Concussion Expert Speaks Out About U.S. Soccer Federation Heading Guidelines

Bianca Edison, MD, MS, FAAP, an attending physician in the Children’s Orthopaedic Center and assistant clinical professor of Orthopaedics at the Keck School of Medicine of the University of Southern California, penned an essay in response to the U.S. Soccer Federation’s new guidelines regarding the technique of heading in practice and in regulation play:

“As a sports medicine physician who treats many youth who have suffered from concussion-related injuries at Children’s Hospital Los Angeles, as well as a mother of two young children, I commend the U.S. Soccer Federation for taking a leadership role in being a catalyst for change and injury reduction in youth soccer. Banning heading for children under the age of 10 can help reduce risk of injury as one’s neck and trunk strength at those ages is not as well developed, nor is the coordination of those muscles to help keep stability to the head when initiating contact with the ball. Moreover, young children may often become fearful of the ball when it is approaching their head, forgetting about proper technique.

“While new guidelines and recommendations from the USSF on heading can help reduce risk to the brain, neck and spine, heading only accounts for a small portion of why concussions occur in soccer. Collision, rather than purposeful heading, has been found in recent studies to be the most likely cause for acute head injuries in soccer. Head-to-head, head-to-body part, and head-to-ground collisions in soccer account for most concussions.

“I would challenge the USSF and its affiliates to use their player safety campaign as an opportunity for proactive awareness and education regarding injury risk and management, to include concussion. As heading is still included in many sports leagues within these age groups as well as older age groups, it is important for athletes to learn proper heading techniques, even if not using regularly during game play.

“Age-appropriate players should have proper instruction on correct heading technique and emphasis should also be placed on neck and trunk strengthening exercises. Drills to develop neck strength and skills using beach or light-weight dry foam balls can be done to teach form without exposure to recurrent head trauma. Developing these skills is essential to appropriate implementation later.

“At the Children’s Hospital Los Angeles Sports Medicine program, we often provide our athletes with neck strengthening exercises to work on at home and integrate into practice. Players should never be forced to head a ball if they are fearful. The ball should be the age-appropriate size, water-resistant, and inflated properly. Goal posts should be padded and other equipment outfitted correctly.

“While regulations regarding play are important, education is even more critical. Awareness of the signs and symptoms of concussion, and knowledge on concussion management and return to play protocols are important to prevent serious injury. Efforts to ensure that young athletes feel comfortable notifying someone when they are hurt keeps our young kids healthy. Those efforts also help to maintain the longevity of their athletic careers. The USSF’s recommendations are wide-reaching, as more than 3 million youth are registered to play. As the governing body over the sport in the United States, the organization’s guidelines about heading will help raise awareness that concussions are a significant risk in soccer. Everyone — coaches, parents and athletes — needs to be serious about recognizing and addressing such an injury.”

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