What You Should Know About CTE and Soccer

The risk to American football players of long-term neurological consequences from repeated brain trauma is well-known.

Although less common, athletes in other sports also can suffer from chronic traumatic encephalopathy (CTE), even if violent physical contact isn’t part of nearly every play, as it is with football.

That’s why all athletes, parents and coaches in any sport that involves some contact should know the risks and signs of concussion and have protocols in place to recognize when athletes of any age might be experiencing head trauma.

That includes baseball, basketball, volleyball, hockey and soccer, a sport that recently had its first confirmed case of CTE in an MLS player.

Scott Vermillion, who played four seasons in MLS before retiring in 2001, died of an accidental drug overdose in 2020 at age 44. Doctors later diagnosed him as having CTE, which might explain some of Vermillion’s erratic behavior in the years before he died.

What Is CTE?

Chronic traumatic encephalopathy is a rare, degenerative brain disease that’s linked to repetitive head trauma. That trauma might be concussions — which cause symptoms such as headaches, loss of balance, dizziness, sleepiness and vomiting — or mild but repetitive brain injuries that don’t cause symptoms, sometimes called subconcussive impacts. 

Neurologically, CTE behaves much like Alzheimer’s disease but acts on a different part of the brain. Patients can receive a clinical diagnosis for CTE, but the presence of the disease can only be confirmed through testing after a person has died.

The onset of CTE and its symptoms often occurs well after an athlete has stopped playing sports. The symptoms of CTE include an unsteady gait, persistent headaches, memory loss, difficulty concentrating, depression and, as with Scott Vermillion, changes in behavior that include aggression, irritability and impulsiveness.

Symptoms of the disease were noticeable in the early 20^th century in so-called “punch drunk” boxers, who would begin to stagger during matches and sometimes show chronic cognitive and physical symptoms.

Head Injuries and Sports

The risk of head trauma to athletes is related to the likelihood of violent contact. The vulnerability of football players was highlighted in a 2017 study that found 99% of the post-mortem examinations of NFL players detected evidence of CTE. 

Athletes competing in hockey, rugby and wrestling also are more likely to experience concussions or milder, asymptomatic head trauma than, say, golfers, runners or tennis players.

In between are those sports that involve some level of physical contact with other players, including the world’s most popular sport, soccer.

A study published in 2020 found that youth soccer players were not very likely to suffer concussions, but when they did it was most likely to be from hitting the ground or colliding with another player. The act of “heading” the ball — when a player deliberately strikes the ball with their head to pass or attempt a goal — was less likely to result in a concussion. Heading a ball also is a more controlled, intentional movement by a player, so is less likely to result in an injury than an unexpected blow.

Still, some youth soccer leagues for kids under 13 years old have rules in place against heading, an acknowledgment of the potential longer-term consequences for younger athletes who experience head injuries.

Recognizing and Treating Head Injuries

Mostly gone are the days in youth sports where a coach would tell a player who took a vicious hit to the head to shake it off and go back in.

Officials running youth, adult and professional leagues — as well as parents and athletes themselves — are much more aware of the potential consequences of head injuries.

At Orlando City MLS games, the on-field medical director has access to multiple camera views and works with a spotter to review plays that might have resulted in an injury. The teams’ staff and on-field physicians are quick to evaluate the situation and get them off the field if an injury is suspected. It’s a consequential decision because league rules limit substitutions, although a trial rule is in place that allow extra substitutions for suspected concussions. Players are not allowed to return until video has been reviewed and the player evaluated. In addition, referees are trained to recognize the signs and symptoms of concussions

Many nonprofessional soccer leagues and other sports programs don’t have the benefit of physicians and video technology to evaluate potential concussions and other head trauma. 

That’s why everyone involved in youth sports should understand the signs and symptoms of concussions, which include:

• Holding head after an impact
• Loss of consciousness
• Dizziness
• Stumbling or difficulty keeping balance
• Confusion
• Worsening headaches
• Changes in vision
• Vomiting
• Sleepiness
• Sensitivity to light or noise

If there’s any suspicion that a player has suffered a head injury, they should be removed from the game. When in doubt, sit them out. And then seek help from a physician.

Playing sports brings joy and satisfaction to many, but there is a degree of risk. However, head injuries that lead to an injury as severe as CTE remain rare.

But you should keep your eyes wide open to the risk of head injuries so athletes can receive treatment and continue enjoying the sport they love — safely.