By CHRISTOPHER CLAREY
WEST NEWBURY, Mass. — Soccer without headers? My team has experienced it for the last two months, and we may not be ahead of the curve for long.
A new study by the University of Stirling in Scotland has found that a single session of heading the ball can significantly affect a player’s brain function and memory for 24 hours. Tens of millions of people have played, and continue to play, the game without health problems. But as hints of evidence of a link between even small, subconcussive impacts and long-term damage begin to accumulate, it is time to at least consider the possibility that the leaders of the world’s most popular sport may eventually determine that heading is too much of a medical and legal risk to allow.
The game, though diminished, surely would carry on. Tactics would be altered, but to eliminate heading would not be the same existential threat to soccer that eliminating tackling would be to rugby or American football. For now, the outright ban on headers is confined to the early stages of youth play in the United States.
That includes the girls whom I coach on an under-12 soccer team in Massachusetts. They are fifth and sixth graders — age 10 or 11 — and the youngest among them have never headed a ball intentionally in competition.
They are part of the first generation to grow up playing soccer with such restrictions, which grew in scope last November when the United States Soccer Federation announced its own limits, in part to resolve a proposed class-action lawsuit that would have charged the federation and others with negligence in treating and monitoring head injuries.
Under the new guidelines, players 10 and younger are prohibited from heading in practices or games. Players from 11 to 13 may head the ball during games but are restricted to a maximum of 30 minutes of heading training per week, with no more than 20 headers per player.
No other nation is believed to have made such a move. A spokesman at FIFA, the sport’s global governing body, said this week in an email that “to our knowledge” a ban such as this “applies in the U.S.A. only.”
But changes could be coming quickly: The BBC reported Friday that the Scottish Youth Football Association would “urgently” review its guidelines for heading in response to the new study. David Little, the association’s chief executive, told the BBC that it would be “unadvisable” for a child of any age to do repetitive heading drills.
George Chiampas, U.S. Soccer’s chief medical officer, said the focus on the younger age groups in the United States was driven in part by concern about the lack of extensive research. The other key element, he said, was that the majority of soccer concussions occur as a result of aerial challenges, not all of which — head-to-head, elbow-to-head or even head-to-ground — involve contact with the ball. It is not the actual heading that causes many concussions, but the attempt to head the ball.
“It just seemed to make a big argument that in this population, knowing that they are all in developmental stages and learning how to fall and jump and protect themselves, that this would be an age we felt we could make a positive impact and decrease the incidence of concussions,” Chiampas said.
The new restrictions were mandatory for U.S. Soccer’s youth national teams and academies, but were only recommended for organizations outside the federation’s control. Nonetheless, many entities have chosen to follow U.S. Soccer’s lead, including the Essex County Youth Soccer Association, which oversees our team’s league. Because U12 squads include 10-year-old players, the effect is that heading is banned for the 11-year-olds here, too.
For now, the game still flows at this level, and the girls I coach do not seem troubled by what they cannot do. Even if they have watched stars like Cristiano Ronaldo and Alex Morgan head the ball repeatedly in matches, they have not lobbied to mimic their role models. Nor have they yet shown any signs of bravado, false or otherwise, by trying it on their own.
Heading, from my experience playing and coaching since the 1970s, is one of the least instinctive elements of the game. Kicking a ball is natural. Heading, for most, is not, and many young players remain leery of it, no matter how sound the early instruction.
They and their parents might be even more leery if they read the University of Stirling study published this week in the online medical journal EBioMedicine.
In the research, balls were launched at players by a machine in an attempt to mimic the speed and trajectory of a typical corner kick. Twenty-three young adult amateur players headed the ball 20 times over a 10-minute period and were monitored using transcranial magnetic stimulation before practice, immediately after practice and then 24 hours and 48 hours later.
The report noted immediately after the heading a disruption of the normal balance of chemicals in the brain and reductions in memory test performance of 41 percent to 67 percent.
“We are showing for the first time quite directly a disruption of biochemistry as a result of heading,” Magdalena Ietswaart, a cognitive neuroscientist and one of the authors of the report, said in a telephone interview on Tuesday.
She and Chiampas, the U.S. Soccer doctor, each cautioned that much more research was needed. Ietswaart suggested tests with magnetic resonance imaging as a next step. “Unfortunately, it’s eye-wateringly expensive,” she said.
But she was clearly concerned even if the impairment from heading did disappear within 24 hours.
“Our study does show that you probably should not head the ball the day before an exam,” Ietswaart said. “The brain is not really firing on all cylinders.”
Little disputed any heading-testing link in his comments to the BBC on Friday, but the greater worry is the longer term.
“What we need to know,” Ietswaart said, “is what happens when that normal balance is disrupted over and over again as you do in weekly heading drills. Do the effects add up? Does the balance get disturbed permanently?”
There is clearly a great deal in need of clarification, and it would come as no shock if the contact sports that have long been main attractions in different parts of the world — from rugby union to Australian rules football — end up with radically new rule books as research and litigation advance.
For parents, suspecting that a sport could be a long-term health hazard to their children is not nearly the same as knowing it is one. When it comes to soccer, typically viewed as a safe haven by American families in comparison with football, there now may be uncertainty.
What is reassuring is that the issue of brain trauma and soccer, too long ignored, is increasingly on the agenda. Chiampas spoke by telephone on Wednesday shortly before boarding a flight to Berlin for a global conference on concussion in sports. U.S. Soccer also released new material on concussion awareness this week.
But the loudest alarm bells rung by the University of Stirling’s research are not about concussions. They are about the potential cumulative impact of subconcussive blows to the head.
“It is a funny game that you intentionally bash your head,” Ietswaart said, expressing concern that the age limits on heading in the United States were arbitrary. “Only recently have we realized quite how much the brain is still under construction right through teenagehood.”
For that reason alone, she said, “I would not like people to feel safe because we have banned heading until the age of 11 or 12.”
Chiampas made it clear, however, that U.S. Soccer is prepared to make further rule changes if the research and science provide clarity. And amid the uncertainty, the Americans deserve credit for getting a head start.
My team — for now — is not complaining.