Soccer Head Injuries & Protection
C. J. Abraham, Ph.D., P.E., FRSC, DEE, JD *
Technical Director - ForceField FF (NA) Ltd.
How many times has a parent or coach of a child playing a contact sport either seen the child/adult get "bonged" or "dinged"? How many times does that experience go unreported?
For decades we have all enjoyed watching athletic teams of all ages, face off and score those points. As participants, they have taken pride in stretching their athletic performances. Whether we block the offense, make a winning pass, or simply run up and down the field, sports will always be a source of pleasure, challenge and fitness.
Unfortunately, contact sports and some recreational sports carry risks for serious head injury. While many people may think that this is obvious, most are not aware that small repetitive brain injuries that can cause long-term damage. There is documentation that continuous sub-concussion level impacts can also result in long term neurological deficits that manifest themselves during the playing time or after the individual is retired from the sport. Soccer is now only second to football in the incidence of concussion in children playing sports. Medical data is mounting on the long term effects on the brain. Literature has indicated that there is a significant risk of permanent brain injury for serious soccer players. Further, there is a high incidence of concussions among youth soccer players. The American Academy of Pediatrics classifies soccer as a "contact/collision sport". J. Scott Delaney, MD, et al. of McGill University in Canada has published, "Concussions Among University Football and Soccer Players: A Pilot Study (on the Internet) and Head Injuries Presenting to Emergency Departments in the United States From 1990 to 1999 for Ice Hockey, Soccer, and Football" (1). He concluded that the, "rates of head injuries for these (3) sports are comparable not only in elite athletes but also in the athletic community as a whole."
A peer reviewed article, "Heading the Ball in Soccer: What's the Risk of Brain Injury?" by Michael J. Asken, et al. and published in THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 11 - NOVEMBER 98, concluded that:
soccer players' reports of increased neurologic symptoms such as headaches, heading-related migraine, neck pain, and dizziness;
the report by Tysvaer and Lochen of neuropsychological changes in soccer players as compared with hospitalized controls;
neurodiagnostic findings of ventricular changes and atrophy in 10% to 33% of former soccer players;
MRI changes in 9 of 20 members of the US National Team, some with focal atrophy; and
more frequent abnormal EEGs in active soccer players as compared with male non-athletes.
Competing in contact sports exposes both children and adults to higher risks of a head injury. This can result in a change of mental status. The injury that causes a change in mental status is called a concussion. The contact sports that expose the participants to concussions include, but are not limited to: full contact karate, soccer, football, ice hockey, lacrosse, rugby, wrestling and boxing. The head injury can be caused without contact the head directly. A direct blow to the neck or upper body can also produce a concussion. Significantly less force is required to produce a second concussion.
When a player has a fractured leg or fractured arm and other injuries that are visible to the rest of the team members, it is understandable why he/she is not participating in the game. However, when a player receives a concussion or head trauma and is not playing, it can be embarrassing and the peer pressure can force the player back into the game when he/she does not admit to the severity of the condition and how he/she truly feels. This is a hidden danger to the player, his parents, his coach and the athletic trainer for the team. The "win at any cost syndrome" can be a detrimental one to all concerned especially the injured player.
According to Michael Collins, Ph.D., a neuropsychologist from the University of Pittsburgh, there are 3.8 million sports-related concussions per year, most of which go undiagnosed. He went on to state at a William "Pinky" Newell Lecture that the injured victims continue in their chosen sport and are re-injured risking the possibility of permanent problems for the rest of their lives.
In most cases, concussion diagnosis is flawed because there is a dependence on the injured player to report his symptoms. Even with all the technologies available, the medical profession is still dependent on the player telling the coach, trainer and/or parent that, "I just don't feel right." What is worse is that most of the young children receiving head injuries in a contact sport do not have access to a medical specialist to whom they can make that statement.
There is no helmet or protective headgear available that is capable of eliminating concussions. The helmets are designed to reduce the risk and/or eliminate subdural hematomas. The helmets have solved that problem but not the problem of concussions and the damage caused by impacts at sub-concussion levels. In soccer, the risk is higher when the player in not wearing any protective head protection.
With reference to the sport of soccer, the ForceField FFTM Headband protector looks just like a regular sweatband. It is lightweight, ventilated and adjustable. An impact absorbing polymeric layer is located within the sweatband, The band wraps completely around the head offering increased protection at crucial impact zones at the forehead and back of the head. It is an advanced technological patented design that does not detract from any of the techniques involved in playing the sport.
Because of the design of the headband, the ball will always play as true as if it were coming directly from a player's head (without protection). The only difference, which is significant, is that the player will experience between 50 to 80% less impact force to the brain.
The ForceField FFTM Headband has been independently tested extensively at McGill University in Montreal, Canada and at Intertek Laboratories in Cortland, New York. The test data shown on the ForceField website (www.forcefieldheadbands.com) is self-explanatory. It is also cited in Exhibit A.
What is important to note is that the headband, by itself, passes the impact test for an actual hockey helmet. In contrast, the Nike sweatband does not absorb or dissipate any impact force of significance.
Although still not widely known, it is now accepted by pediatric neurologists that children, especially infants and preschoolers up to the age of seven, have a substantially higher vulnerability to neurological trauma than adults. Some of these long-term effects do not manifest themselves until after the child has reached adulthood (2). Dr. Beaulieu recently published findings showing that children who sustained injuries in their first five to six years exhibit less recovery of and greater impairment to intellectual skills as compared with children who are aged between six and sixteen. The age of injury and the injury's severity dictate the rate and extent of recovering from deficits in language, memory, attention, and academic and decision-making skills (3).
From a neurological standpoint, the ForceField FFTM Headband is highly beneficial for all players. Every time a player absorbs a direct impact to his/her brain area, neurons can be either destroyed or damaged. A brain contains billions of neurons. The neurons process all of the information that flows from within, to, or out of the central nervous system (CNS). All of the motor information through which we are able to move, all of these sensory information through which we are able to see, taste and to touch, and of course, all of the cognitive information through which we are able to reason, to think, to dream, to plan, to remember, and to do everything else that we do with our minds is affected. Each of these neurons is connected to between 5000 and 200,000 other neurons.
It is a known fact that when neurons are damaged or destroyed they can regenerate and/or repair themselves. Since they generate electrical signals called action potentials that provide all of the motor information described above, it is important for every child, teenager and adult to reduce the risk of damaging or destroying any portion of the neurons in their brain. Neuronal reorganization after head trauma has a significant impact on long-term development.
Even if regeneration and repair take place, there is no guarantee that the individual's brain will normalize to its initial state. No neurologist, brain surgeon or medical theoretician has been able to disprove that statement. As a result of continuous damaging and destroying neurons, without receiving a concussion, one can permanently affect his/her behavior, memory, maturity and learning capacity. No one has been able to measure the magnitude of the initial deficit. However, as the individual ages, there have been numerous reported cases where his/her brain starts to deteriorate. This has been recognized and reported in the sport of boxing and football.
Sporting authorities around the world are beginning to digest reports published in medical and scientific journals concerning an Italian study that suggests that footballers are six times more likely to develop motor neuronal disease (MND) than the general population.
The illness is incurable. Neurons that carry the brain's messages to the body degenerate as described above. In Britain, neurologists have connected related illnesses such as MND, Parkinson's or Alzheimer's to repeated brain trauma either from heading the ball, clashing of heads or an elbow to the head to be the precursor to the ultimate neurological problem.
In 1974, The Sunday Times quoted that the British coroners' findings relating to eight deaths was directly caused by heading in football (soccer). It is only through well directed epidemiological and prospective studies that accumulated data from the past can now be accurately analyzed.
A London neurologist, Professor Andrew Lees studied the case of Ray Kennedy who developed Parkinson's Disease soon after helping Liverpool win three European Cups. He concluded that Mr. Kennedy's illness could have been detected 14 years before he was diagnosed at the age of 35. It is also known that Jeff Astle died at the age of 59 from brain injuries caused by repeatedly heading a football in his 20-year career.
Ballistic engineers at the University of Glasgow demonstrated that they soccer ball can approach a speed of 80 mph prior to impacting with one's head. It should also be noted that Billy McPhail, a player with the Glasgow Celtics in the 1950's, wound up disabled with pre-senile dementia and died in 2003. Other football players of note was Celtic player Jimmy Johnstone who, in 2002 was diagnosed with ALS; former England manager Don Ravie-ALS; Derby's Rob Hindmarch-ALS and Middlebrough's Willie Maddren-ALS.
A 1992 Norwegian study found that 35% of active soccer players in that country had abnormal brain scans, and another study in that country of retired professional players found one third (33%) of them had brain atrophy or a shrinking of brain tissue that resulted in behavioral and cognitive problems. The study concluded that the damage was directly related to repeated heading.
Although young children and teenagers do not experience the extreme force of the ball that the professionals experience, their skulls and skills have not matured and are constantly at risk. Rob Hughes, a columnist for The Sunday Times, stated in 2005 that, "The line between a hardy and a foolhardy sportsman is sometimes too blurred to sense, let alone to see."
One of the major benefits of wearing the ForceField FFTM Headband when participating in soccer is to reduce the risk of damaging and/or destroying neurons. Another benefit is that the impact force required to cause a concussion is increased significantly because the headband is able to absorb and dissipate a significant amount of the force. It will take a much larger force to cause that same injury when the ForceField band is worn.
Additional benefits are that the headband absorbs and dissipates perspiration just like a regular sweatband. It is easily washed by hand. It can be placed in cool water and then worn while playing on very hot days, and it looks just like a regular sweatband.
There have been opinions expressed that if "helmets" are worn, soccer will start resembling American football. Others state that a helmet would be annoying and look "silly" The fact is that the ForceField FFTM Headband looks and acts just like a headband except for the added protection and the appearance will not look silly or be annoying. Headbands are worn in many sports from tennis and track to basketball.
The risk of head injuries to players colliding with one another, hitting the goal post and the ground will also be reduced. Those are the other ways soccer players are injured and must be protected. It should always be noted that concussions will not be eliminated, but the severity of the injury will be reduced by wearing the ForceField FFTM Headband.
For all of the young participants involved in football/soccer throughout the world, the sport provides an experience and an environment in which each of the young participants can grow and develop physically, mentally and socially. It is the responsibility of the sponsors of these programs to provide an environment that minimizes the foreseeable risk of injury. There is nothing more important than to protect the brain of a child. His/her future is at stake and the ForceField FFTM Headband will help reduce the risk of injuring it.
There is no method of reducing the risk of head injuries when a player is hit in other parts of his/her body and not the head. The percentage of head injuries that relate directly to head impacts relative to impacts to other parts of the body that also result in head trauma is not of significant consideration. From a risk analysis standpoint, when there is an inexpensive product available that will reduce the risk of head injuries from direct blows to the head, then the benefits are certainly desirable. The choice would be obvious.
Year-round, sports are the leading cause of injuries in the 11-to-18 population. The U.S. Centers for Disease Control and Prevention estimates that one-half of the 1 million-plus sports injuries seen among young children each year could be avoided with proper education and the use of protective equipment. The ForceField FFTM Headband is one of the positive choices a player, a parent and/or a coach could make in behalf of the safety and welfare of the player and the sport.
Kevin Guskiewicz, director of the Sports Medicine Research Laboratory at the University of North Carolina at Chapel Hill has stated, "While many parents and athletes think that concussions rarely occur in sports such as lacrosse, soccer, softball and baseball, recent data suggests that concussions occur more frequently in these sports than previously thought."
Experts say that because the brains of teens and those younger are less developed, the possibility of head injuries and concussions should be seriously considered. If the risk of injury to a child's brain can be reduced by wearing a ForceField FFTM Headband, the choice is rather simple.
Delaney, J. Scott, Head Injuries Presenting to Emergency Departments in the United States From 1990 to 1999 for Ice Hockey, Soccer and Football; Clin. J Sport Med, < 14, No. 2, March 2004.
Jeanette, R. M., Predictors of Outcome in Severely Head-Injured Children, 29 Critical Care Med. 534 (2001).
Cynthia L. Beaulieu, Rehabilitation and Outcome Following Pediatric Traumatic Brain Injury, 82 Surgical Clinics N. AM. 393 (2002).
This report summarizes the results of preliminary testing to determine the impact absorption performance characteristics of prototype headbands for soccer.
The independent measure of interest was peak G (i.e. impact deceleration).
The dependent variable of impact velocity and energy were held constant at 1.9 m/s and 9.2 J, respectively.
An ISO headform (size L ~ medium adult) with triaxial accelerometer (Kistler) mounted at the approximate center of mass was dropped by means of a bi-rail basket guide (similar to CEN 960 for ice hockey) from a height of 30 cm (see figure 1).
Ten initial tests were conducted without any headbands mounted to provide baseline measures. Three impact per sample were conducted with approximately 30 seconds between impacts.
The initial ten impacts without headbands produced peak G values of 652.4 G’s. With the new patented headbands introduced, impact absorption (i.e. the ratio between no head band versus with headband) demonstrated values up to 83% (average of three impacts).
ASTM F 1446-04
The impact test apparatus complied with ASTM F 2220-02.
Drop height : 40.6 inches
Impact velocity: 4.41-4.59 m/s
Impact Surface: MEP Pad-N594
ANSI/DOT Headform size: C
Steel flat anvil except for (*) triangular anvil with batter’s helmet
The test results are as follows:
Batter’s helmet with ForceField FFTM headband (1)*
ForceField FFTM Headband (1)
* With triangular hazard anvil (extremely severe test)
(1) PATENT NOS.: US 6,675,395, US 6,978,487 & US 7,234,174.
The testing of the helmet insert and protective device was independently performed.
The test method used was ASTM F 1045 with a 41" drop.
The protocol was used to determine the feasibility of the concept of adding the patentented headband (1), the consistency for a variety of protective helmets and whether the results would make a significant difference in the absorption and dissipation of forces. A small change would not be useful.
Franklin Youth Batting Helmet
(Location - ear)
With patented insert (1)
Difference minus 98 gs or a reduction of 36%
Bauer/Nike Hockey Helmet
(Location - left & right ear)
With patented insert (1)
Difference minus 43.34 gs or a reduction of 33.4%
Bauer/Nike Hockey Helmet
(Location - left & right ear)
With NIKE sweatband
(No effect, within experimental error)
JOFFA 390 Senior Hockey Helmet
With patented insert (1)
Difference minus 41.1 gs or a reduction of 31.9%
NIKE Batting Helmet
(Location - left & right ear)
With patented insert (1)
Difference minus 98 gs or a reduction of 35.9%
(1) THE FORCEFIELD FFTM HEADBANDS PATENTS:
2008/03600 (South Africa)
PCT/US 2005/034267 (International-European)