Santino Quaranta, founder of Pipeline Soccer Clubs, talks about the concern with headers and concussions in youth soccer. (Karl Merton Ferron/Baltimore Sun video)
When Camryn Gerben was 12, she saw a corner kick coming her way and used her head to deftly bang the ball into the net. But she paid a steep price for the goal: her first soccer concussion.
"The power was just too much for her neck," said Dan Gerben, her dad.
Five years later, the 17-year-old's experiences — she has suffered two more concussions playing her favorite sport — helped convince Camryn and her father to embrace controversial new restrictions on heading in youth soccer.
Under U.S. Soccer Federation guidelines adopted in Maryland last year, children under 11 are banned from heading — a dynamic way to score or advance the ball — and those who are 11 and 12 must limit heading in practice.
Dan Gerben calls the rules "long overdue," and Camryn says she now avoids headers because "even the smallest hit can cause a lot of damage."
A trio of former U.S. women's soccer stars — Brandi Chastain, Joy Fawcett and Cindy Parlow Cone — are keeping the conversation going by lobbying to ban heading by players under 14.
Dr. Danielle Raines, a neuropsychologist at Mount Washington Pediatric Hospital, has seen several patients with soccer-related concussions.
"Definitely any restriction is an improvement, I think, especially in early childhood and school-age children," she said. "Any strike to the head creates an acceleration-deceleration movement of the brain — it's going to cause the brain to move.
"In practice, you're controlling how fast the ball is going to the player. And in the game you have no control of that."
But the rules have provoked criticism from some coaches, administrators and parents, who say they hinder kids' soccer development by unnecessarily removing an integral part of the game.
"I have a 10-year-old son who can head the ball better than most college players and has been able to for a couple of years, but he can't now because of the new rule," said Natalie Powell, president of the Catonsville Youth Soccer League. "I'm curious how this will impact him when he is finally allowed to once again."
The conversation echoes the discussion over how best to curtail concussions and other brain injuries in football. A growing list of professional players have been posthumously diagnosed with a degenerative disease following repeated blows to the head.
Youth football leagues, responding to declines in participation, have limited contact in practice, emphasized proper tackling techniques and plan to experiment this year with broad changes such as fewer players and smaller fields.
Safety concerns in youth soccer are "very similar to the dynamic you see in football," said Eddie Hegewisch, president and executive director of Crofton-based A3 Soccer, which has about 1,200 players.
"The number of [football] players is declining rapidly," he said. "A lot of people refer to that as the 'Mommy Factor.' That has manifested itself in the soccer world. You're getting a big divide."
In youth soccer and football, organizers are trying to institute new safety measures without diluting the essence of the sports. But the efforts have encountered pushback.
Powell, a former Division II college soccer player, is an assistant coach on her son's travel soccer team. On a field in Catonsville one recent weekday, she tossed the ball lightly a half-dozen times to her son, Isaak.
"Straight to me, OK?" she said. He launched his slim body at the ball, directing it back to her with his head each time.
Powell said she understands the health concerns about heading by recreational players who might not understand proper technique. Many preteens playing recreational soccer avoid heading the ball because they are afraid of the contact.
But she said the restrictions mean that more advanced players "are now limited in their growth because they're having to wait years to use a skill that is a fundamental component of the game."
A study released in February by the journal Neurology found that serious adult amateur soccer players who head the ball frequently were far more likely to have concussion symptoms — such as headaches or confusion — than those who did not.
The scientists did not study heading by kids. They didn't examine the possible long-term consequences of heading.
Raines, the neuropsychologist, said cumulative effects remain unclear.
"For concussions with children, it's a very recent hot topic," she said. "Enough time hasn't passed to have the long-term data."
About 63,000 kids in the state are bound by the rules issued by the Maryland State Youth Soccer Association, a U.S. Soccer federation affiliate. Besides prohibiting headers by younger kids, the requirements limit players ages 11 and 12 to no more than 15 to 20 practice headers per player each week. Referees are to award an indirect free kick to the opposing team when they spot violations in games.
Since the national federation doesn't directly control the rules governing millions of soccer-player youths, it framed the initiative as a strong recommendation. The Maryland association and many other members have adhered to the guidelines.
"I don't know if it's the best answer or the right answer," said Greg Smith, the state association's executive director. "We do all we can to be fully compliant. The federation probably didn't have a lot of choice in the matter."
Smith said the rules can become difficult to enforce when a 10-year-old "plays up" — meaning he or she participates in a game with older kids. The 10-year-old would not be permitted to head the ball — but the other kids would.
"It gets tricky," Smith said.
Craig Blackburn is executive director of the Soccer Association of Columbia, which has about 6,000 players.
"Is it taking away from the game? Yes, of course it is," Blackburn said. "It is what it is. I don't agree with it, but I have to. And I will follow the rules."
The federation issued the guidelines in settling a lawsuit. The 2014 suit, filed in California by the parents of youth players, alleged that U.S. Soccer "failed to implement or enforce the internationally accepted guidelines" for concussion management and prevention.
The federation also has been pressured by Chastain and Parlow Cone, members of the 1999 women's World Cup champion team.
In addition to lobbying for what they call "safer soccer," both have pledged their brains to scientists to check for chronic traumatic encephalopathy, or CTE, the degenerative disorder that has been found in the brains of many football players.
At least 30 percent of soccer concussions are caused by players attempting to head the ball, the California parents said in their lawsuit.
Former Towson University and Baltimore Blast player Barry Stitz coaches club soccer and the varsity boys team at Archbishop Curley High School.
In his experience, he said, soccer concussions aren't often caused by the ball itself.
"The injuries to the head are usually from heads colliding going after a ball in the air, or a head hitting the ground after a foul or contact," he said.
In Camryn Gerben's first concussion, her father said, she was receiving a corner kick from the girl on her Anne Arundel County club team who "had the strongest foot on the team."
The kick was a hard line drive, he said. Camryn didn't feel right the next day, he said, and missed a few weeks of school.
Camryn made the Chesapeake High School varsity team as a freshman, and is considering playing in college. She endured a second header-related concussion on a direct kick when she was 14, and a third concussion and neck injury at 15 in a collision with another player.
"I still love the sport just as much," she said. But she is concerned about more concussions.
"Every time I've come back from one, I'm always scared of getting into a situation of heading a ball," she said. "But from my coaches I've learned different ways to still play the game without having to head the ball.
"I believe it's extremely important for players to be able to trap and play the game without depending on head balls. It's not worth the effects they leave on your body."
Her father, a federal employee, said he agreed to be interviewed because he believes safety should be paramount, and limiting heading "is not going to prevent you from getting a Division I scholarship."
Former U.S. Men's National Team and D.C. United player Santino Quaranta said parents might initially resist restrictions on heading.
"It has been part of the game for so long, and they say, 'Why are they doing this now?'"
In 2011, Quaranta sustained a severe concussion during his professional career. He said he was elbowed in the temple.
He is now vice president of Pipeline Soccer Club, a Baltimore youth program with more than 900 players.
Quaranta said the heading restrictions aren't likely to slow youth players' growth. He runs heading drills, and encourages players to keep their necks stiff.
"Make sure you hit it here below your [head] band," he told an 11-year-old girl at a recent practice. He demonstrated the technique himself, lunging and striking the ball at his hairline.
But Quaranta and Stitz, the former Blast player, said that heading, once learned, is not a skill that requires much repetition.
"Don't get me wrong, a player that is good in the air and wins balls with his head can be an important part of a team and game," Stitz said.
But "very little time is spent practicing heading the ball. It's one of those things that just happens in games."