FIFA under pressure to make soccer safer for all players

A new class-action suit filed against soccer’s governing body seeks to eliminate the heading of the ball for players under the age of 14.

It popped up suddenly last week in The New York Times that FIFA is being sued by parents in California. Only in this lawsuit, it’s not about monetary damages. They are seeking rule changes in the game of soccer to make it safer.

Last week, I had the chance to visit in-studio WAKR morning show host Ray Horner to discuss this topic.

We talked about the 3 main rule changes these parents are seeking, centered around heading the ball and substitution patterns, as well as how the association could possibly reduce concussions across all levels of this high-energy sport.

Below is an audio file and transcript of our discussion. Originally aired on 1590 WAKR-AM on Sept. 3, 2014.

HORNER: In our studio, our good friend, Dr. Joe Congeni from Sports Medicine Center at Akron Children’s Hospital joining us. What I see you’re gonna do, what, a forum at The Lippman School, what next week or something like that?

DR. CONGENI: Yeah, I think the 16th of September, and, you know, there’s a lot of interest. People want information about head injuries and what it means. So, they contacted me over there. We’ll be at the Shaw JCC, sponsored by the Lippman School.

HORNER: Well, they contacted the right guy.

DR. CONGENI: Well, I hope so.

HORNER: I mean, really, you’ve put a lot of time, research into not only the topic, but really you’re looking down the road for protection for these kids.

DR. CONGENI: Yeah, I mean we’re really trying to advocate for, you know, the balance between sports that have a lot of good things to it, but, in the meantime, for the life-long safety of these kids.

Dr. Joe Congeni

HORNER: And with that being said, let’s go down the soccer road.

DR. CONGENI: You know what, we’ve heard it. We know the NFL was sued a couple years ago, and then the NCAA was sued. This came out of nowhere, a little bit in The New York Times last week, and Ray, I know you saw it, too: the concussion lawsuit against FIFA.

FIFA is the Federation of International Football (Association), and international football around the world means soccer. So, the soccer association was sued.

They are not seeking monetary damages here. These are parents in California. They’re seeking changes in the game of soccer. They give 3 reasons why they want changes in the game of soccer.

• No. 1: There are 50,000 high-school concussions a year, according to FIFA from soccer. That’s more than the sports of wrestling, basketball and baseball combined. More in soccer than those 3 sports combined. And, they want to make it safer.

• No. 2: They’re looking for rule changes in the younger kids and heading the ball, and how much they’re able to head the ball, and at what age and all that. We talk about that a lot.

• [No. 3]: They also, at all levels, want changes in the substitution patterns. I’m all for that. They’re very rigid, as you know if you have kids who play soccer, with substitutions, so people don’t want to come out.

So, what happens in the very high-profile cases like the World Cup — and this is what brought some of the outrage — twice in the last couple of games, including the World Cup final, there was a player who was, a guy by the name of Christoph Kramer, I think was his name, was actually dazed on the field and you could see, but he couldn’t come out because of the substitution pattern. He continued to play on.

Nowadays, with all the discussion, parents, coaches, everybody knew that wasn’t right that that guy should continue to play on the field.

And, I think all three of those things together led to this lawsuit.

HORNER: Joe, let me expand one thought that I thought of immediately with soccer. What does research say pertaining to the use of the head in the game, the head shots and stuff? How much of the concussions come from that particular play in soccer?

DR. CONGENI: Like so many things in medicine, there have been good studies in the last 10 years, but they’re a little bit — to be totally honest with you — on both sides of the spectrum.

So, the initial studies were done in professional players and it seemed that heading the ball repeatedly did have some association, accumulative effect on brain injury. That was the first study that had everybody worried about a decade ago.

Then, they looked at real young players that had never had a lot of head injury and it looked like heading the ball was reversible and wasn’t a cause of concussion. [Instead], it kind of made kids [who] were hit in other ways, it amplified or made their hit to the brain worse.

So that in other words, if you got elbowed in the head, or kneed in the head, or hit the goal post with your head, and then headed the ball, it made it a lot worse. But, there were real questions as to whether it actually caused concussion. That study was limited too, and the way it was done wasn’t ideal.

You know my mantra, so many of these young kids just aren’t strong enough yet, and technique is such a big deal.

So, the questions that really need to be answered and helped by good study are at what age should we start? [How can we] teach good technique? [How can we be] sure kids are strong enough in the shoulders and neck girdle to be able to properly head the ball? I have no doubt that when kids are not, they can sustain brain injuries.

HORNER: Joe, we’ve seen football adjust major rules because of the concussion problems. The game has changed a lot for the better health-wise. You gotta lead with your shoulder now and all these different things. Why can’t they just eliminate the head shot in soccer?

DR. CONGENI: [sigh]

HORNER: Is it that vital of a part of the game?

DR. CONGENI: They seem to think that it is. I know, you and I from here are saying, “Hey, we’re in the middle of this thing.” I know you are, too. Just like me, I’m trying to advocate for balance ’cause I think these sports have good lessons for kids.

Even in high school and college this week with football, Ray, the kickoff is the play that most concerns me. I saw it all weekend again. Yet, people say that’s such a big play. We can’t eliminate it.

The NFL tried with the kickoffs in the end zone — about 80 percent now go in the end zone. The kickoff is such a big play, and let’s eliminate things that are obvious.

But then I was on a forum in New York City and people are saying … “You’re whimpifying this game. You’re making it terrible.” Same thing in the soccer world.

The soccer purists that I talk to just say heading the ball is absolutely so essential. In fact, in my coverage of soccer through the years, the higher the level you go, when you get to the level of say, the University of Akron, which is about as high as it gets in college soccer …

HORNER: Right.

DR. CONGENI: … they probably hit the ball, direct the ball more with their head than they do with their feet. It’s pretty darn close. It is such a big part of that game. It might be a third to a half of the game. So, they’re talking about major, major changes there, and they want proof and things to make those changes.

But, I’m not all that dissatisfied to say what happened in the World Cup can’t happen. We can’t have people staggering around the field. It might have brought about this discussion and maybe there will be changes. I hope there are changes to the heading rule perhaps because of this lawsuit.

HORNER: Well, with that being said then — because I had the feeling that was the answer I was gonna get from you that it is a vital part of the game — we really have to work hard to develop some sort of helmet. I know it’s been tried, but [it] hasn’t caught on in soccer as widely as it should.

If we’re having major concussion problems and the head shot is vital to the game, and I’m okay if it is, then don’t you agree that they gotta work harder in developing some sort of helmet or would that not help?

DR. CONGENI: People use the term more than helmet, Ray, I think headgear. And actually the helmet, a hard-shelled helmet, could cause more injury to other players and things using a hard-shelled helmet.

HORNER: I got it.

DR. CONGENI: I think the thing that’s being looked at the most … is headgear that looks more like, uh, boxing-type headgear. You’ve seen that. There are at least 3 that are on the market.

The problem is again, we have to be honest with people. We don’t want to be disingenuous; we don’t want to tell them things that aren’t true. We think our general feeling is hey, if you wear something on the head, you can protect it more, but in the lab, it hasn’t proved itself out.

… Really on the field, a lot of the studies that have been done show that those types of headgear we’re talking about — the headband, the padded headgear — didn’t make a significant difference in the concussion rate in soccer. So, that may not be enough.

HORNER: So, where does soccer go then? I know, I know this is important to you. You really look at these concussions, so where do they go to drop those numbers down? If they can’t change the game, and the headgear’s not working, what are the alternatives?

DR. CONGENI: I think, uh, we have to change the game.

HORNER: Yeah.

DR. CONGENI: They’re pretty, pretty savvy about it I think in football. They’re doing it piece by piece, year by year, rather than something really dramatic at first — so the kickoff, then the strike zone. …

I think in soccer it’s going to have to be piece by piece. And I think it’s going to be reducing heading the ball, only heading in certain situations. Substitution patterns should really change. That’s been way too long.

HORNER: Yeah. I don’t understand that anyways.

DR. CONGENI: I don’t get that either, never really have. It’s not good for so many other things, too. …

HORNER: … especially when we’re talking the youth and the high school side.

DR. CONGENI: For sure, for sure. So, I think changes in substitution are going to come down the road from this. I think it’s gonna be piecemeal, piece by piece on heading the ball. And I think ultimately in 5 or 10 years things will look very different.

HORNER: Hmm. That’s interesting. What are statistics telling you about the improvements, changes in the game, and the helmets and headgear in football? Are we seeing a reduction in concussions?

DR. CONGENI: It’s early, but I think some of those changes are bearing fruit in that we are seeing some reduction. The numbers are small, again depending on how you look at it. There are so many different levels. The numbers are small.

But, the other thing that we’re seeing, the numbers are small, but we are seeing a trend toward, uh, two years in a row, where there’s decreased participation in youth kids playing football. If that continues, then this game that everybody loves [is in trouble].

So when people tell me, like this guy that was on the panel with me from Ohio State, “Hey, don’t change our game,” I [respond], “You’re not going to have a game in 5 or 10 years if we don’t make realistic changes.”

So, right now it’s incremental and small. There’s a reduction in injury. We need to do more, and I think it’s gonna be a year by year thing in football, and uh, I think soccer’s gonna have to follow the same pattern.

HORNER: I agree. Joe, good visit today, good insight, and good back and forth. I liked it.

DR. CONGENI: Yeah, great questions. Thanks, Ray.

HORNER: Thanks for coming in. Dr. Joe Congeni, Sports Medicine Center at Akron Children’s Hospital, with us.