Reposted from The New York Times

Corinne Spurrier was as enthusiastic as any soccer mom in Manhattan. On a crisp Saturday morning in Riverside Park, her 9-year-old son’s team, the Golden Eagles, played their final game of the season on the banks of the Hudson River. She cheered as her son, Ian, raced across the grass in his yellow jersey. She clapped whenever one of his teammates scored and yelled when a player missed an opportunity.

Only one thing nagged her: heading. When she saw Ian hit the ball with his head, a red light flashed on in her mind. “I should ask his pediatrician if this is a good thing for him to be doing,” she said. “I think of Muhammad Ali. What are the side effects?”

The same question disturbs many parents of soccer players. Sure, heading looks easy when done by professionals, and it makes for great television. But many parents are all too aware that children are less physically developed than their world-class counterparts.

In the last year, from league meetings to scientific conferences, there has been renewed debate about whether young players should head soccer balls.

Members of the American Youth Soccer Organization proposed a rule that would ban heading in games and practices for players under age 10. The proposal was narrowly defeated in May during a vote of the executive committee members of the A.Y.S.O., which oversees more than 650,000 players on 50,000 teams.

In October, the Institute of Medicine at the National Academy of Sciences held a one-day conference. Experts on head injuries discussed the potential risks of heading, but reached no firm conclusions.

And scientists at the University of North Carolina at Chapel Hill are scheduled to start a five-year study in January that will track elite players to try to determine definitively whether heading leads to long-term injury.

Experts have conflicting opinions. Since 1999, when a series of studies and letters on soccer head injuries appeared in The Journal of the American Medical Association, researchers have criticized one another’s studies and eagerly stepped forward with their own evidence. One camp argues that because there has been no conclusive medical research, children should not be allowed to perform headers until more information is available. The other side says that headers have not been linked to concussions, and so children should not be discouraged from using the technique.

“I think people just generally accepted that heading is a part of soccer,” said Bill Mason, an A.Y.S.O. official and a referee for almost 30 years who lives in Rancho Palos Verdes, Calif. “But there has certainly been more talk. Some people have very, very strong feelings now.”

Those who preach restraint in heading point to several studies conducted on European players. The most recent one tested Dutch professionals on their mental abilities and concluded that repeated heading can lead to cognitive impairment. The study, accepted for publication in The Journal of Clinical and Experimental Neuropsychology, looked at 84 players with an average age of 25; it found that headers led to the kinds of cognitive shortcomings seen in people with frontal-temporal brain injuries. Subjects who had performed more than 1,000 headers a year seemed to suffer from significant impairment because of the accumulation of small blows, said Erik Matser, one of the researchers and a clinical psychologist at the Neuroscience Center at Erasmus University in Rotterdam, the Netherlands.

Researchers speculate that heading causes injuries because the brain collides with the skull and becomes bruised or swells, said Muriel Lezak, one of Matser’s co-researchers.

‘On a Razor’s Edge’

“The conclusion is to teach them football and don’t do heading drills during training,” Matser said in a telephone interview, referring to the worldwide name for soccer and talking about players under age 17. “Let’s first do more research before you say heading is safe for kids. We’re walking on a razor’s edge. There is some concern with professional players, and it could be dangerous.”

Matser and Lezak also said headers should be discouraged because of questions about what is known as the second-impact syndrome, in which a seemingly harmless blow to the head can result in a serious injury and possibly a concussion if the player suffers one or more subsequent blows.

“I think it’s an issue that must be looked at, the possibility of heading contributing to a second-impact syndrome,” Lezak, a professor of neurology, psychiatry and neurosurgery at the Oregon Health Sciences University, said.

“I’d say that anybody under the age of 18 should not be heading,” she said. “I think there’s some risks you just don’t take, because if you do have damage to the brain, there will be some residuals, and they won’t go away.”

The recent study in the Netherlands supports findings that Matser and his colleagues published in 1999 in The Journal of the American Medical Association, based on cognitive tests of 33 adult amateur players. It also backs up the research of Dr. David Janda, an orthopedic surgeon who studied 60 players from 11 to 14 in Ann Arbor, Mich., for two years. He found that symptoms like blurred vision and headaches were more common in children who headed the ball most often.

Several medical organizations have decided to err on the side of caution. One of them, the American Academy of Pediatrics, issued this recommendation in March 2000: “The potential for permanent cognitive impairment from heading the ball needs to be explored further. Currently, there seems to be insufficient published data to support a recommendation that young soccer players completely refrain from heading the ball. However, adults who supervise participants in youth soccer should minimize the use of the technique of heading the ball, until the potential for permanent cognitive impairment is further delineated.”

But some scientists have cast doubt on the research of Matser and others. They note that such studies are done almost exclusively on adult players and cannot be applied to children and the way they play. The studies also do not account for other factors that might explain some of the cognitive defects, like a player’s life style off the field, the critics say. And the same players who perform headers most often could be the natural risk-takers on the field, leading to injuries resulting from moves other than heading, according to some scientists.

But most importantly, they say, proper training leads to safe heading.

“If you are able to tighten the neck muscles, and that involves hitting it with the front of the head, the head does not move itself,” said Dr. James Kelly, a neurologist at the Chicago Neurological Institute. “It propels the ball.”

Duke Study: No Connection

A study at Duke University of 26 college players concluded that intentional heading does not cause concussions, and that such an injury resulted most often from head-to-head collisions.

“Everything we’ve seen does not indicate purposeful heading as a cause of cognitive dysfunction,” said Donald Kirkendall, who participated in the Duke study and is a clinical assistant professor at the University of North Carolina at Chapel Hill School of Medicine. “Can the ball cause head injury? Yes, if it is accidental contact and the player is not prepared.”

Because of that, Kirkendall said, players should be discouraged from using their heads to pass the ball away from the direction in which they are facing, a move commonly called a flick-on. The ball often flies off in a random, unexpected direction, he said.

Kirkendall and other researchers will begin in January to track national team players under age 23 over the next five years. Financed by a $50,000 grant from the United States Soccer Foundation, the study will examine how the players perform on annual cognitive tests. By comparing three categories of subjects — a control group, a group of players who have had concussions and a group of players without concussions — the researchers will be able to determine whether heading results in long-term injury, Kirkendall said.

Parents of soccer players appear to be as split as the experts over heading. Mason, the A.Y.S.O. official, led a push last spring to have heading banned from games and practice sessions for players under age 10. The proposal got unanimous support from subcommittees of coaches and referees, but it was defeated by 10 votes out of the 500 cast at a meeting in May of A.Y.S.O.’s executive committee in Tampa, Fla. Mason said that some supporters of the proposal would most likely push for it again, perhaps in a more limited version in which heading would be allowed during practice.

Banned in Grand Rapids

In Grand Rapids, Mich., where the parks and recreation department runs fall leagues with 1,100 players from ages 5 to 13, heading is banned in games and practice. If the ball touches a player’s head, it is ruled a violation. The rule has been in place for 15 years, and few parents object to it, said John Judnich, the recreation supervisor of the department.

“We’ve seen research both ways, but there’s no guarantee that heading does not cause injuries,” he said. “And when young kids attempt to head the ball, there’s not much accuracy. They may hit another child’s head, another child’s body or a goal post.”

In Riverside Park last weekend, Spurrier’s son, Ian, offered words of both enthusiasm and caution as he hung around with his teammates after their game. “It’s fun,” he said of heading, “but sometimes it hurts, and we kind of have to do it in the right way, because if we do it in the wrong way, we could get in trouble.”

Six blocks away, a group of 11- and 12-year-old girls in bright blue jerseys stood in a circle practicing headers before a game. As two coaches looked on, a girl in the center lightly tossed the ball at the heads of each of her teammates. One them, Natasha Mischenko, said that “heading it into the goal is cool,” even though it hurts.

On the sideline, one parent, Susan Ochshorn, was more concerned about the pain than the cool factor.

“As a parent, it makes me a little nervous, frankly,” she said. “I don’t know enough about it. I just think of their wonderful brains there, and I wonder if there will be any damage. I just have this visceral reaction to watching their heads butt the ball.”