North Carolina has a lot to be excited about these days when it comes to professional soccer. We are in the midst of our first Major League Soccer season with Charlotte FC, and the World Cup is approaching again in the fall. This time around the United States National Team has qualified, which makes it all the more exciting for soccer fans all over the country, myself included.
In addition to being a pediatric sports medicine physician, I’m also one of those thrilled American soccer fans. There are going to be kids everywhere, including the Carolinas, working hard on their soccer skills this summer and fall, trying to mimic their favorite soccer stars.
One of those skills – heading the ball – is one younger players have waited longer to perfect than we did as kids. Since 2016, U.S. Soccer, the sports’ governing body, has recommended that children 10 and under should not head the ball in practice or games and that children 11 to 13 be limited to no more than 30 minutes of practice heading the ball and no more than 20 total headers per week.
The group also advised that substitutes for players being evaluated for a head injury should not count against the total number of substitutions in a game.
As a physician, I support many of the 2016 guidelines, based on what we currently know. Limiting the number of headers kids are doing should help decrease the rate of concussion. And it’s an easy thing to focus on because it's something you can change or regulate out of the game. But minimizing headers might not be as effective as limiting player-to-player contact.
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Headers have gotten a lot of publicity this past half-generation because of the rise in concussion injuries and because soccer is a common sport for concussion injuries. Focusing on a skill that involves your head is a logical place to go. But in actuality, I rarely see concussions in patients from headers.
In our clinic, soccer players get injured more often from collateral damage while trying to head the ball. It’s not usually the appropriately-headed ball that causes an issue for kids. It’s the head-to-head collision or the elbow to head or the miss-hit.
There’s research to show this is a national trend. A large study published in JAMA Pediatrics in 2015 looked at concussion in high school soccer players from 2005 to 2014 and found that contact with another player was the most common concussion mechanism for both boys (68.8%) and girls (51.3%).
Trying to limit player to player contact in soccer is difficult. What coaches can do, however, is to focus on teaching proper heading skills because the properly headed ball isn’t often where injuries occur. Older children who are allowed to head the ball in games should work on perfecting headers in practice, in controlled environments, rather than during the chaos of games.
Coaches can also stress the importance of avoiding upper body contact when possible. Heading the ball for most young players is not a high-percentage play anyway. They’re probably best off playing the ball to their feet.
The goal of reducing concussions in youth sports is a worthwhile challenge. Parents and coaches alike need to do their best to stay informed of significant new information as well as the rules. For now, let’s continue engaging in safety research and these discussions, and let’s also enjoy the games — both the ones on television and the ones on our youth soccer fields.