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Published on April 06, 2021

Heading for trouble?

Head Sports

Now that youth sports are resuming in many places, should parents be worried that playing soccer could harm their children’s brains?

New research raises some alarms. The study of 7,676 former professional soccer players in Scotland showed that they were three times more likely to die of neurodegenerative diseases than 23,028 members of a control group taken from the general population.

The study, published in the October issue of The New England Journal of Medicine, found neurodegenerative diseases, such as Alzheimer’s disease, other dementias and Parkinson’s disease, were the primary cause of death in 1.7 percent of the former soccer players and 0.5 percent of the control group. Medications for dementia were also prescribed more frequently for the former players than the control group.

But, these results don’t necessarily mean you should ban your child from the field, said neurologist Mathew J. Pulicken, MD, of Neurologists of Cape Cod in Hyannis.

“It’s not that children should never play,” he said. “You don’t have to panic.”

The benefits of exercise and social interaction from playing soccer or other sports outweigh the risks if some precautions are taken, Dr. Pulicken said.

“Soccer is not a complete contact sport like football or boxing, but like most other sports there is risk for concussion and head injury,” he said.

What Blows to the Head Can Do

According to the Concussion Legacy Foundation, regular repeated blows to the brain over time can contribute to chronic traumatic encephalopathy or CTE. These blows do not have to be strong enough to cause a concussion, but repeated sub-concussive hits could be a major cause of CTE. The disease was first recognized in 1928 in boxers described as having “punch drunk syndrome,” according to the foundation.

CTE’s early symptoms of mood and behavior changes, including impulsiveness, aggression and depression, often appear when a patient is in their 20s or 30s. Cognitive symptoms of memory loss, confusion and poor judgment may become evident in the middle age with dementing illness that follows. It has been found in the brains of pro football players, including former New England Patriot Aaron Hernandez.

Researchers are examining the effects of repeated brain trauma in collegiate and professional sports. At the Boston University School of Medicine, studies of three groups are ongoing. One is looking at former professional or national female soccer players; a second, former male NFL and varsity college players; and the third, men and women 50 and older from New England who participated in football, soccer, rugby, ice hockey, boxing and mixed martial arts at college, semi-pro or professional levels.

But what does this mean for young children and teens?

Activities that can cause head trauma, including repeated heading a soccer ball, should be limited for children under 10, Dr. Pulicken said. Even though there are no clear studies to prove the effects on heading , the general consensus is to limit this activity at young age. The younger brain has not developed fully enough to cope with them.

CTE is associated with years of exposure to hundreds or thousands of sub-concussive hits, and athletes with longer careers suffer more cumulative damage, according to the Concussion Legacy Foundation. Most of these injuries occur during practice, not during games. It recommends modifying practice drills to lessen hits and having age-appropriate rules to protect younger players.

How to Prevent Concussions

The Centers for Disease Control and Prevention lists tips to prevent brain injury for many sports. For soccer, it follows the U.S. Soccer Federation guidelines that no athlete 10 years old or younger head the ball and that heading be restricted for players 11 to 13 years old.

According to a May 2016 article in JAMA Pediatrics, the U.S. Soccer Federation guidelines resulted from a California class-action suit seeking rule changes, and claiming 50,000 high school soccer players suffered concussions in 2010, more than from the combined sports of baseball, basketball, softball and wrestling.

The CDC also recommends that soccer coaches teach students to:

  • Avoid collisions.
  • Not hit another player’s head or use their head to hit a player.
  • Play fair and not try to injure another player.

Furthermore, coaches should also have a plan for reporting and recording suspected concussions.

Concussions occur most often in high school soccer during heading, and girls suffer from them more often than boys, according to the CDC. Heading-related concussions typically happen during collision with another player – 74 percent for boys and 58 percent for girls. Contact with the ball, goalposts or other equipment is involved in heading concussions for 13 percent for boys and 35 percent for girls.

Athletes who may have suffered a concussion should be removed from play and monitored , and not be allowed to return until evaluation and clearance by a licensed healthcare provider, according to the American Academy of Neurology.

Dr. Pulicken said that while student athletes may experience sub-concussive hits and perhaps even a concussion, “one event does not mean the end of their season. There are guidelines established by American Academy of Neurology on concussion and return to play. As long as we limit the extent of head trauma and follow the recommendations as above, we should still let children play."