Soccer Headgear: Does It Do Any Good?

Most soccer players on the Santa Clara University women's team will enter the N.C.A.A. quarterfinals today wearing protective equipment - headgear - that is as controversial as it is lightweight.

In the 15 months since FIFA, soccer's world governing body, began permitting its use, headgear has been worn by thousands of American players from youth leagues to high schools to colleges to the pros. The headgear gained international visibility during the 2003 Women's World Cup and the Athens Olympics this summer.

This has triggered skepticism within the United States Soccer Federation, which contends that marketing to the fears of parents has trumped science regarding the effectiveness of headgear in preventing concussions.

This resistance has not dissuaded some youth clubs from requiring the use of headgear.

"I remember when baseball players didn't wear batting helmets," said Steve Ryan, commissioner of the Major Indoor Soccer League, which approves of headgear. "You see some resistance in soccer, which is natural. But I expect, over time, you will see it broadly accepted."

The founder of a San Diego-based company called Full90 said he had sold 100,000 pieces of headgear. The headgear resembles an enlarged headband, weighs less than 2 ounces, and covers the forehead, temples and occipital bone in back of the head. The device is made of shock-absorbing foam situated between an outer layer of Lycra and an inner layer of sweat-absorbing polypropylene. Several models are available for $24 to $39.

Full90 does not claim that its headgear prevents concussions. But the company does say the headgear can reduce, by up to 50 percent, the peak impact forces that occur during typical collisions when a player's head strikes another head, the ground, an elbow or a goal post.

The headgear debate is occurring at a time when some studies indicate that concussions occur in soccer at a rate similar to the rate in football.

There also is disagreement on whether heading the ball can cause concussions or long-term brain impairment. Studies have presented contradictory results, and the matter remains disputed as the soccer federation undertakes a long-term examination of head injuries.

The resolution of these head-related issues could have far-reaching health and financial impacts, given that nearly 18 million people play soccer in the United States.

On one side of the headgear argument is Jeff Skeen, founder of Full90. He said he developed the protective device after his daughter Lauren suffered two soccer-related concussions in high school, causing her to quit the sport.

At 46, Skeen possesses the righteousness of the aggrieved parent. He believes his product can reduce head injuries without giving an illicit advantage in heading the ball.

The soccer federation, which permits headgear but does not endorse it, fears that its wide use would undermine the assertion that soccer is a safe alternative to football, Skeen said. He likens the doubt of soccer officials to familiar but failed arguments once made against the use of bicycle helmets, automobile seat belts and soccer shin guards.

"They are trying to thwart the evolution of headgear in soccer because they think it will scare soccer moms away from the sign-up table," Skeen said of soccer federation officials. "And because they think it could be viewed as an admission that heading the ball itself is dangerous."

Calvin Williams, founder of the Kangaroo headgear company, said he thought soccer officials resisted the equipment because they felt "it is sissified."

Soccer federation officials disagree, saying their caution is based on scientific uncertainty.

Insufficient independent evidence exists to confirm that headgear can reduce the risk of head injuries, they say. Doctors affiliated with the federation also say that headgear is being marketed primarily to children, who least need them because there is little incidence of concussions in players under the age of 12.

Players might develop a false sense of security, relying on headgear instead of proper medical evaluation after suffering a concussion, federation doctors say. Or, they say, players might feel invincible in headgear and play with reckless aggressiveness, displaying behavior known as the Superman effect.

Rather than headgear, federation officials advocate better technique, stricter rules enforcement and improved officiating to reduce the number of head injuries. Some also recommend mouth guards and padded goal posts instead of padded headgear.

"There is no evidence headgear are going to help, and some theoretical stuff that it could hurt," said Dr. Gary Green, a clinical professor at the U.C.L.A. division of sports medicine who is on the soccer federation's medical advisory committee. "Why take a chance until this gets studied?"

Because Full90 pays some pro players (the equivalent of $50 to $100 per game, it says) and some state soccer associations ($4,000 to $10,000) to endorse its product, the soccer federation says the company's claims are suspect.

"We're talking about marketing and fear and manipulation," said Dr. Bert Mandelbaum, team physician for the United States national teams.

Dr. J. Scott Delaney of McGill University in Montreal said laboratory data, not yet published, does indicate that headgear could reduce impact forces by 10 to 30 percent. (The soccer federation says this involves low-level forces that don't cause concussions.) Delaney said an industry standard for headgear has been drafted and could be instituted in May.

In a study, published in the Clinical Journal of Sports Medicine, Delaney queried 328 Canadian university football players and 201 university soccer players as they reported to fall training camp in 1999. He found that 70.4 percent of the football players and 62.7 percent of the soccer players had experienced symptoms of a concussion in the previous year.

"We've shown concussions are a problem, and in the lab these things work," Delaney said of headgear. "What else do you need? Why wouldn't you start protecting people?"

Studies involving large numbers of players can occur only after headgear is used widely, said Delaney, who is team physician for the McGill soccer team and the Montreal Alouettes of the Canadian Football League.

The concern over concussions, and whether headgear can protect against them, is a growing issue for youth soccer associations. In September, the New York State West Youth Soccer Association, which governs more than 200 clubs and 80,000 youths in the Buffalo-Rochester area, voted to require headgear for all players under 14.

The association later retreated over concerns about liability and protests from some coaches and officials. Several coaches interviewed in Rochester wondered why headgear were proposed for young children and not for older teenagers, who are more likely to get concussions.

"Where are you going to draw the line? Make everyone wear knee braces?" said Tom Maines, who coaches an under-10 boys team in Brockport, N.Y.

Ross Paule, a midfielder for the Columbus Crew of Major League Soccer, wore Full90 headgear for a dozen games in the recently completed season, seeking some security after suffering three earlier concussions.

"I'm on the fence," said Paule, who was not paid to endorse the headgear. "I don't agree it should be mandated. If something makes you comfortable, why not?" He added: "I can't tell you if it was a huge help. When I got hit one time, maybe it gave me a little extra cushion."

Any club or association that makes headgear compulsory risks losing its affiliation with the United States Soccer Federation, Dr. S. Robert Contiguglia, its president, said.

But that threat is either unknown or ignored by the Temecula Valley Soccer Association in Southern California, which for three seasons has required headgear for players under 8. Peter Schilperoort, president of the association, said headgear prevented bumps and cuts previously suffered by his players, calling the equipment "the best thing since sliced bread."

The De Anza Force soccer club of Cupertino, Calif., will require headgear for players under 17 beginning in March, said Tom Pridham, a club official. Both the Temecula and De Anza clubs are sponsored by Full90.

Jerry Smith, coach of the Santa Clara women's team, which received free headgear from Full90, said the equipment made his players more confident in challenging balls in the air, and more assertive, but not overly so.

Anson Dorrance, who has coached the women's team at North Carolina to 18 national championships, said compulsory use of shin guards had not changed the nature of soccer, as many feared. He predicted that headgear would not, either.

"I'd challenge any of these doctors who feel this has no value to run into the goal post without a Full90 and with it, then tell me, if they were forced to do it a third time, whether or not they would wear it," said Dorrance, whose team is also sponsored by Full90.

Several players, including Joy Fawcett of the United States women's national team, who endorses Full90, discounted the so-called the Superman effect, saying the headgear did not make players dangerously aggressive.

"It's like a flag that reminds you not to go up for stupid plays," said Jill Conaboy, a defender at Downingtown West High in suburban Philadelphia, who wore headgear last weekend as her team won the Pennsylvania Class AAA state championship.

Kathy Conaboy, Jill's mother, said she held no illusion that her daughter, who has suffered two concussions, would never be hurt again while wearing headgear. What she hopes, she said, is that a blow that might have caused a third concussion will result in only a bruise.

"A seat belt is not going to save a life in a 90-mile-per-hour crash into a wall," Kathy Conaboy said. "A 30-mile-per-hour crash, a fender bender, it helps. I'm looking at this as a seat belt."

I have been a soccer coach for 45 years on all levels. I have seen this coming for the last 20 years.

This subject has been knocked around at many coaches meetings. The general consensus from the coaching community goes something like this.

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If players are taught the proper way to head a ball, there is little to no injury. The problem here is that there are so many amateur coaches out their in the youth leagues, a lot of them don't know how to teach it.

Serious head injuries occur in two ways:
1. Players bumping heads. This is by far the most common head injury.
2. Playing on a hard field and coming down unbalanced and hitting the head.

There is an even more serious issue and that is one of players jumping up and pulling down the goal post on their heads from a non secured goal.

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I can actually see the need for headgear for the ages of around 10 to 15. That is a crucial growing time for the head. But at 16 and up the remaining players that have not gone on to the fat sports know pretty much what they are doing and the head development is almost mature.

It is ridiculous for college players to be wearing head gear. But look at what liberal school is using them.

I have no problem with padding the keepers more than they are. Playing goal is going to be somewhat more dangerous than other positions, particularly for aggressive players, but the problem with aggressive players is that if you pad them like football players, they're going to play like football players. It's really incumbent on referees to do an adequate job of protecting the keeper as well, or else it'll turn into a damn rugby scrum every time the ball crosses the penalty arc.

The other thing I've seen from time to time is that sometimes you'll get leagues who have one-size-fits-all goalposts to try accomodating all ages, where the goalposts split the difference between youth and adult players, which causes the goal to be too small for older players. For players 12 and up, the goal really should be FIFA standard-regulation 8 feet high by 24 feet wide - anything less is just asking for trouble.

If you think that the Full90 or other headgear is seen as a "fashion statement", then you obviously don't have a teenage girl!

Confession: You are correct, I don't have a teenage girl.

I guess what I was getting at was that once headgear use reaches a certain 'level', the fashion imperative will kick-in. Cut & color are going to be as important as functionality.

Hope your daughter doesn't have continuing problems with concussions. My experience from football is that successive concussions come easier after you've had that first one. After a while, no headgear is going to help.

1. Players bumping heads. This is by far the most common head injury.

Exactly. Typically, for older players, two guys go up after the ball and header each other instead. I'm of two minds on this - headgear would certainly mitigate that, but then again, I've rarely seen the same player do that more than once. Clunking heads tends to instill a certain amount of situational awareness, so to speak ;)

The other common thing I saw was players engaging in the classic "dangerous play", where they dip their heads down into the other fellow's kicking zone. That's an instant penalty for dangerous play when I was refereeing. Failing to keep your head up is hazardous play, and if the coaches are not teaching that, the referees are, again, responsible for protecting the players - in that case, from themselves.

I can actually see the need for headgear for the ages of around 10 to 15. That is a crucial growing time for the head.

I can sort of buy that. But the thing is, the younger you get, the less common head injuries seems to be. Under 12, most players just aren't coordinated enough to make headers a regular part of their repertoire, so you just don't get as many situations where head injuries are likely. If parents want it, by all means they should have it. Unfortunately, I think the next inevitable step is requiring it, and I'm not so sure that's a good idea.

Unfortunately, more than a few refs do little to protect the keeper. Their attitude seems to be that if my daughter is "stupid enough to play goal, she has to be tough enough to take what she gets." The girl that kicked my daughter square in the head should have been red-carded, but didn't even get a yellow. If she could legally play soccer with a combination catcher's mask/NFL helmet on, we'd have her wear it!

My son played travel soccer for one year when he was 10. We couldn't get out soon enough. You are absolutely correct that the travel soccer teams even at that age are hypercompetitve to the point of being reckless with the kids. Your lightning story is pretty typical.

Both my boys have played football for 3 years now and I have yet to see a significant injury or cutthroat behavior. I've no problem putting on padding (I make them where rib cages). The idea that soccer is safer than football is a canard.

I've coached soccer both competitively and recreationally for fifteen years. I have no doubt but that most injuries are caused by poor coaching and poor officiating. A properly executed header will not cause a concussion and will not even hurt. The best change that could be made in soccer today--eliminate the shoot-out to resolve tie games and instead pull both keepers from the field and play golden goal.

Stryker

Well, keep in mind that as she gets older, the game is going to open up a bit - that's just the nature of the beast. That being said, it seems like there's four video cameras per player at games these days, so if you see something that looks like it's clearly over the line, don't be shy about getting the coach to approach whoever's in charge of officiating for your league.

Our local park district has a 30-minute rule. Any time the park district rep sees lightning anywhere in the sky, all activity is suspended for at least 30 minutes.

And travel soccer teams? That is where all the stereotypes end up! We've noticed that most of the high school soccer team comes from local teams and not travel teams - the travel team kids burn out from the sport and change to something else as soon as their parents outgrow the sport.

Playing men's indoor soccer about twelve years ago, I took a very hard and straight on shot from a ball I was heading and was momentarily dazed. I continued to play, however, and finished the game without incident. A few days later a co-worker noticed that my right pupil was noticeably smaller than the left. I went to a Henry Ford Hospital medical center in Troy, MI and they immediately recommended that I go downtown to the main hospital where I was admitted through emergency and diagnosed with a dissection of the right carotid artery. I was told that type of injury is almost invariably the result of head trauma and usually associated with auto accidents. The only trauma inflicted on my head was by that soccer ball.

My recovery was complete and though that was my last soccer game, I'm more physically active now and in better shape than at any time in my life. If I were to give soccer another try, I think I'd want to give something like this a try.

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