During the heading technique in soccer, a 0.5- to 1-pound soccer ball is hit with the forehead between the eyebrows and scalp hairline while keeping the eyes open to propel the ball to change its direction. During this maneuver, the soccer ball can be traveling up to 20 miles an hour.

By Mark Leitman, MD, FACS

Assistant Professor, Albert Einstein College of Medicine

Soccer is the most popular sport in the world, enjoyed by 265 million people. It is an evolving game from the original codification in 1863, with constant tweaking of the rules. This article presents arguments to again change the rules and ban heading. In this technique, a 0.5- to 1-pound soccer ball is hit with the forehead between the eyebrows and scalp hairline while keeping the eyes open to propel the ball to change its direction, and the mouth is closed to prevent biting of the tongue. During this maneuver, the soccer ball can be traveling up to 20 miles an hour.

I first became aware of the powerful impact the ball can have when I was viewing the game through a steel wire fence. When the ball hit the barrier, the fence kept shaking. Beginners learn heading by starting with an underinflated soccer ball, or a foam ball. This helps the child overcome their natural inherent fear of hitting their head.

Soccer balls Size 4 (medium size) are for ages 8-11, and larger size 5 balls are for ages 12 and above. At practice, the ball is tossed lightly to build the child’s confidence, and practice sessions are kept short to prevent headaches. Heading is often limited to children over age 11. Those ages 11 to 13 year old are limited to a few headers per day, with no more than 30 minutes of heading practice a day. They average about 12 headings per game.

Some coaches recommend “no parent or friend should ever teach heading or throw at the child’s head” and also state that “heading is not inherently dangerous and is actually fun and makes the game most appealing.” I don’t agree. In practice sessions, children hit the ball back-and-forth to each other and are warned to inform the coach if they experience headache, dizziness, sensitivity to light, blurred vision or neck pain. A study has shown that “one in five experience mental health symptoms for up to six months even after a mild head injury.”

A study has shown that ‘one in five experience mental health symptoms for up to six months even after a mild head injury.’

The Brain

The human brain is unique in the known universe and is the only brain that can reason. It reached its present incredible complexity 200,000 years ago, after millions of years of evolution. The human brain contains a 100 billion neuron cells that contribute to a 100 trillion circuits connecting all parts of the brain. This network consists of microscopic nerve fibers crisscrossing in all directions (see below).

The prefrontal part of the brain doesn’t fully mature until 25 years of age and during this time period is most susceptible to damage. This front part of the brain is referred to as the Executive Center and is responsible for intellectual activities, planning for the future, emotional well-being, empathy and other higher functions that distinguish us from other mammals. Each neuron cell has 10,000 branches. Dead cells are not replaced.

The human brain contains a 100 billion neuron cells that contribute to a 100 trillion circuits connecting all parts of the brain. This network consists of microscopic nerve fibers crisscrossing in all directions.

Chronic Traumatic Encephalopathy (CTE)

Non-penetrating blows to the head cause a rapid forward or backward movement and shaking of the brain inside the bony skull that results in swelling and tearing of microscopic nerve connections. Symptoms indicative of serious injury (CTE) include headache, dizziness, psychiatric disorders, fatigue, apathy, decreased motivation, changes in eating or sleep habits, emotional lability, changes with speech and personal relationships. Loss of consciousness, even very brief and not remembered, is a hallmark sign of concussion. Symptoms that do not always occur after each hit are referred to as a subconcussive injuries.

In soccer, these asymptomatic cumulative blows can give the player a false sense of security with immediate return to the game. This could set the stage for future dementia. Boxers with CTE referred to as “punch drunk syndrome” may remain asymptomatic for up to 16 years, causing them to return to harm’s way in the ring. Slowly occurring injury to a nerve and its connections results in decrease in the speed of conduction in the nerve, which often goes unnoticed by the player but could result in slowing of mental activity.

Scientists believe that most mental illness from any cause is due to faulty neurotransmitting of chemical messengers at the junction between neurons (synapses). Head trauma could additionally cause physical damage to the synapse or even tear the two cells apart, worsening an existing condition or creating a new one.

The most common cause of concussion in high school athletes is football (of 1 million high school players, 250,000 had concussions last year) followed by girls soccer and then boys soccer. Soccer results in more concussions than wrestling, baseball, basketball and softball combined.

Aggressive soccer players who head the ball up to 124 times in two weeks are 3.5 time more likely to experience concussion symptoms than less frequent headers. Professional soccer players in Scotland also had 3.5 times the incidence of neurodegenerative disease and dementia.

Sports and other types of exercise without head banging is, on the other hand, beneficial in preventing dementia.

Sports injuries are becoming an acceptable practice in the world. In the pursuit of applause, trophies and monetary compensation, players are willing to take risks and play with pain. Sadly, cheering spectators encourage this risky behavior.

Pain often manifested as headache may be treated by physicians or illegally on the street with opioids (oxycodone) and fentanyl. Fentanyl is the driver of drug overdose deaths and accounts for 80% of opioid-related deaths. There is a crisis of drug addiction, which is the No. 1 cause of death in this country (105,000 last year) in people under age 50. Modeling predicts this to increase to half million deaths in the next decade. According to the American Medical Association, 20% of opioid users become addicted in just 10 days.

Let us begin to address this problem by helping these trusting kids and banning heading.

The office of Dr. Mark Leitman, eye physician and surgeon, is located at 13 Brunswick Woods Drive, East Brunswick. The office may be contacted at 732-254-9090.