In Search of the Final Head Ball: The Case for Eliminating Heading from Soccer.

• Author: Duru, N. Jeremi

1. Introduction 560 II. A Brain Trauma Primer 562 III. Soccer, Football, and Their Interaction in the United States 565 A. Soccer and Football in the United States: Born of One 565 B. Football's Violent Ascension 567 C. The "Soccer is Safe" Narrative 569 IV. Soccer's Head Danger 574 A. The Tragic Case of Patrick Grange 574 B. Concussive Blows 576 C. Sub-Concussive Blows 580 V. The Helmet Fallacy 583 A. Helmet Use in American Sports 583 B. The Inefficacy of Soccer Headgear in Preventing Brain Injury 585 VI. Eliminating Heading from Soccer 588 A. The Original Header-Less Game 588 B. Attempts to Restrict Heading Among Youth 590 C. What About Adults' Brains? 592 VII. Conclusion 594 I. INTRODUCTION

   Soccer is unquestionably the world's most popular sport. (1) Two hundred and eleven countries have national soccer associations, (2) hundreds of millions of people across the globe play recreationally, (3) and Federation Internationale de Football Association's ("FIFA") quadrennial World Cup soccer tournament is unchallenged as the highest profile (4) and highest grossing sporting competition on Earth. (5) Notwithstanding its popularity, however, soccer sits at a troubling crossroads as the sport's governing bodies grapple with the impact that the risk of brain injury is having on the game. (6) Soccer is, of course, not alone in this regard. The risk of brain injury exists in all team contact sports, most famously in American football ("football"), which provides a cautionary tale from which soccer could stand to learn. (7)

   As evidence reflecting the epidemic of brain injury in football began to pile up in the early 2000s, the National Football League ("NFL"), far and away the world's leading football entity, was slow to react. The NFL initially discounted the connection between football and brain injuries and, in some cases, sought to delegitimize those who challenged the league. (8) Eventually, the NFL acknowledged the dangers attendant to playing football and has since instituted a bevy of rule changes to protect the players' heads. (9) Notwithstanding the rule changes, violent collisions causing damage to the head continue at an alarming rate. During the 2017 NFL season, players suffered 281 concussions, up 13.5% from 2016. (10) Indeed, many in the NFL community quietly concede that the violence inherent in football unavoidably risks head trauma. (11)

   Soccer, however, is different. When not challenging for the ball, contact beyond that which is incidental is not permitted; even when challenging for the ball, challenges are to be made with the feet in the area of the ball--generally at another player's feet. (12) Moreover, to the extent that any pushing, striking, charging, or jumping deemed dangerous by the referee accompanies the challenge, the opposing team will receive the ball. (13) In contrast, dangerous pushes, strikes, charges, and jumps are part and parcel of football and are generally encouraged and even demanded. (14)

   Soccer encourages and demands one action, however, that puts the head in consistent danger: heading the ball. (15) Thirty percent (30%) of concussions in soccer occur when two players attempt to head the ball at the same time, resulting in head clashes or heads colliding with other body parts or the ground. (16) The desired outcome of an attempted header--head to ball impact -causes untold damage as well. (17) This Article, therefore, argues that soccer's governing bodies should eliminate the practice of heading from the game. Doing so would protect generations of soccer players to come and would limit potentially wide-spread liability among soccer governing bodies, as well as the ensuing economic consequences, ensuring the continued existence of "The Beautiful Game." (18)

   Part II of this Article offers a primer on brain trauma and its incidence in contact sports. Part III details the historical relationship between soccer and football, the ties that bind them, and each game's position vis-a-vis the other in the pecking order of American sports. Part IV explores the underappreciated danger of brain trauma that playing soccer poses. Part V examines the inefficacy of headgear in protecting soccer players' brains. Part VI tracks the technological advances in soccer ball development that have led to increased heading and examines the movement to reduce heading in youth, but not adult, soccer. Part VII concludes that for the safety of soccer players and the future of the game, heading should be eliminated from soccer at all levels.

2. A BRAIN TRAUMA PRIMER

   The human brain is a wondrous organ. It exercises control over the body's other organs, and its size and power separate humans from other animals. (19) The brain's soft gelatinous consistency, however, renders it extremely delicate. (20) Although the skull and the fluid in which the brain is suspended protects the brain, a blow to the head or a sudden head movement can send the brain sloshing in its fluid against the inside of the skull, (21) causing mild traumatic brain injury commonly known as a concussion. (22)

   The Center for Disease Control ("CDC") defines a concussion as "creating chemical changes in the brain and sometimes stretching and damaging brain cells." (23) Symptoms include headache, confusion, blurred vision, dizziness, nausea, irritability, sensitivity to light, and difficulty sleeping. (24) Sometimes symptoms manifest immediately, and sometimes they take days, weeks, or months to develop. (25) Through rest and avoiding strenuous physical activity, most people will recover from a concussion. (26) But if one sustains a second concussion before the first has healed, the individual could experience second-impact syndrome, which can have catastrophic consequences, including severe brain swelling and sometimes death. (27) Even if a person has not suffered an additional concussion, multiple concussions over time can produce long-term neurological damage and consequent functional deficits. (28)

   Not all blows, of course, are concussive. Sub-concussive impacts are those that cause the brain to bounce against the skull but do not produce concussion symptoms. (29) While long deemed to be only minimally damaging, current research suggests that an accumulation of sub-concussive blows, like multiple concussive blows, can be neurodegenerative. (30)

   Both concussive and sub-concussive blows are common in contact sports, with some athletes seemingly more prone to their effects than others, both acutely and in the long term. (31) Why some athletes are more prone than others is not known, (32) but for those who suffer most from the long-term effects of these blows, the consequences can be devastating. (33) While the neurodegeneration can manifest in different ways, it can ultimately result in Chronic Traumatic Encephalopathy ("CTE"), a protein accumulation that interferes with neuron function and causes the brain to atrophy. (34) As the brain atrophies, symptoms progress from those associated with concussion--such as confusion and dizziness--to debilitating dementia and death. (35)

   Once known as dementia pugilistica, because it was believed to exist principally in boxers (known also as pugilists), (36) CTE is now recognized as occurring in athletes who play non-combat contact sports, as well. (37) And because there is no way to know which athletes are most likely to develop CTE or other forms of brain trauma, athletes who play contact sports and their loved ones are justified in their concerns regarding blows to the head.

   These fears have cast a pall over football's future and, in the views of some, have opened the door for soccer to fill the void. If soccer is able to address its own head trauma concerns and fills that void, it would represent another chapter in the complex, longstanding relationship between these two sports. Moreover, it might take a few steps toward football's current spot atop the professional American sporting hierarchy.

3. SOCCER, FOOTBALL, AND THEIR INTERACTION IN THE UNITED

   STATES

   A. Soccer and Football in the United States: Born of One

   Historians regard an athletic contest held on November 6, 1869, between Princeton University and Rutgers University as America's first football game as well as its first soccer game. (38) By that time, however, soccer was firmly established on the global scene. (39)

   When and where in human history a group of people first kicked a roughly round object amongst each other is unclear, but some form of "kicking game" has existed since ancient times, and virtually every world culture has seen a version of it. (40) The ancient Greeks played, as did the Romans. (41) So, too, did the Chinese and the Japanese. (42) And when the Pilgrims landed in what is now Massachusetts, the Native Americans they encountered played a "kicking game" called "Pasuckquakkohowog," which often involved "entire villages" playing on a massive patch of ground. (43) Those games, however, are related to modern-day soccer only in that they involved the act of kicking a ball or something like it. (44) The concept of two opposing teams on a bounded playing surface, each defending its own goal while simultaneously working to kick the ball through the other team's goal, is generally credited to the nineteenth-century English. (45) Before long, English expatriates began spreading the game to other nations, including the United States. (46) It was a form of the English game, combined with aspects of rugby, that pitted Princeton and Rutgers in the 1869 match. (47)

   Although the game would not be recognizable today as either football or soccer, it featured characteristics of both sports. As in soccer, the players used a round ball and were permitted to strike it with their feet. (48) As in football, however, players were able to catch the ball, and they recorded points by kicking the ball between two upright posts. (49) On that November day in New Brunswick, New Jersey, soccer stood even with football on the American...