Should girls who play soccer be required to wear headgear?

PITTSBURGH (AP) - Coming soon to a soccer field near you - maybe: 22 girls wearing space-age headbands designed to protect them from concussions.

Stemming from a growing national interest in soccer, doctors and other experts are considering whether to recommend that girls who play soccer be required to wear some type of headgear to reduce concussions.

The concern has intensified as more athletes in all sports are diagnosed with head injuries. Soccer seems to be facing particular scrutiny now.

Last year, a study released by the American Academy of Orthopaedic Surgeons said female soccer players may face a greater risk of head injuries than in other sports due to a “lack of headgear, an emphasis of in-game contact and the practice of ’headers’ ” based on a sample of high school injury data from 2005-2015 in an online injury reporting system used by high school coaches.

The study also said concussions were more common in female soccer players in the 2014-15 school year than in any other sport in which high school girls participate.

Though protective soccer gear - such as shin guards - is not a new concept, ideas for protecting players are evolving.

Pennsylvania-based Unequal Technologies, for instance, created a headband-like device called the “Unequal Halo” that has been used by soccer players to protect them from head injuries. Athletes in other sports, such hockey and football, have used similar equipment as added protection beneath their helmets.

Unequal founder Robert Vito’s company, based in Glen Mills, Delaware County, gained a following after the U.S. women’s soccer team requested that the company create a product to protect its players from head injuries.

Unequal’s headbands, made with Kevlar, wrap around players’ foreheads and are similar in appearance to sweatbands. Vito said his product reduces the energy caused by a hit to the head by up to 70 percent.

Soccer’s injury rate is just one-fifth to one-half of that of football’s, according to UPMC Sports Medicine. A 2015 Journal of the American Medical Association study said football’s concussion risk was more than double soccer’s, which the study said occurred in 9.2 out of 10,000 cases. But the same study said soccer was the second leading cause of injury in female athletes, sandwiched between basketball and volleyball.

Julian Bailes, director of neurosurgery and co-director of the Chicago-based NorthShore University HealthSystem Neurological Institute, described soccer concussions as a “significant issue,” particularly for female players.

Dr. Bailes, a former team doctor for the Pittsburgh Steelers, was portrayed by actor Alec Baldwin in the 2015 movie “Concussion” for his efforts in revealing the existence of chronic traumatic encephalopathy, a head injury-related condition that can cause impulsive behavior, suicidal thoughts and substance abuse, among other things.

“I would believe headgear would be better than nothing,” Dr. Bailes said.

Meghan Klingenberg, 29, a member of the 2015 World Cup champion U.S. women’s soccer team and a graduate of Pine-Richland High School, said she has never been diagnosed with a concussion but has experienced concussion-like symptoms. When she was younger, concussions were not widely examined, leading to a lower amount of diagnoses and inadequate safety protocol.

Klingenberg said she believes more can be done to increase protection.

“I truly believe there’s no good protocol in place in every level,” she said. “I think things need to be different.”

Klingenberg said she knows soccer players who have been kept out of games for concussions, with symptoms ranging from ongoing headaches to an inability to focus.

“There’s not a lot of good treatment options to help,” she said.

University of Connecticut neurologist Anthony Alessi estimated that Americans will see more concussions related to soccer as the popularity of the sport increases. He said he’s not sure that headgear would reduce concussion rates.

Head injuries can be particularly common in young athletes whose neck muscles are still developing, according to Dr. Alessi. He said many athletes are still developing when injuries occur, sometimes leading to a higher number of concussions in young players.

“Lawsuits don’t necessarily solve the problem,” Dr. Alessi said, adding that organizations may want to consider moving away from allowing “heading” the ball to lower the concussion rate in young players.

But studies show this is not the only way concussions occur. The JAMA study stated that the most frequent cause of soccer-related concussions was player collisions.

“Although banning heading from youth soccer would likely prevent some concussions, reducing athlete-athlete contact across all phases of play would likely be a more effective way to prevent concussions as well as other injuries,” the study said.

Klingenberg said concussions can come from a variety of hits - including heading, player contact and hitting the ground. It is important, she said, to look into a variety of remedies.

“It shouldn’t be limited to one instance. (We should) look into what else is out there,” she said, suggesting that headgear may not be the best option for players seeking protection.

Many teams, including those in the North Allegheny School District, follow guidelines suggested by UPMC known as immediate post-concussion assessment and cognitive testing. This form of evaluation, called ImPACT, has been implemented in the National Football League, the National Hockey League and in more than 8,000 high schools nationwide, according to the UPMC website.

ImPACT mandates a baseline test for each athlete and a post-injury testing and evaluation process at UPMC. Injured players are required to undergo physical exertion tests; depending on their performance, players may be kept out of games for two weeks up to three years.

“People have to realize that concussions have been around a long time, but that we’re getting new information each day,” said Bob Bozzuto, North Allegheny’s athletic director. “Each day, manufacturers are trying to improve. We’re doing our part.”

Bozzuto said he would be open to making headgear a requirement for soccer players, but only when the technology is up to speed.

“Right now proper technology is very important,” he said. “(We) don’t want to solve one problem and create another. We want to be proactive but don’t want to be reactive.”

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Information from: Pittsburgh Post-Gazette, http://www.post-gazette.com