Hamtramck — Cory Miller heads the ball a lot, playing semi-pro soccer for the Detroit City Football Club.
Among the tallest players for Le Rouge, the center back helps repel opponents’ forays, firing balls back against the attackers.
“I head the ball more than anyone,” said Miller, whose Twitter handle is “big bald assassin.”
“I’ve been blessed enough never to have had a concussion, which is strange for my position. That is usually not the case.”
It is also not the case, doctors say, that avoiding concussion will surely save Miller from the potential of long-term brain damage.
He is 29. He began heading the ball at 3.
Lowered cognitive function in soccer players is caused more often by heading the ball than from collisions, according to a study at the Albert Einstein College of Medicine, published last month.
Heading has been previously associated with temporary cognitive problems. But the study is the first to compare it to collisions.
The lead author, Dr. Michael Lipton, said it suggests efforts to reduce long-term injuries focus too much on collisions, and not enough on heading.
But, while Lipton warns of the danger, he and others say they cannot yet prescribe specific precautions.
“Unfortunately, there is not rule-of-thumb advice,” said Lipton, who has authored two internationally recognized studies on heading and brain trauma. “That is one of the big messages.”
“What we have is enough information to say that there is something going on, here. What we’re not saying is that any amount of heading causes brain damage.
“We’re not saying that if you head the ball once, or twice or maybe a few hundred times you’re going to become brain-damaged,” he said.
“But there’s some amount that you pass and get into trouble.”
Where that danger point is, generally, or for individual athletes, requires more research. But the knowledge may be precise enough someday to consider changing the way soccer and other sports are played.
“The problem is that we don’t yet know what that safe level is,” Lipton said. “And that safe level likely varies from person to person.”
Until then, in everything from Major League Soccer to local youth leagues, participants and parents are mostly watchful, and curious.
When he heard about the study and the lack of clarity, Miller chuckled, knowingly.
“It’s hard to say what to do, since we’re still kind of trying to figure it out.
“I cannot imagine heading a lobbed ball in is necessarily doing that much damage,” he said. “There are instances, though, where you’re heading the ball out that is coming in at a higher velocity.
“I think, yeah, you probably can do some damage.”
Some safeguards seem only logical.
United States Soccer requires no heading for children 10 years old and younger. From ages 11 to 13, there are some strict limitations.
After that, watch out.
In the study, published in a leading, peer-reviewed journal, Frontiers in Neurology, questionnaires were distributed to 308 amateur soccer players in New York City.
The players headed the ball an average of 45 times, in the two weeks. About one-third also suffered at least one unintentional blow to the head.
Players who reported the most headings had the poorest performance on psychomotor (the brain signaling the start of motion) speed and attention tasks.
Both functions are known to be affected by brain injury.
The study also established a correlation between heading frequency and some memory tasks. In contrast, the unintentional head impacts were not related to any aspect of cognitive performance.
The changes in cognitive function did not cause explicit impairment.
But, as Lipton and the other doctors wrote in the paper summarizing the study, even transient reductions in function from heading “could translate to microstructural changes in the brain that then lead to persistently impaired function.”
Such brain trauma, without concussion, is increasingly seen as the cause of chronic traumatic encephalopathy (CTE).
“We need a much longer-term follow-up study of more soccer players to fully address this question,” Lipton said.
Until then, many are left to wonder.
In MLS, heading remains a part of the game, with no sense of a need for immediate change.
“We have very, very detailed protocol when it comes to head injuries that are suffered, from baseline testing for concussions and SCAT3 (Sport Concussion Assessment Tool), independent doctors on site, and two doctors who are experts,” said Dan Courtemanche, a spokesman for MLS.
Professional leagues and colleges emphasize proper technique and conditioning.
“Right where the hairline hits on the forehead,” said Damon Rensing, coach of men’s soccer at Michigan State University. “There, is where you should do it.
“Eyes open, should be, most of the time.
“You move through your back. You kind of flex through your hips.”
Those principles should be emphasized, even from the time it is explained to young players why they either should not head, or do it with limitations.
“We try to do neck-strengthening exercises, which may not necessarily be just for that, but for general concussion prevention and protection,” Rensing said.
“And then, I think, we just monitor it.”
The NCAA requires baseline tests of athletes to determine normal brain patterns, to provide better information for recovery.
“And, we’ve got doctors, here,” Rensing said. “It’s really out of the coach’s hands.”
Monitoring is important.
“All of our student-athletes go through an education process, and it’s pretty in-depth about signs, symptoms and awareness,” said Brian Bauer, director of medical services in athletics at Western Michigan University.
“We do it for every one of our student athletes. It’s part of NCAA legislation, along with baseline concussion testing.
“Head injuries are very difficult things to access, but I believe our student-athletes are aware,” Bauer said.
“The education piece is huge. People need to understand what is going on and know the signs and symptoms to watch for.”
The issues of heading and concussion in soccer have been the first topic at the last few meetings of the Soccer Committee of the Michigan High School Athletic Association, according to Andy Frushour, the director of brand management.
“They read the research. They know about the concussion reporting we have at the MHSAA,” Frushour said.
“They say, over the years, they’ve just become more aware of it.
“They practice technique more,” he said. “They do less live heading in practice, they save those for the games.”
In youth soccer, prohibitions established by U.S. Soccer for youths are of the utmost importance, according to doctors and many people involved in the sport at all levels.
In 2016, the national sanctioning body for the sport adopted an absolute prohibition of heading by anyone 10 years old and younger.
Players 11, 12 and 13 years old must limit heading in practice to a maximum of 30 minutes of training per week, with no more than 15-20 headers per player, per week.
“Over the last three or four years in the United States, we are having greater and greater conversations around head injuries in soccer,” said Dr. George Chiampas, medical director of U.S. Soccer.
“I think that’s a very important point that should be noted across players and parents and a coaches and referees.
“This conversation is being had, and it’s being had among scientist and researchers and clinicians, amongst the technical staff among the players,” Chiampas said.
The critical, ongoing work is to understand how players use their bodies to head the ball, if anything can be done to prevent injuries and the extent to which both may differ with and age.
“Heading is a potential cause of brain injury,” Lipton said. “And since it’s under control of the player, its consequences can be prevented.”
Miller said he remains vigilant.
“I guess that science is still kind of telling us,” he said.
“And, I think just more data or analysis of past players and what they are dealing with now, like the NFL dealing with guys that did it for 10 or 15 years, the effects that it has on them, would be helpful.”