Dr. David Bernhardt sees a lot of concussions. A pediatric sports medicine specialist at UW Health's Sports Medicine clinic, he treats them and also attends conferences devoted to the injury. His three teenage sons are all soccer veterans, and this gives him some perspective on recent alarms regarding concussions and chronic brain injuries sustained by youths who head the ball.
"There's not a ton of research" to support heading as a leading cause of concussions in soccer, Bernhardt says. Head-to-head collision, head-to-goalpost contact and a player's head hitting the ground "are the three most common mechanisms that account for the majority of concussions sustained in 'the beautiful game,'" he explains.
It's difficult to find definitive data on soccer injury rates, though the most common soccer injuries are believed to be sprains, strains and contusions of the lower extremities. Some studies do suggest mild to severe loss of attentiveness and memory among adult soccer players who took up the sport in their youth, with higher rates of cognitive loss among those who headed the ball more. But even these studies caution that more research is needed.
Meanwhile, public anxieties have prompted some manufacturers to market headbands claimed to soften the blow of heading the ball and reduce the risk of sustaining chronic brain injury. "The worry that many of us have," Bernhardt says, "is that if you put one of those bands that supposedly cushions the blow of heading on an athlete, the athlete feels more invincible, so they're more likely to lead with their head."
Bernhardt does agree with the principle that players ought not head the ball if they don't have to. From what he's seen on the field, this is what kids are being coached to do. And if he has sometimes seen his sons head the ball, he views the risks as lower than those posed by concussions sustained in U.S. football.
"Any concussion is a serious head injury," Bernhardt observes. "In our circles it's more commonly called a mild traumatic brain injury, and any injury to the brain is not a good thing." Symptoms include confusion, dizziness, headache and nausea. Kids who sustain head injuries should not play again until they are symptom-free and cleared by a medical professional.
Some kids recover from a concussion. Others are affected long-term. But serious head injury resulting in death or severe brain damage is "more likely to happen in a car than any of the sports we've talked about," Bernhardt says.
He also notes that kids here play soccer with balls that are size-appropriate for their age. His own sons started playing in kindergarten. "For the little kids, I think they're doing a good job of trying to make it safer," he says.
Among the newer safety measures is a procedure called computerized neurocognitive testing, which provides a baseline parents and physicians can use to gauge an athlete's response to and recovery from head injury. Testing a participant's reaction times and verbal and visual memory is becoming a significant tool in evaluating head injuries and recovery. This is important because returning to action before full recovery from a concussion and sustaining a second one puts an athlete at heightened risk for long-term memory and sleep problems, chronic headaches and personality changes.
Offered by the UW and several local clinics, these tests are often not covered by insurance but cost only about $20, depending on the provider. Bernhardt says the UW uses a product called ImPACT, which is also used by the NFL, National Hockey League, Major League Soccer, various Olympic organizations and a growing number of high school athletic departments.
The Madison Area Youth Soccer Association has taken a number of steps to reduce the frequency and severity of head injuries among its players.
Chris Lay, MAYSA's executive director of operations, notes the organization hopes to work with Wisconsin Youth Soccer Association to make baseline cognitive testing a more routine option for parents who want to protect their kids.
MAYSA has introduced coach-education courses to address questions regarding when to start teaching young players how to head the ball. "Our answer is, invariably, you should start teaching it as early as possible, because the fact of the matter is it's part of the game," says Lay.
Heading in the youngest age groups is minimized by playing with smaller goal dimensions and dispensing with goalkeepers, whose play "typically leads to more heading in the game because they punt the ball."
Lay feels that teaching kids the right way to head a ball is critical. The sooner you introduce proper technique, he contends, the sooner you can help kids overcome their fear of the ball, learn to judge its flight and master heading skills that will remain part of the game as they progress. "Better technique is going to reduce risk," he says.
MAYSA has about 12,000 players arrayed among 37 clubs in Dane and seven surrounding counties, and recent concern regarding soccer-related head injuries has had no discernible impact on enrollment.
Ultimately, the game is a contact sport, Lay observes. Head injuries are among its risks. Safety is a responsibility shared among referees, administrators, coaches and parents, he notes, calling it "everyone's issue to collaborate on."