So does heading the ball cause concussions or not? The answer appeared to be yes in November when the United States Soccer Federation (USSF) banned heading the ball by players 10 and under while limiting headers by players aged 11-13.
Then earlier this months the USSF’s Chief Medical Officer Dr. George Chiampas stated that “heading, in and of itself doesn’t cause concussions.” The doctor quickly qualified his remarks, adding, “purposeful heading has not shown to this date scientifically to lead directly to concussions.”
With some confusion surrounding the vitally important issue of concussions in soccer, Dr. Chiampas spoke exclusively with GotSoccer in an effort to clarify and expand on his comments.
The doctor made his remarks on a December 2 media conference call to announce a new U.S.S.F. health program Recognize to Recover. Speaking by phone to GotSoccer on Thursday afternoon Dr. Chiampas went deeper.
“I think that there are circumstances where we know that a ball can strike a person’s head and there are other factors that may be around that individual circumstance,” Chiampas began. “For example the size of the ball, the condition of the ball, the environmental conditions during that game.”
“If you remove those factors, what we have seen with purposeful heading, which is when a player prepares themselves, and uses proper technique, in that environment there has not been a direct correlation to the cause of injury of a concussion.”
Chiampas continued. “Now there are circumstances, again where a ball may be too large for an individual’s head, or their development, or the ball is water soaked, or the quality of the ball may be questioned, that is outside of that description that I described earlier.”
“But,” the doctor underlined, “current science is showing that purposeful heading – in the description that I described to you – has not led to a substantial amount of concussions.”
Emphasizing the point that his original statement was not absolute, Chiampas said, “now there are also individual characteristics that we don’t know with individuals and we’re still learning with regard to concussion injuries. Why do some individuals have the same force of injury but there are two completely different outcomes? Those are things that science is going to provide us (answers to) in the future, but we still don’t know.”
With those variables in mind, GotSoccer asked the doctor why he and the U.S.S.F. Medical Advisory Committee elected to ban heading the ball for players 10 years old and younger and to limit headers for players 11-13?
“We know that that is not necessarily the problem, heading the ball,” Chiampas said. “What we do know is that when two individuals attempt to head the ball – what we are starting to describe is something called an aerial challenge, over 50% of concussions occur when individuals are attempting to head the ball, where technique may be off, where someone brings up their elbow, where heads collide, when an individual falls and hits the ground.”
“And so,” the doctor continued, “the thought is, especially in this age, during a developmental phase, 10 to 14-year-olds and then under 10, is there a way that we can decrease the incidence of concussions?”
Chiampas calls the process “two-fold.” “One can we decrease the incidence of (concussions)? and if we decrease the incidences, that’s also the time period where individuals, especially at younger ages, take a much longer time to heal and recover.” Chiampas calls the recovery period issue, “critical,” and believes that it is something “that may not be discussed enough.”
Chiampas says that for, “a 10-year-old or an 11-year-old, while the incidence of concussion may be small in some people’s eyes, the duration of recovery may be a whole lot, maybe two or three or four times longer than let’s say a 16, or 17, or 20-year-old, and if we can provide that safety then I think that is a positive outcome for that kid to continue to play the sport and not be deterred from being active in life.”
Research and process are two areas that people had concerns about and GotSoccer asked Dr. Chiampas to discuss how and why the USSF came to decide on its concussion rules, in particular, the heading ban.
“I think it’s critical to point out, especially to parents, and I think once they hear this they’ll be like like wow – that’s actually a true statement, it’s extremely difficult to be able to obtain research in the youth in the United States.”
“From a legal perspective,” Dr. Chiampas explained, “it’s very difficult to get institutional review boards to allow you to study 10,11,12,13 year- olds.”
“So,” Chiampas noted, “there are not many studies out there in all capacities in those ages. Looking at soccer as well, there’re very few studies in those ages in soccer.”
How then did Dr. Chiampas and the USSF Medical Advisory Committee make its recommendations?
“The process that we did go through, we brought in about 15, 16 months ago, a medical advisory committee specifically in the area of concussions. We have national leaders in the United States that are part of other professional entities, other national governing bodies, that are part of our Sports Medicine Committee, and looked at the current medical science, looked at our game, (and asked) is there an area where we could potentially impact in a positive way, with this injury while maintaining the integrity of the game?”
“Realizing that there are some limitations in research,” Dr. Chiampas acknowledged, “and realizing that research is still forthcoming, and having the adaptability to change if that research directs us that way.”
‘Knowing where the injuries are occurring is one of the things that we do know,” Chiampas emphasized. “We do know that injuries occur, the vast majority occur in the circumstances we describe, which is aerial challenges.”
“If we can decrease that incidence (of aerial challenges) can we positively impact players lives and the game?” Chiampas posited. The doctor also relayed that the Committee looked at, “the development phase of the kids, where between 11 and 14 years old we know that they are developing speed and strength, motor skills. Where that skill set becomes critically important is technique (heading technique).”
“Can we introduce this technique in somewhat of a controlled environment, in training?” the doctor asked. Speaking to the limitations placed on the 11-13 age group Dr. Chiampas said, “we set a certain amount of parameters with regards to time allotted and quantity (of headers) at the same time providing a safety measure.”
“That,” the doctor summed up, “was essentially the process. Taking the research, using common sense, using medical expert opinion and applying that in the rules, yet still having the flexibility as research becomes more forthcoming to adapt.”
And while the GotSoccer comments page has been filled to overflowing with opinions ranging from enthusiastic support to angry denunciations of the heading ban, to doubts on Dr. Chiampas’ statement saying that purposeful heading doesn’t cause concussions, the doctor has found reaction has been positive.
“I think the overwhelming response has been a good one,” Dr. Chiampas told GotSoccer. “There hasn’t been a precedent set with this,” Chiampas notes, “and obviously U.S. Soccer taking this step is first and foremost a bold step.”
“It is taking the players’ health and safety as its top priority, realizing that there are going to be some critics out there, but at the end of the day highlighting safety in our sport as science becomes more forthcoming is critical.”
“We have to utilize all the tools that U.S. Soccer has,” the doctor told GotSoccer, “all of its assets, to utilize our national team games. There are opportunities from a marketing perspective to ensure that our message emanates across all age levels down to the youth levels.”
Dr. Chiampas told Gotsoccer, “that even in the last week or 10 days since the information has come out the impact has been extremely significant and extremely positive.”
Chiampas added that “it the (new concussion program) requires us to be available to our member organizations, to be able to work with them, understand their hurdles and challenges but,” the doctor concluded reasonably, “it is absolutely going to be a process.”