World Cup play offers lessons in properly using one’s head

The World Cup grabbed attention globally, and no doubt Sunday’s victory by the U.S. women’s soccer team has inspired more youth to take up the sport.

For viewers paying attention, the matches also were a good place to see proper techniques for heading the ball to reduce concussion risks, said a researcher with the Sports Institute at UW Medicine.

The top concussion risk in soccer is from players colliding as they jump up to head a ball, say experts in a program to teach safer youth soccer heading techniques. In the final World Cup game, U.S. defender Kelley O’Hara was forced to leave at halftime after a head-to-head collision with a Dutch player.

“With the World Cup, it’s been interesting to watch, because you can see a lot of heading as it’s happening in the sport,” said Sara Chrisman, a pediatrician and Sports Institute expert. “You really see some amazing control of the ball with heading and space.”

When skilled adult soccer players head the ball, they almost always have their arms going up, much as a basketball player does in boxing out his or her space, she added. There are also different types of headers, such as a gentle tip toward a goal.

“Also, they’re using their whole body to hit the ball, and that is a safer way of heading a ball because then the impact is being absorbed by your whole body rather than just your head or just your neck. That’s one of the things we’re really working on teaching kids to do.”

The Seattle institute, working to improve sports safety and expand participation, is part of the UW Medicine health system including Harborview and the University of Washington School of Medicine.

More than 6 million kids ages 6-18 play soccer in the U.S. The institute is involving researchers, medical experts and former Sounders player Roger Levesque in developing a program called Aerial Training to teach kids safer soccer heading.

Collision concussions aren’t always from heads knocking together, Chrisman said. Sometimes, it’s from an elbow or knee hitting hard against a head, or a fall against the ground.

But Chrisman, a concussion researcher, added that the risks in youth soccer are relatively low.

“When you look at youth soccer, it’s not a high risk, so within one season maybe 5% of females and 2% males will develop a concussion,” she said. “There is a higher risk for females that we don’t completely understand.”

About 30% to 40% of those concussions occur during a heading attempt that results in a collision, Chrisman said, adding that’s partly why U.S. Soccer has put some limits on heading in youth soccer.

“They saw this is an area where we really need to teach kids how to be safe with this part of the sport, but it hasn’t quite caught up with how do we teach kids to be safe with heading the ball,” she said.

“We’ve designed a program that really is about teaching kids how to be in the air with your arms up and looking around for other players.

“It’s about practicing active drills, where they are in the air and another player is there, so they’re learning how to be in the air. We’ve conducted a few pilot studies and we’re still in the process of refining this. We’re thinking about how to test it on a broader level.”

Since 2016, and after a lawsuit was filed in California, U.S. Soccer has mandated that players 10 and younger can’t be taught the skill of heading and can’t intentionally head the ball in a game.

Players who are 11 and 12 can receive heading instruction in training, the rule says, but it’s limited to 30 minutes per week. Kids 13 and older are allowed to head the ball in competition.

In its early stages, the Aerial program is being designed to offer drills also to teach kids how to move through crowded spaces avoiding collisions.

“We started to think about how to do that and teach kids how to be safe within a heading procedure, because the real danger of soccer heading is actually every time you go up to head the ball, it’s almost always contested,” she said. “There is another player in your space, and that makes it more likely for there to be a collision.”

Proper technique and guidelines in practices have gone far to limit injuries in youth sports, said Laura Fralich, a Spokane sports medicine physician and team physician at Gonzaga Prep. One example is that high school football players are limited in the amount of tackling they do in helmet-to-helmet drills per week.

“I think in football, soccer, any collision sport, the most important thing is to be taught proper technique for your sport early on,” Fralich said.

“Proper technique for heading is important. The coaches who are teaching this need to be well-versed in how to head the ball, whether they’ve played or have a good understanding of how to teach the proper way.”

Fralich agreed that the few cases she’s seen of soccer-related concussions are from collisions with other players. But injuries do occur from hard-hit, unexpected balls.

“I have seen kids, even adults, who got a ball to the head kicked rather close to the head, or they just weren’t prepared for it, so they sustained a concussion,” she said.

She’s a proponent of referees enforcing the rules, such as fouls, to help prevent injuries. “Officials have an obligation to make sure a game is played safely.”

Signs of a concession can include a headache, loss of consciousness, confusion, double or fuzzy vision, dizziness, balance problems, nausea, slow reaction time, difficulty remembering, difficulty concentrating, sensitivity to light and noise, feeling sluggish, irritability and sleep disturbances.

However, losing consciousness doesn’t always happen when there is a concussion, Fralich said. She watched the World Cup, including the incident with O’Hara. She wasn’t knocked out but appeared dazed.

“The U.S. absolutely did the right thing by removing her from play,” she said. “My guess is she failed the concussion protocol. The rule is, if a person has a concussion, they can’t return to play in the same day – at least for high school sports.”