions and all scientific data backs that up. The overwhelming majority of concussions in soccer are actually caused by hard body to body contact, head to body contact, or head to head contact. With a very, very, very tiny not even full percent being caused by improper technique of heading the ball. I do not wish a concussion or an injury on any player ever, however to question the science or the doctor’s credentials is frankly just incorrect and uninformed. Yes a large percentage of the collisions that cause concussions come within the act of heading the ball however the heading of the ball itself with proper form is NOT the thing that causes the concussion. I also coach and have sons in high level hockey, note that hockey has a lot of concussions despite wearing a protective helmet and having little direct head contact, again its the sudden jarring stoppage or change of direction of the head and/’or body that causes the brain to basically bounce of the skull that causes the concussion, not direct, expected head contact. Please understand what is being said and what the science says before trying to discredit the doctor and his factual statements.

    • Linda says:

      I have three sons who all played soccer since they were 4 years old. 2 stopped playing when they were about 16 to pursue crew and rugby. They have played all sports while they were growing up. My youngest, who is 17 now, still plays all year round on his high school team and on a travel team as well as ice hockey. He plays center and right back and heads the ball a few times at every game. None of my boys have ever had a concussion. As stated by the doctor and the trainers that are at all of my son’s games, the majority of their injuries, (bloody noses, black eyes, sprains) all came from body to body contact, banging heads and bodies, not from hitting the ball with their head. There have been kids on our teams that have had concussions and most of them who’ve had multiple concussions never recovered from the first one before playing therefore instigating another.

  2. Shawn says:

    We have known for a long time that concussions are caused by the brain bumping the inside of the skull. That does not happen from a direct header. Yes, if the head rocks back or is jerked in one direction quickly, the brain moves inside the head and can bruise the side. This decision without explanation will incite more parents with their misinformation on heading. I agree that young players should avoid it until they are stronger and better able to head correctly, I have never asked my U11 players to head. To many think heading is allowing the ball to hit their head instead of them hitting the ball.

    • John says:

      I totally agree with you Shawn. The specifics are never mentioned. If you jump, arch your back, thrust your upper body forward and push forward with your neck, your head meets the ball there with so much speed and force behind that the skull and brain move in unison, and the ball is struck with the force being directed into the ball. The brain doesn’t move inside the skull, so there is no bouncing of the brain into the skull wall. The problem is no one is teaching kids proper heading technique. My 10-yr old practices heading with a super soft material covered volleyball. I have him do this so he knows the proper technique. And he also has seen first hand how much more power he has in his headers and they don’t even hurt him. Mind you this is just for technique and timing. I don’t want him or expect him to do this on the pitch with a real soccer ball. At least not yet. But I’ve told him and he now knows. I remember I learned this the hard way in High School. But when I’d jump and whip out a good header, I hardly felt it.. Letting the ball hit my head always hurt like crazy. YOU hit the ball…don’t let the ball hit you. I think kids need to learn the proper technique early…even if they aren’t allowed to do it in a game. So that way they’ll be prepared when they are able to. I do agree, I think all the danger is in trying to get that ball with head/head, head/elbow collisions.

  3. Tim says:

    Though not popular, I believe Dr. Chiampas is correct. Concussions occur from not being prepared for heading the ball intentionally or from another subsequent occurring action (head to head, elbow to head during the aerial challenge or ground to head contact after the challenge). This isn’t only a soccer problem. My daughter was concussed during a high school basketball practice from being hit in the head with an errant pass. The problem stemmed from an awareness issue (not “seeing the ball coming”) and her body was not prepared for the impact. This same daughter has played soccer since she was 4 years old and continues to play in college. She had a second concussion last year, but it stemmed from contact with another player during an aerial challenge (head to head from behind).

    Teaching proper technique is important as incorrect execution of heading technique can cause injury. Limiting the practice of heading may reduce the number of these type of injuries but that will remain to be seen.

    Regardless, as heading is part of the beautiful game, correct technique must be taught. You can’t legislate all injuries out of a sport.

  4. Pasco says:

    I am not a doctor, but I am a parent with three children in youth soccer and I love the beautiful game. I don’t know what causes a concussion but when I think about it as a lay person it certainly seems like heading would cause the brain to move back and forth and impact the skull. From a lay perspective (again not a doctor) some heading seems innocuous like a glancing header from a throw-in. Other heading looks much more devastating, like a midfield header off of a goalie kick back in the direction the kick came from. Again from a lay perspective, I tend to concur with the doctor and do not believe that any amount of headgear short of something really stupid looking will prevent concussions.

    To me it seems like a fairly simple equation. IF HEADING CAUSES CONCUSSIONS, it should be banned from the sport from the youth level all the way up to the professional level. To suggest anything else is to ignore the problem and end up where pro football is now.

  5. Justin Poarch says:

    Heading DOES cause concussions. The older the girls get, the harder the ball is kicked. My daughters JUCO team had 5 concussions this season, all from heading the soccer ball, not getting a head butt from another player. This doctor obviously has not looked at statistics. Both of my daughters have had concussions, either from heading or the ball hitting them from a kick. I agree headers at a young age do not cause concussions, because the ball does not have the velocity on it, until they get older.

    • Soccer Coach says:

      You just made the doctors point. If your daughter was hit in the head she was not ready for it hence that is not a header. A header with proper technique does not cause concussions and the science verifies that over and over and over. You are ignoring stats and science and are ignoring the facts of your daughters injuries. I suspect on the other headers she was being challenged by a defender that likely knocked off a bit of balance or something which caused the ball to hit her rather than her heading the ball. You also show improper understand in the “head butt” comment as the body collisions are much more often to blame than direct head to head contact though those can do it as they are equally unexpected. Understand the science and you will understand that the doctor is correct

  6. David Silverglade says:

    I believe that in our society we, as responsible adults / parents, need to guide our children away from doing all things that may permanently injure them, especially as regards their development. It is a scientific fact that child brains continue to develop until they are beyond 21 years old. It is also an established scientific fact that adolescents lack rational judgment skills that adults have, and they choose to take more errant chances (like, “I’m sure I can get to that header and if we slam heads I’ll be fine.”). Thus, we don’t allow children to drink ANY alcohol until they are 21 years old. They also should NOT drink caffeine. They don’t vote until they are 18, because that is when we consider them to be ADULTS – able to make their own decisions. In this vein, their should be ZERO heading in USA soccer, until kids are old enough to decide for themselves if they are ready to learn a skill they may be life altering. [Like boxing; it IS a sweet science, but not for kids.] And yes, my brilliant goalie’s life was altered in 8th grade by a concussion.

  7. Francisco Bravo Jr MD says:

    I agree with Dr Chiampas, heading the ball will not cause a concussion,letting the ball hit you on the head will. I played soccer all my life and was able to attend medical school. I agree younger players should not be encouraged to head the ball as their neck muscles are still developing and not strong enough. Education and proper technique are of utmost importance especially when kids head a goal kick for no reason, or challenging with their head in middle of field for no good reason. Hard to teach young players to control the ball or trap it instead of heading it in middle of field when professional players do it everyday. Training and teaching the technique and the appropriate time should begin with adolescent players

  8. Vicki G says:

    Thank you, Mr. Nolan, for reporting this story. I would like more information. First, please ask Dr. Chiampas to cite his “research” and his credentials in the area of Traumatic Brain Injury (especially if he is a “top U.S. Dr.” as you claim). Second, I would like to know how parents and players can contribute to this “research” that U.S. Soccer is following. I agree with the thoughtful comments of Nancy and Tim (above), and agree with the ban on heading for 10 and under and would like to see additional restrictions for all youth through the high school years (U18). I invite all parents of any soccer player who has suffered a Traumatic Brain Injury from “purposeful heading” (not contact between players, or the ground, or the goal post, but just ball-to-head contact) to post the date of the incident, the age of the player, the sex of the player, and the consequences (missed school, changes in personality, physical symptoms, etc.), here, so that those of us that have experienced Traumatic Brain Injury first hand may be able to contribute to the research that U.S. Soccer is evaluating.

  9. NJ Soccer Dad says:

    I’ve seen two players on my daughter’s club team sustain concussions directly from heading the ball. One (at U14) headed a goalie punt and spent the next minute wandering around the field clearly dazed. The other (at U16) headed a punt and “toughed it out” / did not complain about the likely concussion she suffered. The following day, she headed another goalie punt and suffered a severe concussion / did not know where she was and couldn’t answer simple questions. It was the last game she ever played. This was on a college showcase team and both players were well trained and skilled.

    • Soccer Coach says:

      I can tell you without even having seen it that it was the result of improper technique and perhaps lack of neck muscle strength. It does not make the good doctor incorrect in his statements.

  10. Jason says:

    The Dr. Is correct for the majority of concussions will come from head to head, head to ground or unaware hit. I’m sure there a few that happen from heading but that’s due to incorrect teaching or unlucky glance of the ball mis hit. If it where otherwise every country would ban heading in their national sport, but they don’t because that’s a US trait. If the kid ha already had a concussion prior from some other trauma then it wasn’t heading Which caused it but rather aggravated it. Anyone who has sustained a concussion should be evaluated and might not be able to he’d again. But if tought correctly heading will not be the cause. If a team had 5-7 in the other response then they are not taught correctly and are more reckless. I have 37
    Years playing and 24 years coaching 1000s of kids to adults and can remember only 2 concussions, 1 from a head to knee as he fell and another head to head, never from heading. We should not weaken a sport fit the US for this, what are the other countries saying? We should however teach how to land and brace ourselves better as we play to help prevent such a trauma.

  11. Vance Wilson says:

    I’m a physician. I completely disagree with allowing adolescents to risk permanent, life changing preventable head injuries. It’s a fact you can get a concussion from heading a ball – it is simple physics.

  12. SDM says:

    Although not a big fan of the toughest players head the ball….this has been the initiation, so to speak. Let’s be smart about the whole movement of heading the ball….where is the focus on increasing neck muscle strength if it is not going to be banned. Within the amount of time it takes to debate this topic, let’s get some trainers to jump on board with soccer at an early age 13-14+ about the importance of neck muscle development. Also, I am in favor of fouls for too many heads knocking at once, if the ref is on the ball. Half the time the refs are not competent or one can be missing in these youth games. Been to many and my daughter has suffered concussion and stiffened c-spine area; which ultimately resolved. Irregardless about how the concussion specifically occurs, they OCCUR! Let’s now in the interim of this debate, focus on increase of muscle strength in the neck and traps. Working in military with a top notch trainer it is clear to me how this can prevent an injury.

  13. Kris R. says:

    The headline is misleading and possibly harmful. The doctor is talking about intentional, purposeful heading, not any time a player meets the ball with their head. Gotsoccer needs to rewrite the headline.

  14. Nick L says:

    Before you start attacking the credentials of Dr. Chiampas, you may want to actually view the peer-reviewed data on concussions in High School soccer. JAMA Pediatrics. Whose authors determined contact with other players, during non-heading activity, was the most frequent cause of concussions. The lead author even writes “banning heading is unlikely to eliminate athlete-athlete contact or the resultant injuries.” Or you can read the data from The National Academy of Sciences which shows (for high school boys) Football, Lacrosse, Wrestling, and Basketball all have higher rates of concussions and none of those sports even have heading. So are those development leagues telling their players to stop any contact for concussion safety? Good luck enforcing that rule.
    This new policy by US Soccer is a great dis-service to the sport in this country. No other country in the world restricts they player development to this extent. Rather than letting kids learn and develop these skills early, this policy wants to wait until they are bigger, stronger, and faster. Having kids start trying to head a ball when they are more likely to cause serious injury with an error, how is that an improvement? To the people above who relate the stories of kids and young adults who had to quit the sport, everyone states multiple concussions. What’s needed is education. You have ONE concussion, stop playing sports until your brain fully heals. How many of those cases above did the player keep going, or return next week? They, their parents, or their coaches made the choice to IGNORE what a concussion really is…an injury to the brain. People need to let it heal before risking injury again.
    To me this policy is mistaken band-aid for people who don’t take responsibility for their own actions. “I won’t stop my child from playing with a concussion, so someone else better do it for my child’s safety.” Sorry, bad news for you. The studies show your child is more likely to get a concussion from that other kid running him over than heading a ball. So what’s next, restricting all contact? US Soccer made a mistake when they agreed to remove one of only two methods its developing players have for advancing/controlling the ball. For the people who applaud this effort, you can go play Bubble Soccer and feel safe with your sport. Stop messing with a global sport for those of us responsible enough to care for our kids health AND development.

  15. Eugene Dickens says:

    I am a general surgeon trained in trauma. I have to also take exception with the clear bias this article puts forward. Obviously, this is a push back to the recent ban on headers in youth division soccer. The facts are a little short, however. It sounds like he has claimed that wearing headgear in soccer and hockey has not shown to prevent concussion. Seriously? Would be tough to prove how many concussions they have prevented. The fact that concussions still occur in these contact sports despite appropriate headgear does expose a vulnerability in the protective gear available. But to say that headgear hasn’t shown beneficial in these contact sports and then suggest it will never help in soccer is simply ridiculous. I love watching soccer and would hate to see headers go. However, my daughter has not been allowed to take headers from goalie punt for years now. It is simply not worth it. Taking a corner kick and driving it in the back of the goal… different story. There is certainly still a risk of a TBI, but the velocity is certainly less. With proper technique, I believe the risk is reasonable. You cannot take injury out of sports, especially youth sports. Minimizing the risk will continue to be important as we continue to understand the pathophysiology of head injury. I do believe it is worth mentioning that studies exist that show wearing headgear reduces the risk of head injury when contacting non-ball objects (heads, elbows, goal posts, ground). It is true there is no demonstrated advantage as it relates to head-ball striking, but as the article points out, many head injuries come from attempted headers that result in inadvertently striking other harder objects.

    Best to all those who have suffered from TBI either personally or through a family member.

    • Peter Nolan says:

      The article has no bias, it is merely reporting what was said. The remarks regarding headgear are direct quotes.

    • Soccer Coach says:

      Head injuries and skull fractures are not concussions good sir. As a physician I would have expected you to understand the difference. And the science is vast in regards to helmets in the sport f hockey and it is determined they do little to prevent concussions but they do ALOT to prevent skull fractures.

  16. Fred says:

    Wether heading does or does not, educating officials, coaches & especially parents / players needs to continue, my daughter playing u-13 in the last game of the season struck a ball with her foot, the ball then struck an unsuspecting opposing player in the head, had play continued our team was 2-1 with keeper in the box, however ref stopped play to check player’s condition. When the ref called the player’s coach on the field to check on player and have her taken off the field the player’s parents protested, she should not be removed from field “that is a high school rule”, kudos to the ref she was removed from the field, but seriously mom & dad what is important your 13 year old daughter or 70 minutes of 1 game, the player did return and subsequently injured her foot, keep it classy Cincinnati West Soccer parents keep it classy.
    Kings Hammer Thunder

  17. MICHAEL DIKER says:

    The statement, “purposeful heading has not shown to this date scientifically to lead directly to concussions” is misguided. I have coached for over 20 years and watched perfectly executive heading put a kid on the ground or have them see stars. Clearly the risk is dramatically increased with distance, height and speed of the ball. If the doctor is looking for a scientific explanation, please consult Newton’s 2nd law of physics (F=ma), it is pretty renowned as being good science. As for the ban, it is spot on. As a Club president I banned heading for our U9 and under players back in 2000. There is no tactical advantage to the game having children hit a ball with their head since very rarely at that age is there any intent of direction or accuracy. Also when teaching heading to young children 11 and older, please use a light weight training ball or indoor tennis ball style soccer ball. The ‘skill’ of heading is learning how to track a ball in flight and make good contact using proper technique. This skill can be learned with balls that have less mass than a regulation soccer ball. This still will not eliminate the risk but a coach can greatly decrease the risk of concussion with a ball with less mass and by controlling the speed of the ball.

  18. Brian Dozark says:

    I agree with the Dr. Chiampas. Have had my 2 older kids play soccer through college (son & daughter) and they have headed plenty of balls with proper technique w/no concussions nor concussion like symptoms. My daughter did break her arm in a college match after being hit directly by a ball off a corner kick. Perhaps we should ban corner kicks as not allowing corner kicks in this case would’ve prevented my daughters arm from being broken. Are we really banning heading over possible concussions or are leagues, clubs, youth associations really afraid of lawsuits? Are we trying to save ourselves from ourselves? Have coached for well over 20 years; youth, club, high school, semi-professional and have seen numerous injuries. The few concussions all came from being hit with an elbow, head hitting the ground, goal post, etc,. While I certainly wish none of them ever occurred, unfortunately all types of injuries occur in sport. We are attempting to prevent every injury from ever occurring and it’s simply not going to happen. While head gear can prevent other head injuries, just like a football helmet it will not prevent a concussion since the brain simply floats in the head. When the head is jolted and it hits the skull, no helmet or head gear is going to prevent it.
    Am all for education and teaching proper technique however like many sports, soccer is a contact sport thus concussions as well as numerous other injuries will occur.

  19. John says:

    There is inherent risk in all sports and physical activities. Bicycle riding is one of the most dangerous activities known. People need to make choices in life and should not expect to be protected from danger/injury/risk. If you feel that the risk is not worth the reward, then don’t participate; find another pastime or physical endeavor that is less risky (swimming, tennis, golf etc.) and leave the rest of us alone. One cannot legislate risk without altering the historical beauty and essence of a sport to the point that it becomes unrecognizable and loses its appeal. Be a grown up and deal with life. Some of theses folks don’t want to have to make the tough decisions that life requires so they want to crap on everyone else’s parade. Leave the game alone and decide for yourself and your child if it’s worth it under the current and traditional elements. Some these people will next try to alter rules so that their children’s feelings don’t get hurt after their team loses or they have an individual bad performance. The single most effective way to lessen the amount and severity of injuries in soccer is to improve the performance of referees so that they control the game and reduce some the unnecessary physicality of the sport. There should be zero tolerance for out of control players who continuously engage in dangerous play and obviously show a propensity for fouling. If referees consistently carded such players early in the game and set the tone, it would curtail such activities, make their jobs easier for the rest of the match and eventually send the message to not only the players but also to the sizable minority of coaches that teach such tactics. If the USSF made this an emphasis, it would do a lot more for player safety than this fixation with headers without altering the essence of the game.

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