A posthumous diagnosis forces soccer to reconsider risk of head harms

MLSlogo-150x150In 2015, public attention galvanized around the significant risks of head trauma and the sport of football with the disclosure that Andre Waters, 44, a hard-hitting, onetime Philadelphia Eagles player, had been diagnosed after his suicide with chronic traumatic encephalopathy, or CTE.

Has soccer — one of the most popular pastimes on the planet and a dominant game of U.S. suburban life — also hit its day of reckoning for head injuries? The issue has been brought to the fore with the revelations that Scott Vermillion, 44, a onetime soccer pro, has been posthumously diagnosed with CTE, the degenerative brain disease “linked to symptoms like memory loss, depression and aggressive or impulsive behavior,” the New York Times reported, adding:

“The diagnosis gave Vermillion the grave distinction of being the first American professional soccer player with a public case of CTE. It was a solemn milestone, too, for MLS, a league that has, even in its young history, seen the consequences of the type of brain injuries more commonly associated with collision sports like football, boxing and hockey. For soccer as a whole, the finding will add another note to a small but growing chorus of concern about the health risks of playing the world’s most popular game. ‘Soccer is clearly a risk for CTE — not as much as football, but clearly a risk,’ said Dr. Ann McKee, the director of the CTE Center at Boston University.”

If soccer takes a lesson from American football, those who run the games have a ways to go to safeguard players, especially professionals but also those of all ages who participate in the sport for fun, the newspaper reported:

“The specter of CTE began hovering over the NFL almost two decades ago, when the first cases of the disease were found in the brains of former professional football players. Since then, CTE, which is associated with repeated blows to the head, has been discovered in the brains of more than 300 former NFL players. In soccer, though, the research and public conversation around CTE and head injuries are still emerging, even as the confirmed cases mount. An English strikerA Brazilian World Cup winnerAn American amateur. The former MLS players A Brazilian World Cup winner and Taylor Twellman have been vocal about how concussions ended their careers and affected their personal lives. Brandi Chastain, a two-time Women’s World Cup winner, publicly pledged in 2016 to donate her brain for CT research. ‘We have to understand the gravity of the situation,’ Chastain said. ‘Talking about concussions in soccer is not just a hot-button topic. It’s a real thing. It needs real attention.’”

Soccer leagues, notably the MLS, have started to change, including liberalizing substitution rules for players to give those with head injuries more time to be looked at, including by independent parties assessing their head harms.

Players, coaches, and those who run soccer leagues also are zeroing in on preventing injuries to the head, brain, and neck by reducing or eliminating — especially for younger athletes — the header: striking the ball with the head. As the New York Times reported:

“In 2015, U.S. Soccer — resolving a lawsuit — announced a ban on heading in games and practices by players under 10 and created guidelines for restricting heading in practice for older players. And last year, English soccer officials released guidelines for heading, recommending professional players limit so-called “higher force headers” to 10 per week in training. (How, exactly, this should be enforced has been less clear.)”

The news article, in poignant and painful detail, describes the importance of soccer’s dealing with head trauma, chronicling the promise and downward spiral of player Vermillion:

“Vermillion started playing soccer in Olathe, Kan., when he was 5 years old. He loved the incessant movement of the game, the swashbuckling action, family members said. His coaches in elementary school, in the interest of sportsmanship, often kept him on the bench for long stretches because he would score too many goals, said his father, David Vermillion. His talent eventually earned him places on elite regional club teams and U.S. youth national teams as a teenager. It took him to the University of Virginia, where he was a third-team all-American in his junior year. It carried him to MLS, where he joined his local club, the Kansas City Wizards, now known as Sporting Kansas City, in 1998 at age 21. But Vermillion, a scrappy defender, never fully blossomed as a pro. He moved on to two other clubs before a nagging ankle injury forced his early retirement after the 2001 season. His career earnings in the fledgling league were meager; his father recalled his son’s salary being around $40,000 a year when he left the game.”

Vermillion struggled thereafter, managing a family store, coaching kids’ teams, and studying nursing. He developed big problems with sustaining relationships, alcohol and prescription drugs, his family said. His behavior became increasingly erratic until his suicide.

Experts quoted by the newspaper cautioned that loved ones should not rely on a CTE diagnosis — which can be formally made only posthumously — to explain all the issues in deeply challenged lives. They said that some players may be reluctant to seek needed and helpful psychiatric help, fearing that they may be suffering from what can be a progressively debilitating and potentially lethal head and brain conditions.

Coaches, friends, and loved ones should urge troubled athletes to seek appropriate medical and mental health care, the experts said. Indeed, if you are in crisis or know someone who may be, please call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or text HOME to 741741. Both work 24/7. More resources are available at SpeakingOfSuicide.com/resources.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them by spinal cord and brain injuries, especially due to concussions and other head trauma. Brain harms change forever the lives of patients and their families. These injuries cannot be taken lightly or ignored, especially as growing evidence shows that severe damage can occur not only with big shocks to the head and neck but also due to repetitive lesser blows.

Progress has occurred in the battle against preventable head harms, especially in pro and amateur athletics — from soccer to diving to equestrian events. Better gear, more sensible rules and play, and other more positive steps are making a difference. It also has helped that those with injuries have sought justice in the civil system, including with a $1-billion lawsuit settlement reached by the NFL with former players.

Players like Chastain and families like Waters’s and Vermillion’s deserve praise for ensuring that athletes stay safe and their sports take needed steps to protect them from preventable harms., We have much work to do to minimize the risks of head trauma and other injuries in what should be fun, exciting, and healthy sports that are so much a part of our lives.

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