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HBO Segment Puts Youth-Soccer Headers Under the Microscope

A recent episode of HBO's Real Sports featured two former U.S. women's national team stars, Cindy Parlow Cone and Brandi Chastain, speaking with correspondent Mary Carillo about their campaign to remove headers from youth soccer.

In conjunction with the Sports Legacy Institute and the Institute of Sports Law and Ethics, Chastain, Parlow Cone, and fellow former U.S. women's national team star Joy Fawcett launched their Safer Soccer initiative in June 2014. By 2017, the campaign aims to have youth-soccer organizations not teaching or allowing children under the age of 14 to head the ball.

"This is about the health and wellness of millions of kids," Chastain, who scored the game-winning penalty shot in the 1999 FIFA Women's World Cup final, told Carillo in regard to banning youth-soccer headers. Chastain acknowledged, however, that this campaign could wind up harming her chances of achieving her goal of becoming the U.S. women's national team's head coach one day, as some in the soccer community see it as an attack on the game.

While the full episode is only available to HBO subscribers, the network posted a clip of the segment on YouTube:

A white paper from the Safer Soccer campaign estimates "that delaying the introduction of heading until age 14 would conservatively prevent over 100,000 concussions among middle school-aged players registered with U.S. Youth Soccer every three years." It calculated that figure by taking the number of middle school-aged players registered with U.S. Youth Soccer (900,000), multiplying it by the percentage of youth-soccer players who suffer concussions annually (13 percent), and multiplying that figure by the percent of concussions found to be caused by headers in a 2014 JAMA Pediatrics study (30.5 percent). Over a three-year period, that amounts to 107,055 concussions directly tied to heading the ball.

"As a professional and now a parent and coach, I believe that the benefits of developing heading skills as children are not worth the thousands of additional concussions that youth-soccer players will suffer," Chastain said in a statement when the campaign launched in 2014. "As a parent, I won't allow my children to head the ball before high school, and as a coach I would prefer my players had focused solely on foot skills as they develop their love of the game."

Experts Debate Efficacy of Heading Ban

The issue of allowing headers in youth-soccer has been extensively discussed over recent years. In 2011, a study presented at the annual meeting of the Radiological Society of North America found youth-athletes who head soccer balls had brain abnormalities similar to those found in patients with traumatic brain injuries. In his 2012 book, "Concussions and Our Kids," Dr. Robert Cantu recommended prohibiting youth-soccer players under the age of 14 from performing headers, too.

However, in a March 2012 editorial published in the Journal of the American Medical Association, New York-based pediatrician Dr. Ann R. Punnosse urged caution before conclusively linking soccer headers with brain injuries. "Until researchers proceed with better studies that determine exactly how heading affects the brain, whether the practice might pose a risk to children remains an open question," Punnosse wrote at the time.

That debate hasn't died down in recent years. Earlier this month, a study published in the journal JAMA Pediatrics suggested banning headers in high school soccer may not be the most effective way to limit concussions among players, as athlete-to-athlete contact was at fault far more often. For boys, 68.8 percent of concussions during the study period occurred following contact with another player, while 51.3 percent of girls' concussions were after athlete-to-athlete contact. However, in terms of soccer-specific activities, heading the ball was the activity most commonly associated with concussions. For girls, 25.3 percent of concussions occurred following a header, while 30.6 percent of boys' concussions resulted from headers.

"We postulate that banning heading from soccer will have limited effectiveness as a primary prevention mechanism (i.e., in preventing concussion injuries) unless such a ban is combined with concurrent efforts to reduce athlete-athlete contact throughout the game," the authors concluded. They suggested banning heading "may be a secondary prevention mechanism (i.e., as a way to reduce the severity of the soccer concussions that occur)," but insisted reducing player-to-player contact would have more wide-reaching effects.

However, Dr. Edward D. Snell, the team doctor for the Pittsburgh Pirates and the director of the Sports Medicine Concussion Center at Allegheny General Hospital in Pennsylvania, told the Pittsburgh Post-Gazette that "young soccer players are using their heads too much."

"I think it is dangerous, using the head like you use a fist, but your brain is in a floating atmosphere that if accelerated and stopped quickly, can cause injury," Snell told the paper. "I do not find heading the ball to be a good thing."

Realistically, experts are mostly on the same page when it comes to youth-soccer headers. While there's debate about exactly how headers affect youth-athletes brains—and whether banning them is the most effective way to lower concussion risk—most experts appear to agree that reducing the number of headers in leagues with younger athletes certainly won't hurt.

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