Use your head — or maybe don’t

Study of soc­cer play­ers shows head­ers cause more dam­age to women than men

USA TODAY US Edition - - SPORTS - Amanda Chris­tovich

The loud clack­ing sounds and co­coon­like en­closed space of the MRI ma­chine lulls soc­cer player, teacher and now coach Kiah Mahy, 25, into a peace­ful slum­ber for the du­ra­tion of a two-and-a-half-hour scan.

Mahy, along with 97 other am­a­teur soc­cer play­ers, had MRIs as part of the Ein­stein Soc­cer Study at the Al­bert Ein­stein Col­lege of Medicine, an on­go­ing ef­fort that hopes to de­ter­mine the ex­tent of brain dam­age from head in­juries in soc­cer.

The study found that women who headed the ball a sim­i­lar num­ber of times to men (ages 18-50) in a 12-month pe­riod ex­hib­ited five times more ex­ten­sive brain tis­sue dam­age than men. The find­ings were sig­nif­i­cant not only be­cause they sup­ported a long­stand­ing be­lief that women ex­pe­ri­ence more trau­matic head in­juries than men, but also be­cause the study takes the deep­est dive into soc­cer-re­lated head in­juries and sex to date, ac­cord­ing to re­searchers. The find­ings also sup­port in­di­vid­u­al­ized head in­jury pro­to­col, sug­gest­ing a com­pletely new ap­proach to sports-re­lated head in­juries.

“I think the scari­est part is just how un­known they are, how big of a deal they can re­ally be, es­pe­cially for women,” Mahy, who is from Greenwich, Con­necti­cut, said in a phone in­ter­view with USA TO­DAY. “It’s so im­por­tant that ev­ery­one knows how bad con­cus­sions are in foot­ball, but I feel like that’s tak­ing all the fo­cus … that there isn’t any in­for­ma­tion is scary.”

To fill this in­for­ma­tional void, re­searchers ex­am­ined 49 women’s and 49 men’s brains. They found eight brain re­gions dam­aged by soc­cer head­ing in women and only three in men.

But what do these find­ings mean? Af­ter all, whis­pers of CTE have al­ready tar­nished soc­cer: Over 250 for­mer pro­fes- sional soc­cer play­ers have suf­fered from “some form of neu­rode­gen­er­a­tive dis­ease,” ac­cord­ing to the Jeff As­tle Foun­da­tion founded in honor of for­mer Bri­tish soc­cer player Jeff As­tle, who was posthu­mously di­ag­nosed with CTE.

Does the brain dam­age found in the study di­rectly cor­re­late with CTE?

“I def­i­nitely want to be clear that I’m not say­ing that these peo­ple are des­tined to de­velop CTE,” study leader Michael L. Lip­ton, M.D., Ph.D., pro­fes­sor of ra­di­ol­ogy and of psy­chi­a­try and be­hav­ioral sci­ences at Ein­stein, a re­search in­sti­tute in the Bronx, in New York, and med­i­cal di­rec­tor of MRI Ser­vices at Mon­te­fiore, said in a phone in­ter­view with USA TO­DAY. “So I think that while (the study) is not nec­es­sar­ily in­ex­orably lead­ing to a bad out­come, it does sug­gest that there is some­thing go­ing on in the brain re­lated to head­ing. And that it’s an area that re­ally mer­its look­ing at more closely.”

These find­ings, part of a larger study, were pub­lished at rsna.org.

Lip­ton be­lieves the next steps for re­search­ing head­in­gre­lated in­juries in soc­cer in­clude cor­rob­o­rat­ing his find­ings, re­search­ing long-term ef­fects of this brain dam­age and de­ter­min­ing why women suf­fer more ex­ten­sive brain dam­age than men.

Af­ter con­duct­ing more re­search, an­swer­ing the last ques­tion could lead to “in­ter­ven­tions” that might in­form more suc­cess­ful safety proto- cols in the fu­ture.

“It’s likely that there needs to be dif­fer­ent ap­proaches and tai­lored rec­om­men­da­tions for peo­ple based on sex,” Lip­ton said. “But not only based on sex — there may be many ar­eas where a more per­son­al­ized ap­proach will al­low us to re­ally pro­tect peo­ple bet­ter, but also not over­pro­tect peo­ple in ways that isn’t nec­es­sary.”

U.S. Soc­cer has al­ready im­ple­mented changes to pro­tect youth soc­cer play­ers from head in­juries. In 2016, the or­ga­ni­za­tion be­gan en­forc­ing a con­cus­sion ini­tia­tive that banned head­ing in soc­cer for chil­dren 10 and younger and lim­ited the amount of head­ing in prac­tice for chil­dren be­tween the ages of 11 and 13. The suc­cess of the rule, of course, is pred­i­cated on youth coaches en­forc­ing the rule.

Of course, the ini­tia­tive fails if coaches do not en­force it. When study par­tic­i­pant Rachel Hirsch, 25, ref­er­eed in the Westch­ester Youth Soc­cer League in New York, she says she of­ten found that young play­ers would break the no­head­ing rule even af­ter she re­minded them that head­ing was pro­hib­ited.

“I don’t think that coaches are nec­es­sar­ily fol­low­ing (the con­cus­sion ini­tia­tive) as much as they should be,” Hirsch said in a phone in­ter­view with USA TO­DAY. “A lot of times, kids who headed the ball, it seemed like they were do­ing it out of re­ac­tion, like mus­cle mem­ory. And so that to me in­di­cates that they’ve been head­ing the ball pretty reg­u­larly.”

Mahy said she be­lieves head­ers should be pro­hib­ited al­to­gether.

“I think when (the con­cus­sion ini­tia­tive) first came out, I kind of said, well, that changes the game — I didn’t like it,” Mahy said. “But the more I think about it, and the more I’ve started coach­ing stu­dents on my own … hon­estly, I think that we shouldn’t head the ball at all.”

And soc­cer would change. Mahy said the ball would more of­ten re­main on the ground and that scor­ing would be­come even more rare. Young soc­cer play­ers also could no longer em­u­late scor­ing tech­niques of their he­roes, such as those of two-time Olympic gold medal­ist and World Cup cham­pion Abby Wam­bach, who scored a record 184 in­ter­na­tional goals of­ten with head­ers.

The best prac­tices for pro­tect­ing women from header-re­lated in­juries re­mains un­clear, but both re­searchers and study par­tic­i­pants say they be­lieve the topic mer­its more at­ten­tion.

Said Hirsch of the head in­juries she has wit­nessed: “At that point, it’s more than just about a game.”

DAVID BUT­LER II/USA TO­DAY SPORTS

U.S. mid­fielder Julie Ertz, cen­ter, and Aus­tralia for­ward Hay­ley Raso (16) work for the ball in the Tour­na­ment of Na­tions on Sun­day.

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