As research into head injuries expands to include women’s soccer, some of the sport’s former stars are calling attention to the health fallout from heading the ball multiple times.

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With a new NFL season starting tonight, concerns about head injuries in football are expected to ramp up again, and now the discussion is expanding to women’s soccer. After the Women’s World Cup, researchers are preparing to study how a lifetime of head impacts could affect women, including heading the ball. NPR’s Tom Goldman reports.

TOM GOLDMAN, BYLINE: Using the head to redirect a soccer ball or to score a goal – that’s an integral part of the game, especially as players become more skilled. But in an era of increased concussion awareness, heading is fraught with potential risk, and the science exploring that risk hasn’t been inclusive.

ROBERT STERN: We really have needed to expand this research to include women.

GOLDMAN: Dr. Robert Stern studies chronic traumatic encephalopathy – that’s the degenerative brain disease known as CTE. He and others at Boston University have focused a lot of their attention on CTEs linked to head trauma in men who play tackle football. But next month he’ll start working with former female soccer players, some well-known, on a study called SHINE – it stands for soccer head impacts and neurological effects.

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UNIDENTIFIED ANNOUNCER: The shot saved, rebound – score. Michelle Akers’ first goal. And the U.S. goes on top, 1-0.

GOLDMAN: Former national team star Michelle Akers, now 53, was the catalyst for Stern’s study. She’s concerned about her peers and wonders whether certain mental lapses are 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 to be at least 50 headers per game during her career.

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MICHELLE AKERS: I would not be heading a million balls like that. There is no way on earth I would do that again.

GOLDMAN: Robert Stern says prior research shows a relationship between the amount of heading and cognitive and even chemical changes in the brain, enough so that, in 2015, the U.S. Soccer Federation banned heading for kids 10 and younger.

DAN PINGREY: So how do we head the ball? We look with what?

UNIDENTIFIED CHILDREN: Our eyes.

PINGREY: OK?

GOLDMAN: Youth coach Dan Pingrey has led his Seattle United club team through its first year of heading. By the time they start playing games this fall, most of the girls will be 11, meaning no more ban. At a practice on the University of Washington campus, Pingree runs a refresher drill.

PINGREY: Upper body straight. Don’t bend your head. Nice and easy. Right to the forehead. Good. Don’t bend over, Ella. Don’t bend over, Ella.

GOLDMAN: What Pingrey doesn’t want to see is 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, creating a protective buffer to help prevent smacking skulls when someone else is flying in to head the same ball.

UNIDENTIFIED CHILD #1: Up.

UNIDENTIFIED CHILD #2: Ella.

UNIDENTIFIED CHILD #3: I got this.

GOLDMAN: Shahram Salemy daughter Hannah plays on the Seattle United team. He says the new study isn’t creating extra concern among parents. He hasn’t sensed the kind of concussion hysteria that’s gripped some parents of young boys playing football.

SHAHRAM SALEMY: I will say that I know parents who have kids that are older – they’re teenagers – 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 at – maybe it’s just the age of the kids.

GOLDMAN: In 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 who play 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.

STERN: I’m one of the people who does the bulk of this research, and I’m not really sure exactly what leads to CTE and how it’s manifest and what the risk factors are.

GOLDMAN: But, Stern stresses, repetitive head impacts of any kind, even ones that don’t cause concussions, are not good. And he hopes the 20 women signed up for his soccer study will help science inch closer to understanding the risks of playing the games we love.

Tom Goldman, NPR News.

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