On a turf field at a Washington, D.C., elementary school not long ago, the Jaguars were playing the Thunderbolts in a big fifth-grade boys’ soccer game. The airborne ball struck a Jaguar head. It bounced to a Thunderbolt head. Then another Thunderbolt head. And then a Jaguar head and another Jaguar head and finally to the ground. With each successive header, the parents oohed and cheered—how cute! how cool!—their delight echoing off of the school’s brick walls.
The game was part of a daylong school soccer tournament, and I was watching with the all-girls rec team that I coach. I don’t allow my team to head the ball. Naturally, then, when the girls saw the Jags and T-bolts Ping-Ponging the ball around the field with their noggins, they turned to gauge my response. I smirked and shook my head. Then, with the timing of a seasoned stand-up comic, one of the girls announced, “No wonder they’re all so dumb!”
It was less a statement of fact, of course, than an exquisite preadolescent takedown of the opposite sex. But lurking, literally, beneath every header is a mystery: Can the routine act of heading a soccer ball cause traumatic brain injury? The answer to this question still isn’t entirely clear, but I believe we know enough to say this much: It makes no sense to allow young children to knock their heads repeatedly against a soccer ball.
This week, the New York Times reported some sobering and potentially troubling news for the sport: the first documented case of the degenerative brain disease chronic traumatic encephalopathy, or CTE. The victim was Patrick Grange, a 29-year-old former college and semipro player who died in 2012 of amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease. “We can’t say for certain that heading the ball caused his condition in this case,” Boston University neuropathologist Ann McKee, who examined Grange’s brain, told reporter John Branch. “But it is noteworthy that he was a frequent header of the ball, and he did develop this disease. I’m not sure we can take it any further than that.”
McKee has found CTE—which can lead to memory loss, depression, dementia, and other diseases, including ALS, with which Grange was diagnosed at 27—in the brains of dozens of athletes. She said the sort of frontal-lobe damage in Grange’s brain had been seen in other deceased athletes in their 20s, but that all of them had played football. She also noted that the damage corresponded to the part of the head typically used to strike the ball—the upper part of the forehead. Grange, his parents told the Times, started heading a ball when he was 3 years old.
As a teenager in the 1970s, I watched Pele, when he played for the star-studded New York Cosmos, explain how to head a ball. First he pointed to his forehead. Then he placed the thumb and forefinger of each hand in front of each eye and opened them both wide. Then he dragged his thumb and index finger across his closed mouth. Moving his head and shoulders back in tandem to prepare to strike the ball, Pele demonstrated how the neck muscles needed to be tensed at the moment of impact.
Failure to take Pele’s steps can result not only in a misdirected ball but in greater force imparted to the brain. That’s because a header is a collision that can cause the brain to shake inside the skull. “If you take a header off the back of your head or the side of your head and it whips your head around, there are much greater forces, 40 or 50 G’s, as opposed to a proper header where the G-force is under 20,” Dr. Robert Cantu, a colleague of McKee’s and the co-author, with Mark Hyman, of the 2012 book Concussions and Our Kids, told me recently.
Most prepubescent children aren’t capable of making the necessary preparations to head the ball; they’re just not strong enough or aware enough or coordinated enough. And if they do keep their eyes open and their mouths shut and strike the ball with their foreheads, their neck muscles, even if tensed, aren’t strong enough to prevent their heads from absorbing what often are elevated G-forces. Plus, Cantu says, the heads of children are bigger and wobblier in proportion to the rest of their bodies than those of adults. The wobblier the head, the more likely the brain will shake inside the skull upon impact. Just as 6-year-olds aren’t developmentally ready to pass the ball to a teammate, 10-year-olds aren’t ready to head the ball.
(And girls might be less ready than boys. Girls’ heads are typically smaller than those of boys, and their neck muscles tend to be weaker. A similar blow to the head, consequently, might concuss a girl but not a boy. In a 2005 study at Temple University, the head and neck of female subjects exhibited “significantly greater” angular acceleration and displacement in response to an external force compared to that of the male subjects. Translation: The female heads and necks moved more and faster, increasing the risk of brain trauma.)
It shouldn’t take much to persuade an impartial observer that heading in youth soccer is pointless. Watch a recreational or even an elite travel soccer game involving preadolescents. Heading, when it occurs, is usually a random act. Eyes shut. Head scrunched into neck. Shoulders clenched. The ball usually makes contact on the top or the rear of the skull. It isn’t directed to a specific place—to a teammate, toward the goal, out of bounds. It ricochets to points unknown, in direct opposition to a fundamental teaching tenet of the sport. Players would get better at soccer by learning to control the ball out of the air with other parts of their bodies.