By Tara Hessenthaler and Dylan Henry, of Montgomery McCracken
Researchers at the Boston University (BU) CTE Center have reported they found evidence of CTE in ex-MLS (Major League Soccer) player Scott Vermillion’s brain in a posthumous autopsy. This is a milestone discovery, as it would mark the first CTE diagnosis in the MLS. As with most CTE diagnoses, the BU CTE Center could not link the diagnosis to any one hit, but believes it is the result of repeated subconcussive blows to the head during Vermillion’s twenty-two year soccer career.
Vermillion began playing soccer at the age of five and played for the University of Virginia Cavaliers, and represented the United States on the U-17 and U-20 squads. Vermillion’s MLS career included a total of four seasons with the Kansas City Wizards, Colorado Rapids, and D.C United. He eventually retired in 2001 after suffering a career-ending ankle injury.
As with others who have been diagnosed with CTE posthumously, Vermillion’s signs and symptoms were evident in the years after his retirement. Vermillion suffered from depression, and reported having issues with impulse control and aggression. It is unclear whether he reported any of these issues before he retired. He spent the last decade of his life withdrawing from his family and struggling with memory loss and substance abuse.
Vermillion’s father, Dave Vermillion, hopes this diagnosis will be a wake-up call to the soccer community and will lead to the community establishing a support network and fund for former players who received head trauma or injuries during their MLS careers, which caused—or may cause—long-term neurological problems and cognitive decline (similar to the relief sought by the class of former NFL players In re: National Football League Players Concussion Injury Litigation and the settlement fund, established in April 2016, and In re NCAA Student-Athlete Concussion Litigation, established in November 2019.). The MLS Players Association also hopes that this will be a wakeup call to the league. The Association is now calling on the league to officially adopt a rule that would expand substitutions for players with concussion symptoms (currently, only five substitutions are allowed per team per game). Beginning a twenty-month trial at the beginning of the 2021 season, the league is set to formally decide on the rule after August 31, 2022. Under the rule, teams will be permitted up to two “concussion” substitutions per match to replace players suffering from a concussion or suspected concussion, regardless of how many substitutions a team has already used. The hope is that such a rule will allow substitutions to be used in the interest of player health and safety, and will reduce the severity of concussions experienced by MLS players.
While the implementation of concussion safety-based rules is a step forward in promoting player health and safety, the death of Vermilion calls for an investigation as to the impact of CTE on professional soccer players and its relationship with repetitive concussive and sub-concussive blows in the sport. Chris Nowinski, co-founder of The Concussion Legacy, believes an investigation is necessary into how many players, both former and current, suffer or are at risk of suffering, from CTE. He stated that Vermillion’s CTE diagnosis is a time for the global soccer community to have a real conversation about the risks of heading the soccer ball, especially in the youth game. The U.S. Soccer Federation took an initiative in 2015 by announcing a protocol that players in U-11 programs and younger shall not engage in heading. There is concern, however, that such a rule may have come too late for many present-day players.
Vermillion’s diagnosis should not come as a surprise after CTE has been diagnosed and studied in overseas soccer leagues. In 2016, a British study suggested that routine heading of the ball can cause damage to brain structure and function. In 2017, the University College of London Institute of Neurology conducted postmortem examinations on six former Premier League players who had symptoms of Alzheimer’s disease. Four of these former players were confirmed to have CTE. In response to these findings, the Football Association released new guidance for heading prior to the 2021 season. The new guidelines affected all clubs in the Premier League, EFL, Barclays Women’s Super League, FA Women’s Championship, the National League System, all grassroots football, and across the England national teams.
Vermillion may have been the first MLS player diagnosed with CTE, but he certainly will not be the last. On July 5, 2022, Bruce Murray, a former MLS player and American soccer legacy, spoke out about his expectation of a postmortem CTE diagnosis. Murray presently deals with mild dementia, but at the age of fifty-six, he has forgotten to turn off the ignition in his car, had to remind himself that his two young children were in the back seat, checked himself in at a hotel for no reason, and even lost his balance running, causing him to tumble into a tree and roll into the water. Murray was only diagnosed with two official concussions during his career, he suffered numerous subconcussive blows and even recalled that while playing in Switzerland, players were punished by having to head punted balls for two hours. He hopes that by speaking out about his experience, other former players will follow.
CTE is a concern among female soccer players as well. In 2019, the BU CTE Center announced the launch of the Soccer, Head, Impact and Neurological Effect (“SHINE”) study. The SHINE study is a first of its kind and is recruiting twenty former soccer players to donate their brains and create the first all-female study cohort dedicated to understanding CTE. Brandi Chastain, Michelle Akers, Abby Wambach, Megan Rapinoe, and Briana Scurry have already pledged to donate their brains to the study upon death. Two-time Olympic gold medalist and 1999 World Cup Champion, Briana Scurry, is another athlete that expects CTE to be found in her brain. Scurry suffered three concussions during her career, with a career-ending one occurring in 2010. Her post-soccer life has been filled with multiple suicide attempts, constant headache pain, and even pawning off her two Olympic gold medals and the Rolex watch she received for her 100th appearance for the national team. In 2011, while commentating for ESPN on the Women’s World Cup, Scurry even struggled to remember facts and names during the broadcasts. While Scurry has now reclaimed her medals, received surgery to alleviate her constant headaches, and written a book, she hopes that telling her story will shed light on concussions and the long-term risks in soccer.
As scientific and medical researchers continue to develop our understanding of CTE (and what it causes) and other neurodegenerative disease and as more diagnoses are made, it is likely that the MLS could face a landslide of lawsuits (individual and class action), similar to the suits filed against other major sport organizations, such as the NFL, NCAA, and RFL (Rugby Football League). We will continue to monitor CTE in MLS and provides updates.