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The loud clacking sounds and cocoonlike enclosed space of the MRI machine lulls soccer player, teacher and now coach Kiah Mahy, 25, into a peaceful slumber for the duration of a two-and-a-half-hour scan.
Mahy, along with 97 other amateur soccer players, had MRIs as part of the Einstein Soccer Study at the Albert Einstein College of Medicine, an ongoing effort that hopes to determine the extent of brain damage from head injuries in soccer.
The study found that women who headed the ball a similar number of times to men (ages 18-50) in a 12-month period exhibited five times more extensive brain tissue damage than men. The findings were significant not only because they supported a longstanding belief that women experience more traumatic head injuries than men, but also because the study takes the deepest dive into soccer-related head injuries and sex to date, according to researchers. The findings also support individualized head injury protocol, suggesting a completely new approach to sports-related head injuries.
"I think the scariest part is just how unknown they are, how big of a deal they can really be, especially for women," Mahy, who is from Greenwich, Connecticut, said in a phone interview with USA TODAY. "It's so important that everyone knows how bad concussions are in football, but I feel like that's taking all the focus ... that there isn't any information is scary."
To fill this informational void, researchers examined 49 women's and 49 men's brains. They found eight brain regions damaged by soccer heading in women and only three in men.
But what do these findings mean? After all, whispers of CTE have already tarnished soccer: Over 250 former professional soccer players have suffered from "some form of neurodegenerative disease," according to the Jeff Astle Foundation founded in honor of former British soccer player Jeff Astle, who was posthumously diagnosed with CTE.
Does the brain damage found in the study directly correlate with CTE?
"I definitely want to be clear that I'm not saying that these people are destined to develop CTE," study leader Michael L. Lipton, M.D., Ph.D., professor of radiology and of psychiatry and behavioral sciences at Einstein, a research institute in the Bronx, in New York, and medical director of MRI Services at Montefiore, said in a phone interview with USA TODAY. "So I think that while (the study) is not necessarily inexorably leading to a bad outcome, it does suggest that there is something going on in the brain related to heading. And that it's an area that really merits looking at more closely."
These findings, part of a larger study, were published at rsna.org.
Lipton believes the next steps for researching heading-related injuries in soccer include corroborating his findings, researching long-term effects of this brain damage and determining why women suffer more extensive brain damage than men.
After conducting more research, answering the last question could lead to "interventions" that might inform more successful safety protocols in the future.
"It's likely that there needs to be different approaches and tailored recommendations for people based on sex," Lipton said. "But not only based on sex -- there may be many areas where a more personalized approach will allow us to really protect people better, but also not overprotect people in ways that isn't necessary."
U.S. Soccer has already implemented changes to protect youth soccer players from head injuries. In 2016, the organization began enforcing a concussion initiative that banned heading in soccer for children 10 and younger and limited the amount of heading in practice for children between the ages of 11 and 13. The success of the rule, of course, is predicated on youth coaches enforcing the rule.
Of course, the initiative fails if coaches do not enforce it. When study participant Rachel Hirsch, 25, refereed in the Westchester Youth Soccer League in New York, she says she often found that young players would break the no-heading rule even after she reminded them that heading was prohibited.
"I don't think that coaches are necessarily following (the concussion initiative) as much as they should be," Hirsch said in a phone interview with USA TODAY. "A lot of times, kids who headed the ball, it seemed like they were doing it out of reaction, like muscle memory. And so that to me indicates that they've been heading the ball pretty regularly."
Mahy said she believes headers should be prohibited altogether.
"I think when (the concussion initiative) first came out, I kind of said, well, that changes the game -- I didn't like it," Mahy said. "But the more I think about it, and the more I've started coaching students on my own ... honestly, I think that we shouldn't head the ball at all."
And soccer would change. Mahy said the ball would more often remain on the ground and that scoring would become even more rare. Young soccer players also could no longer emulate scoring techniques of their heroes, such as those of two-time Olympic gold medalist and World Cup champion Abby Wambach, who scored a record 184 international goals often with headers.
The best practices for protecting women from header-related injuries remains unclear, but both researchers and study participants say they believe the topic merits more attention.
Said Hirsch of the head injuries she has witnessed: "At that point, it's more than just about a game."
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