Doctors to Issue a Heads Up on Soccer Move

For Wylie Drummond, coach of the Hollywood-Wilshire-based Mighty Blue Bashers, it’s a moment of triumph--and surprise--when one of his 8- and 9-year-old players “heads” a ball down the field during play.

For the all-girl Bashers, such a soccer coaching feat means practice--three or four minutes of “heading drills” a week, during which a girl will probably be bopped off the head 10 to 15 times by a ball tossed from about 10 feet away.

“You lob this thing like a powder puff at them,” he said. “That really doesn’t jolt them.”

Not everyone agrees. In fact, the nation’s leading group of pediatricians is set to warn parents and coaches that for children and teens, the repeated practice of “heading” a soccer ball could result in lasting brain injury. Meeting in Chicago next month, the American Academy of Pediatrics’ sports medicine committee expects to prepare a statement on youth soccer safety that outlines existing research and, pending further studies, makes a case for restraint.

“We’re putting out a word of caution,” said Dr. Bernard Griesemer, who is drafting the statement for the committee’s May meeting. “On repetitive heading of soccer balls in young athletes, the bottom line is probably ‘less is better.’ ” Griesemer stressed that heading drills, in which a child’s head is knocked repeatedly, are of greater concern to the pediatricians’ group than is the occasional head-punt in the course of play.

Given the popularity of youth soccer leagues across the country, the doctors’ expected warnings have set off a new wave of chattering across the nation’s playing fields. Pushed by enthusiastic coaches and often prodded by gung-ho parents, more and more children are hurling themselves into competitive sports--and getting hurt doing it. From the sidelines, however, more protective parents are watching the athletic exploits of today’s kids with furrowed brows. So are the doctors.

In the last two decades, doctors’ warnings have sunk youth boxing, brought compulsory batting helmets to Little League baseball and outfitted pee-wee hockey players with mouth guards and eye protection. Now, as coaches roll their eyes and parents hold their breath, doctors are focusing on soccer--the sport so many baby boomers embraced for their children as a safe alternative to football.

What they have found is troubling, though far from conclusive.

At the coming meeting, pediatricians will be weighing the words they will use to guide parents and coaches in safe soccer play. Their concerns over heading drills has been prompted largely by a pair of studies that compared the mental functioning of large groups of adult soccer players to adults of similar age and circumstance who did not play soccer. One was conducted in Norway, the other in the United States, and all involved soccer players who had begun playing--and heading drills--at a very early age.

In the Norwegian study of 106 former and still-active professional soccer players, 81% were found to have impairment of their attention, concentration, memory and judgment that ranged from mild to severe. The more recent U.S. study compared 60 young adult soccer players with a smaller group of nonplayers found that attention and concentration deficits were significantly more common among those who “headed” the ball most often.

The studies do not prove that the practice of heading is to blame, and they don’t establish how much drilling might be dangerous to the developing brains of children. But they have appeared at a time when neuroscientists are demonstrating that lasting brain injury can happen even when a victim does not lose consciousness or suffer a concussion, and that the brain--like any delicate tissue--can be harmed over time by small, repeated stresses.

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Against that backdrop, sports medicine specialists find the soccer studies alarming. And when it comes to the safety of children and the protection of their still-developing brains, the medical establishment is inclined to err on the side of caution. Hence, the movement within the American Academy of Pediatrics to put out the red flag on heading drills.

“Most people feel like you can never be faulted by being conservative because of what happens with cumulative stresses,” said Dr. Steven Anderson, chairman of the American Academy of Pediatricians’ committee on sports medicine and fitness. Head injury, he added, has become a hot topic among sports medicine specialists, and he acknowledged “no one has a good answer.” But the public is looking to the medical establishment for specific common-sense guidelines unclouded by team loyalties or the stoicism of athletic traditionalists.

Anderson said the pediatricians’ planned warning has drawn little debate within medical circles, and no opposition within the committee’s seven pediatricians. For its part, one national soccer group, the American Youth Soccer Organization, says it discourages heading drills for young players, while acknowledging that it doesn’t send down firm rules to coaches.

And some soccer coaches are already questioning the doctors’ planned warning, according to Anderson.

“You get people in the sport who have the mentality that people getting dinged and seeing stars is part of the game--it was part of the game when they played and it will always be that way. And they ask, what do you want to do, outlaw the sport?”

That, effectively, is just what the group sought to do in 1984 when it adopted a consensus recommendation against youth-boxing. The group cited studies that found progressive neurological impairment in older boxers and early evidence of problems among teenage boxers. The pediatricians’ position helped lead the American Medical Assn., the powerful doctors’ group, to call later that year for the elimination of boxing in both its professional and amateur forms.

At the time, organized youth boxing drew only about 15,000 kids to gyms across the nation. Soccer participation, by contrast, has swept the land, making the physicians’ task far more delicate. Today, some 12 million people play the game regularly, and about half are 14 and younger, according to the U.S. Soccer Foundation. The U.S. Youth Soccer Assn., which organizes league play for children 5 to 19, has more than 3 million kids signed up.

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In California, the Hawthorne-based American Youth Soccer Organization, the largest league in the state, draws 244,000 kids to competition. Many start as young as 4 1/2 years old.

While heading drills are unusual among very young players, they become more common as children get more proficient in the game, Griesemer said. Such drills, often intensive ones, remain common, especially in high schools and among elite teams that travel widely to compete.

With so many listeners and so little direct proof of its dangers, the pediatricians are wary of sounding the alarm about soccer heading drills for young children. And some physicians are warning their colleagues not to get too far out on a limb.

“I’m all for more research for smaller or softer balls for children,” said Dr. Gregory Landry, professor of pediatrics and sports medicine at the University of Wisconsin Medical Center in Madison. “But I don’t think it’s appropriate for us to say that children should not head the soccer ball, and I have no problem with my own daughters learning how to head the soccer ball properly.”

Meanwhile, many coaches say they are already practicing safe soccer and are unsure there’s a need for a national warning.

“We not only discourage [heading drills], we strongly discourage them,” said Dick Wilson, the national executive director of American Youth Soccer. Players “do need to learn how to defend themselves should the ball come toward them in the air. . . . So we try to stress the safest way to deal with the ball as it’s coming through the air, and that gets misinterpreted that they may be doing heading drills.”