Head games: Is a ban on heading the ball in youth soccer in our future?
Credit to Author: J.J. Adams| Date: Fri, 01 Nov 2019 16:02:20 +0000
Nicole Setterlund was 12 when she suffered her first concussion.
She was so off balance, so loopy, in her first game back on the soccer pitch that the simple act of taking a step backwards led to a rolled ankle and broken leg.
After her fourth concussion, she spent the night vomiting and miserable, the first of a weeks-long span feeling “out of sorts.” Despite that, she was back on the field two days after her injury, playing “the worst game of her life,” where her limbs, her touch, her brain all felt out of sync, like a marionette doing a jig.
The concussion count was up to four, and she hadn’t even graduated high school.
While playing for the Washington State Cougars, a clash of heads knocked her cold, the massive knot that bloomed from her temple just the first of many symptoms to follow.
It was her eighth concussion, and was the death of her soccer dreams.
“The worst I had was my last,” says the now 26-year-old. “After that one, I couldn’t be in light, I couldn’t look at a computer. At one point, I drove to campus … and ended up walking home from class because I forgot I drove. And the next couple days, I couldn’t find my car in the parking lot.
“I was very forgetful and spacey. Really anxious, and after the last one I went through some intense depression. It was probably a combination of being told I wasn’t allowed to play soccer — and not allowed to go professional — and feeling anxious all the time, and just really low.”
Nicole Setterlund, now an assistant coach with UBC’s women’s soccer team, was forced to retire from playing the game competitively after suffering eight concussions.
Setterlund was an all-star with the Div. 1 Cougars, played three seasons with the W-League Whitecaps and was part of both the Under-20 and Under-17 national teams — captaining the latter to the CONCACAF Women’s Championship title in 2010. The centre back/midfielder was also B.C. Soccer’s Youth Player of the Year in 2010, and featured in the 2011 Province Head of the Class in her senior year at Semiahmoo secondary.
Her playing future was taken away, but the distant future is what weighs even more heavily on her. A spate of recent studies have drawn links between long-time soccer players and various neurological disorders. The latest is the 22-month study by the Glasgow Brain Injury Research Group indicating former pros were 3.5 times more likely to die with dementia or other neurological diseases.
The same study, released last month, indicated a five-time increase in the risk of Alzheimer’s occurring, a four-fold increase of in incidence of ALS and a two-fold jump in the risk of developing Parkinson’s.
“I try to stay away from (the studies), because it makes me really sad,” said Setterlund. “A lot of people make jokes that I consider in poor taste. They’ll say something about dementia and then say, ‘Oh, that’s going to be you when you’re older.’ And I’m like, ‘Honestly, it might be, so … that’s kind of rude.’
“So, yeah, it is a real fear, especially considering (some of) the long-term effects have been anxiety and depression. It’s something I think about, it’s something my family thinks about and always tries to manage; to understand that this is something you’re going to have to live with, probably.”
Boston University began a study last month focusing on former female professional players — including U.S. stars Michelle Akers and Brandi Chastain — who are nearly 33 per cent more likely to be concussed than men.
Of her eight concussions, Setterlund said three of them were the result of headers and one was from accidentally blocking a shot with her face. Two were from elbows to the head and two from clashing heads.
Heading the ball has been banned completely in the U.S. at the under-10 level, and heading practice limited to just 30 minutes per week in the under-11 and under-12 age groups.
Quebec mulled introducing a provincial ban in 2018 and Scotland and England are now doing the same after the Glasgow study, which was published in the authoritative New England Journal of Medicine.
Dr. Bennet Omalu, the doctor at the centre of the CTE lawsuit that has rocked the NFL, has said that no player under the age of 18 should head the ball.
“Begin with the children,” Omalu told The Daily Telegraph. “There should not be any heading of the ball below the age of 18. Why 18? Because that is when the human brain becomes fully developed. It is usually the age of adult consent. It is not intelligent for a human being to use his head to stop or deflect a ball travelling at a high velocity. As a society we should evolve.”
In B.C., both the University of British Columbia and UBC-Okanagan have delved into the subject. The Thunderbirds women’s team has been doing a trial using mouthguards that measure head impacts, while Paul van Donkelaar, a UBC-O neuroscientist, authored a study last year measuring blood biomarkers that indicate head trauma.
Their work found that repetitive impacts from a ball on a player’s head could cause cellular damage in the nervous system, but the limited scope of the studies’ size meant no definitive conclusion could be made.
Paul van Donkelaar, UBC Okanagan neuroscientist, authored a study that looked at the connection between heading in soccer and brain trauma.
“In a lot of contact sports, there are a lot of impacts that don’t result in a person being diagnosed with a concussion, but may have some effect on brain function, that, if you multiply it over the years, can be quite detrimental,” said van Donkelaar, who has 20 years of experience in sports concussion research.
“Better understanding how soccer heading affects brain function both in a natural game setting as well as a lab setting … is an important bit of knowledge to have, in order the answer the question: ‘How safe is it?’
“… No study has been done over the longer term. The (Glasgow Brain Injury study) was done after the fact, later in life. It was a medical records review, where they looked at who had died, and what they’d died from, and compared soccer players to otherwise healthy controls who didn’t. That’s a final outcome measure, right? What did you die from? And more soccer players were found to have died from neurodegenerative disorders. And that suggests that there’s something about soccer, which includes heading a ball, that might be one of the things that contributes developing those disorders.”
The U.S. Soccer Federation’s decision to change its policy on headers in the youth age groups came in 2015 as part of a settlement in resolving a class-action lawsuit.
The Canadian Soccer Association hasn’t followed suit — yet — due to the lack of concrete clinical research showing a definitive link between heading and brain trauma. The CSA provided the following statement when contacted for comment, as their director in the area, Dr. Kevin Gordon, wasn’t immediately available.
“Canada Soccer’s Sport Medicine Committee has been awaiting the release of the study published by the University of Glasgow’s Brain Injury Group. As a member of Canada’s Concussion Harmonization Project and a pediatric neurologist, the committee’s Dr. Kevin Gordon will review the findings and present on its impacts and effects on Canada Soccer’s current policies at the next meeting of the Sport Medicine Committee currently scheduled for December.”
B.C. Soccer follows the CSA policy on health and player safety, which recommends no players under six head the ball, and up to an under-10 level only with a soft or beach ball tossed from the hands. At that point, training with a hand-tossed, lightweight ball is deemed acceptable.
Many B.C. communities play smaller-sided games, which naturally decrease the amount of heading. Other factors, like the emergence of pass-heavy possession tactics and advances in ball technology — no more heavy, laced leather balls that soaked up water like a sponge, nor plastic balls that turned to rocks in cold weather — have the BCSA comfortable with their current standards.
“I’ve read all kinds of studies on heading, and the effect of heading in the game — and especially on kids — but I think the concussions that come out of the game of soccer are a little confusing, because the majority is not from heading the ball, it’s from the other traumas that exist,” said B.C. Soccer president Kjeld Brodsgaard. “I’m not too sure about the heading part of the game; it seems to be getting blamed for a lot of it, where I think it has a smaller … role than we think it does.
“At this point, we’re not planning on doing anything. We’re certainly keeping on eye on the research and what it shows, but it’s a little conflicting. We feel that we’ve minimized the opportunities for concussions being caused by heading at those lower age groups.”
But the recommendations start and stop with those who are most responsible: the coaches. There are good, bad, the old-school and the new coaches. Their individual standards and practices can vary widely.
Dom Butcher, who won a national title as a goalkeeper with the University of Victoria in 1996, has been coaching youth for the past 27 years. A National B level certified coach who’s now the technical director with the Juan De Fuca Soccer Association, Butcher wrote a paper entitled “To Head or Not to Head” for his master’s degree in coaching studies.
He advocates restricting headers at certain youth levels, as he does with his daughter’s under-12 team, even if it isn’t policy yet.
“Obviously, the CSA’s historical stance has been evidence based and the clear evidence has not been there; there is an unknown grey area,” said the Liverpool-born Butcher.
“That said, from the recent research I’ve looked at, there are definitely risk factors with heading. Even at the pre-concussion level, routine headers can cause transient changes in brain function. What long-term effect do these have on the brain and its function? We don’t entirely know but it can’t be good. Knowing this, and given that the National Coaching Certifications Program’s (NCCP) Golden Rule is ‘do no harm,’ a precautionary approach to heading should be applied. As coaches, we have a responsibility to embody the NCCP’s golden rule. Can we honesty live by that if we are doing headers with our players?”
Brain health has exploded onto the consciousness of the sports world as professional after professional has succumbed to CTE or other neurological disorders once their playing careers have ended, but there are still holdouts.
Nicole Setterlund, left, goes head to head with a member of the Canadian Olympic women’s team during a 2012 game at South Surrey Athletic Park.
A perfect example: the grim circumstances around Setterlund’s fourth concussion, an entirely avoidable injury.
“One of my coaches was trying to prove a point … and he had me head medicine balls over and over again,” she said of training in her youth.
“He was pretty belittling, and would scream a lot. And I guess we weren’t clearing the ball properly (and he) accused us all of being scared to head the ball, which wasn’t the case; we were just s**t that day. He had everyone head one medicine ball, and then me … over and over again.”
That episode was one reason she has stayed involved with the game, specifically on the coaching side. She’s an assistant coach with the UBC Thunderbirds women’s team, working with Jessie Symons — coincidentally her coach when she was playing for the Under-12 provincial team.
“The mentality of coaches with children is so important. There’s a big difference encouraging a child to go into a hard tackle, and it’s another to head drop kicks,” she said. “A big tackle, what’s going to happen? They might get a bump on their knee, maybe they’re going to roll their ankle. That’s just encouraging them to be brave. Encouraging big headers in areas it’s not necessary, it’s not good.
“(Soccer) is my happy place. I really love it … but I also feel a bit of an obligation. I feel like there are a lot of a**holes who are a part the sport that have the ability to ruin it for players. Whatever level you’re at, I love to be that person who … really supports the girls. I think that’s what sport is supposed to be.
“My reason for being here goes beyond my head injuries. It goes more towards I want people to be coached by supportive, awesome, positive people, instead of a**holes.”
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