And Then, Soccer

In the 31st minute of the inaugural meeting between LAFC and the Colorado Rapids on Sunday, August 19th 2018, Colorado defender Kortne Ford slammed his head into the turf during a collision and remained motionless on the ground as play continued. After a stoppage, Ford was able to get to his feet and, though visibly unsteady, continue playing until substituted at halftime.

Four days later, Colorado released an injury report mentioning that Ford’s status for their next game was “Questionable-Concussion Protocol.”

American writing on concussions in sports is dominated by the American style of football; among styles that originated in England, rugby is mostly looked to as a source of ideas for greater safety (never mind its own concussion and CTE crisis, or the fact that the physics of large men colliding at high speeds does not change when they stop wearing pads) and soccer hardly features at all. Yet signs of a crisis in soccer have been there for decades: a 2014 New Yorker article features the story of Jeff Astle, who was diagnosed with CTE after his death in 2002. Long before the diagnoses began, of course, there were stories of center backs pounding aspirin to hold off the headaches before heading out and nodding away another dozen crosses.

Soccer is, compared to sports like football and rugby, well equipped to do something about head injuries: collisions like the one that injured Ford, though they can never be eliminated, are not a core part of the game in the way blocking and tackling are in American football. The chief suspect for CTE appears to be heading the ball: Astle was a center forward in the classic English mold, which is to say a player expected to get in front of the goal and knock in crosses with his forehead. Bellini, captain of Brazil’s 1958 World Cup winning team, member of the 1962 winning team, once again the captain of the 1966 team, and perhaps the most prominent player yet diagnosed with CTE, was the other side of the equation, a central defender expected to knock the ball away from forwards like Astle. A change as extreme as eliminating heading entirely (already the rule in some youth leagues) would certainly change the game, but in a game already significantly defined by what players cannot use it would be a survivable change.

But the prerequisite to action is recognition, and as Ford’s fifteen minutes of play shows soccer too often involves teams ignoring players in distress. More prominent incidents are easy to find: Hugo Lloris, goalkeeper for the World Cup holding French national team, returned to a game with his club in 2013 after being knocked out by an attacking player’s knee. The 2014 World Cup was particularly noted for players repeatedly returning to games following head injuries, culminating in German midfielder Christoph Kramer playing 14 minutes of the final after receiving a concussion (the referee, on Kramer inquiring, assured him that the game was indeed the final, and Kramer came off in the 31st minute when he was unable to continue). The 2018 World Cup did not feature quite so dramatic an incident as a player losing track of whether he was playing in the final, but it did feature Moroccan Nordin Amrabat, hospitalized due to a severe concussion suffered during a group stage match against Iran, returning to the field only five days later against Portugal.

Soccer can surely find reforms to improve the short and long term safety of the sport. Changes in heading rules (up to and including banning playing the ball with the head entirely), better enforcement of rules in situations that create dangerous collisions between players (particularly contests for high aerial balls, which often involve players jumping towards each other at high speeds with unpredictable results), giving teams better opportunities to evaluate and replace players who suffer injuries, and punishing teams who push players back to play too soon are all obvious candidates; many more worth investigating could undoubtedly be found with a little effort.

The first step is to admit that we have a problem.


Guest Author

Andrew P Larson is everything wrong with libertarians on the internet. He is on Twitter at @applarson.

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15 thoughts on “And Then, Soccer

  1. While concussions and CTE in Association Football clearly are a thing, I have never seen one of these articles that include numbers. We are told what there is a risk of, but not how high that risk is. Anecdotes are good for stating the issue, but not for evaluating potential policy changes.

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  2. A view from inside the issue…

    I am the league manager for a non-profit youth soccer organization, 1100+ kids. The more serious teams play year round, but we are mostly focused on the recreational side…and we take concussions very seriously.

    Our coaches and assistants have to go through a three-step process to be on the field with our players, this includes a national background check, becoming ‘Safe-Sport’ trained (covering sexual abuse, hazing, bullying, emotional misconduct, physical misconduct, harassment (non-sexual) as well as reporting obligations) and finally an online course covering injuries and most importantly concussion protocol. The online concussion class is 90 minutes, with testing afterwards to try and insure the subject matter stays with our coaches. In our pre-season meetings and emails we emphasize that player safety is the most important aspect of youth soccer to all of our coaches and parents. Our referees are also trained to look for concussion symptoms and to err on the side of caution whenever there is the potential for a head injury.

    At the younger ages (U9 and below) the goalies can’t punt the ball – they can only kick on the ground or roll it out (google build-out lines for more info). Heading the ball isn’t allowed until our 13/14 year-old age group and even then we encourage our coaches to not practice doing so at all.

    All of these protocols come down from US Soccer – I sincerely hope that all of the other youth soccer organizations are following these rules. Obviously MLS and other professional leagues should lead on this issue, but money and egos invariably get in the way.

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      • Soccer in general has a problem with fragmentation of authority, and the USSF/NFHS split within the US is a particularly large problem for coordinating action at the youth level. The trend of bans at very young ages is genuinely encouraging, though in my experience they tend to phase out around the age when heading became a meaningful part of the game for my unrestricted generation anyway (I played at low levels, but I think the general trend of headers being almost unheard of under 10 but routine by high school is more or less representative, for reasons that are mostly about how players develop in their ability to play the ball with their feet).

        One key thing I would highlight from Timothy Jaxon’s comment, though, is discouraging heading in practice. The RSNA study I linked above includes players who had 5400 recorded headers in a calendar year; that is not a number reached without extensive heading in practice. Between the rarity of heading in game (a particularly active player might reach the double digits) and the much greater amount of time spent practicing than playing at all but the lowest levels, simply changing practice techniques could drastically change the game’s health impact.

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        • 5400 recorded headers in a calendar year

          That seems pretty incredible. I’m just a parent observer, with a son that played on two traveling teams last year at U14, and in somewhere around 50 games, I doubt I saw a total of 1,000 headers. Certainly could be more in practice, but I really don’t think heading was an area of concentration (as opposed to ball movement, in game decisionmaking, footwork). Just to say, I think those number are outliers from my perspective.

          Also, agree that heading seemed rare at young ages. Preventing punts seems like it would go a long way to reducing the number of times that is an option. And just from watching my first three high school games, keepers seem more likely to roll it out anyway. (Though I suppose that is due to the punt option spreading the field)

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  3. It seems so odd to me that I could ride a bike to a soccer game wearing my helmet, take the helmet off to play soccer, and then put it back on again to ride home, and everyone would think that normal. But if I rode to the game bareheaded, put my helmet on to play soccer, and then took it off again to ride home, then I’d be thought weird.

    That, even though soccer sees about 20-30 concussions per 100,000 exposures (i.e. games and practices) (19 per 100,000 for boys, 33 per 100,000 for girls), while transportation cycling without a helmet has about 0.2 head injuries (a subset of which involve concussions) per 100,000 hours – literally a hundred times as safe with respect to head injuries.

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      • I don’t wear my bike helmet because of the risk of concussion. I wear it because the (admittedly small) risk of something much worse happening. Over the years I’ve had two colleagues who kept their bicycle helmet with some part completely crushed hanging in their office so when people asked, they could tell their story and finish, “And that’s why you wear your helmet!” The opinions in both cases by people qualified to have one were that w/o the helmet it would have been a fatal head injury.

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        • Depending on the study you believe, the risk of death by head injury from walking is somewhere between near-identical and double that of cycling. Since I am happy to walk without looking for ways to mitigate risk, I’m not going to worry much about cycling either.

          That’s “transportation cycling” not “bicycle sports”. Mountain biking or road racing are different beasts from riding on smooth pavement at a comfortable pace to destinations around town…

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          • One of the two was “tame” mountain trail — eight feet wide, paved with finely crushed stone, suitable for people in a powered wheelchair with fat tires. He had no idea why he fell because he lost the 30 minutes of short-term memory leading up to the event. Helmet bounced off a basketball-sized rock buried next to the side of the trail.

            The other was a transportation case — car drifted into the bike lane, didn’t touch him but he flinched so violently as it passed that he fell. Helmet bounced off the square corner of the curb. Driver didn’t stop.

            Most of where I ride these days I could do w/o the helmet. If I’m sharing the pavement with cars, though, I wear the helmet.

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  4. I do sport fencing. When I sat on the board of our state division of USA Fencing, one of the things we struggled with was to get coaches to pay attention to possible concussion symptoms. They’re rare in the sport, but do occur. Most commonly by falling backwards and hitting your head on a hardwood or concrete floor. When I have had to lead footwork exercises for beginners, I always have them do two or three retreats in a row and then look at how their feet wind up. Many are in a position where on the next retreat they’re going to trip on their own foot. Occasionally I can even convince some of them that there’s a reason that footwork drill is more than just going through the motions sloppily — it’s building muscle memory so you do it right, every time, w/o thinking about it.

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