With a new NFL season starting, concerns about head injuries in football are expected to ramp up again.
But now the discussion is expanding to women's soccer. On the heels of this summer's World Cup, researchers are preparing to study the potential toll on women from a lifetime of head impacts, including heading the ball.
Expanding research
Using the head to redirect a soccer ball, or to score a goal, is an integral part of the game. Especially as players become more skilled. In an era of increased concussion awareness, heading has become fraught with potential risk. And science exploring that risk hasn't been altogether inclusive.
"We really have needed to expand this research to include women," says Dr. Robert Stern.
He's one of the top researchers studying Chronic Traumatic Encephalopathy, the degenerative brain disease known as CTE. Stern and others at Boston University have focused a lot of their attention on CTE's link to head trauma in men who play tackle football.
But next month, Stern will start working with former female soccer players, some well known, on a study called SHINE, which stands for Soccer Head Impacts and Neurological Effects.
Heading a million balls
Former U.S. Women's National team star Michelle Akers, now 53, was the catalyst for Stern's study.
They talked months ago about her concern for fellow aging players, and whether forgetfulness and other mental lapses were early signs of soccer-induced brain problems, including CTE. Akers and former U.S. teammate Brandi Chastain spoke on CBS about their involvement in the study.
Akers said she now regrets what she estimates were at least 50 headers per game during her career.
"I would not be heading a million balls like that," Akers said. "There's no way on earth I would do that again."
Stern says prior research shows thereis a relationship between the amount of heading and cognitive, even chemical changes in the brain. Enough so that in 2015, the U.S. Soccer Federation banned heading for kids ages 10 and younger.
Careful teaching
Youth soccer coach Dan Pingrey has led his Seattle United girl's club team through its first year of heading.
"So how do we head the ball?" Pingrey asks his 10- and 11-year-old team members at a recent practice. "We look with what?"
"Our eyes!" the girls respond in unison.
By the time they start playing games this fall, most of the girls will be 11, meaning no more ban. At the practice on the University of Washington campus, Pingrey runs his girls through a refresher drill.
"Upper body straight!" he shouts. "Don't bend your head! Nice and easy, right to [the] forehead. Good! "
Pingrey doesn't want to see heads wobbling. Neurologists say girls can be more prone to concussion because they sometimes have weaker neck muscles that cause the head to flop and the brain to shake.
Pingrey also trains his kids to keep their elbows out. That creates a protective buffer to help prevent them from smacking skulls with another player who flies in to head the same ball.
Shahram Salemy appreciates Pingrey's care in teaching the new heading skill.
Salemy is the only parent watching practice on this day. His daughter Hannah has played since she was about 4.
"Coach is fantastic," Salemy says. "He started [the girls] with their parents at home using one of those little inflatable beach balls. Very light. Just to get them used to the motion and how to use [their] whole upper body and core and chest to generate the power. Not the neck. And I think that's a big part of the technique."
In his many years of coaching and playing, Pingrey says he hasn't seen too many circumstances where a header has caused a concussion. But he acknowledges, it can happen.
"A ball kicked by a goal keeper," says Pingrey, "a long distance, high, and [a player] gets under it and heads it wrong, that's going to rattle someone."
And although it's a relatively rare occurrence, he'd rather be cautious.
"Anything we can do now, to help minimize potentially those types of injuries or types of diseases long term, let's do it," Pingrey says. "It doesn't take that much more effort as a coach to put in the effort to teach the kids how to do it right. How to do it well. Not [to] be afraid, which allows them to be more confident and let them do it correctly."
Despite his efforts, there's still some fear.
"I'm really worried about getting a concussion," says 11-year-old Seattle United player Sienna Connell. "Just like I've heard about soccer being the most common sport that girls get head injuries in, so that worries me."
Not enough to stop playing, which, she says, she loves.
Team parents don't seem to share Connell's concern.
Salemy says he hasn't sensed the kind of concussion hysteria that's gripped some parents of young boys playing football.
"I know [soccer] parents who have kids that are older, teenagers," Salemy says, "and what I hear from them is more of a concern about ACL injuries and knee injuries more than head injuries. We just don't see a whole lot of that. Maybe it's just the age of the kids."
Researching with an open mind
Still, 2017 research by the American Academy of Orthopedic Surgeons found high school soccer-playing girls did have a significantly higher rate of concussions. Even more than boys playing football.
The study points to headers as part of the problem.
That's where Dr. Stern now is turning his attention. With an open mind about a subject where there's still much to learn.
"I'm one of the people who does the bulk of this research," Stern says, "and I'm not really sure, exactly, what leads to CTE and how it's manifest and what the risk factors are."
But Stern stresses repetitive head impacts of any kind, even ones that don't cause symptoms of concussions...called subconcussive....are not good.
And he hopes the 20 veteran female players signed up for his soccer study will help science inch closer to understanding the risks of playing the games we love.
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