Souder grabbed a bag of soccer balls and adjusted her prescription sunglasses, the ones she rarely takes off even indoors, because after the six diagnosed concussions she suffered as a high school and college player, simple vision was a daily problem. Everything now seemed like a daily problem, including this 90-degree sun, which just a few years ago might have shut down her body completely.
But memory loss was the worst part of her life after playing, so she whipped out a white card and read aloud directions to her pupil on this July morning. The 15-year-old was working her way back from a concussion of her own, joining the girls’ soccer players across the country who are suffering from traumatic brain injuries at an alarming rate, nearly as rapidly as high school football players.
Souder herself suffered a traumatic brain injury while playing soccer — part of a growing and perplexing challenge that some of the sport’s leaders and medical officials view as a crisis — and had designed custom drills as part of her pupil’s rehabilitation. For nearly an hour their injuries had not come up, not until the end of the workout, after they practiced kicking the ball into the upper corners of the net. The girl asked Souder whether she could head the ball in.
“Why head it?” Souder replied. “What’s the point?”
‘Girls who play soccer really need to be aware’
About two weeks earlier, Souder sat in a sports bar near her home, watching the U.S. women’s national team’s World Cup title-game victory over the Netherlands. She had once dreamed of playing on such a stage, but she remembered this game for the worst reasons.
She watched as U.S. player Becky Sauerbrunn went up for an aerial challenge and came down with blood dripping down her face. Souder excused herself from the table because she had grown nauseous. She needed to leave.
It wasn’t so unlike the jarring hits she had taken as a rising star at Walkersville High and later a starting centerback at Division III Hood College, where by 2015 her career had ended with six concussions, two neck surgeries and a life spinning out of control. She was among the approximately 300,000 adolescents who suffer concussions while participating in organized sports every year. In matched sports, girls are 12.1 percent more likely to suffer a concussion than boys, a 2017 study by the American Academy of Orthopaedic Surgeons found.
It also concluded that female soccer players are more likely to suffer a concussion than male football players — and are three times more likely to suffer a traumatic brain injury than male soccer players.
“What was very surprising was that girls’ soccer was just as impactful as boys’ football. We did not expect to see that,” said Wellington Hsu, an orthopedic surgeon at Northwestern who led the study. “Girls who play soccer really need to be aware of these issues. These symptoms and having a second concussion is sequentially worse from the first one.”
Concussions make up nearly 27 percent of injuries in girls’ soccer, according to Hsu’s study, yet there is no conclusive answer as to why. Some in the medical field have pointed to the fact that girls’ neck muscles are not as developed as those of boys, leading to the susceptibility of more head injuries. Others have blamed heading the ball — and collisions resulting from players attempting headers — as a culprit. In 2015, U.S. Soccer, which governs the sport across the country, introduced new guidelines for headers and banned the practice for youth participants 10 years old and younger.
“I’m not sure that’s solving anything, because I think once you get to the age of 12 … you could easily hurt yourself heading the ball at a high speed if you don’t know what the proper technique is,” Hsu said.
This issue was back in the spotlight during the World Cup after former U.S. national team members Brandi Chastain and Michelle Akers announced they would participate in a Boston University study of chronic traumatic encephalopathy, which is most often associated with football players who have taken constant blows to the head. No female athlete has been diagnosed with CTE, which can only be confirmed through autopsy. Akers and Chastain have publicly expressed concern about memory loss in the years since they retired from soccer.
Hsu said the number of concussions in women’s soccer continues to rise each year, partly a result of growing awareness.
“We have not seen a plateau,” he said. “We have not seen anything tail off as far as incidents with this problem.”
‘She was in denial about how bad it really was’
It’s difficult for Souder to pinpoint what caused so much damage to her brain. Beginning at age 8, she begged her mother to spend hours in the backyard throwing the ball in the air so she could redirect it with her head. She suffered one diagnosed concussion in high school but suspected three others because of collisions. During the first three months of her junior season in college, she suffered three diagnosed concussions, each from a different kind of violent play. She was cleared medically after each, but each precipitated the next.
“I honestly had not grasped the seriousness of concussions up until that point,” she said.
By the next season, after her first game back, Souder was in the emergency room and placed on a beta blocker to manage her heart rate, which was in the 30s. A couple of days later, at a concert with her family, she crumpled to the ground with migraines, clutching her head with both hands. She was carried out of the venue by her stepfather and cousin.
She didn’t know what was happening. She began to have an electrical, burning sensation in her jaw and temple. The right side of her face went numb. By that October, doctors diagnosed her with trigeminal neuralgia, which is also known as “suicide disease” because of the number of patients who took their own lives as a result of the pain.
Yet what might have made Souder the saddest was being away from the game she loved, and she met each suggestion to slow down or give up the sport with fierce stubbornness. Her mother knew Souder was paying her own way through college and felt she couldn’t tell her daughter what to do. Team doctors had cautioned her and helped her find neurologists and concussion specialists to work with, but Souder’s relentless desire to play always won out.
“It was very difficult for us to really just educate her on the dangers behind it and kind of have her sit down and really understand what she was putting her body through,” said Laura Richards, a former athletic trainer at Hood. “She did not want to give up the love of the game.”
“She was in denial about how bad it really was,” said Souder’s mother, Stacy Johnston. “She hid them really well.”
By the time she was a graduate senior, she had endured two surgeries on her occipital nerves — doctors believed a neck issue was causing Souder’s unbearable pain — and countless hospital visits, but she was still heading the ball, justifying her decision by only doing it in games.
On her team’s senior day, she was battling in a double-overtime thriller when in the final seconds her world went dark. Video would later show a defender being pushed into Souder, who fell back and hit her head on the turf. It was the last time she played soccer.
“I knew my life would never be the same,” she said.
‘Brittni is our hero’
There were many times in the six months after she graduated that Souder thought about ending it all. Soccer was gone, but the toll the concussions had taken remained. Souder had trauma-induced anorexia and had to force-feed herself because she couldn’t hold an appetite. She started sleeping all day, leaving the same TV shows on loop because she couldn’t look at the screen. She eventually quit her job at a golf course; the heat was shutting down her body and making her sick.
But workers at that golf course also helped Souder raise $16,000 to see a brain specialist in Georgia in 2016, followed by another visit the next year. She got a dog to help with her emotional needs and moved in with her parents, who joined in spreading awareness to other families of the concussion risks facing girls’ soccer players.
Most players would be bitter about the sport that has created so much pain, but after college, Souder began chasing a coaching career.
“Sometimes I am conflicted,” she said. “But I absolutely love the game, and I want to use what happened to me to help as much as I can.”
The game, Souder said, has saved her in the years since. She has made it her mission to share her story with as many players as possible, and her first conversation with each player is always about head safety. She sees herself in each of them and wonders whether she can relay to them what is at stake.
“She started to talk to me about how she … wanted good to come out of it,” said Alexis Andrukat-Price, a former college teammate. “To see her try and take this thing that would have made a lot of people quit … and literally craft her life’s work out of it is remarkable.”
Jennifer Grunwald, the mother of Allyssa Grunwald, the 15-year-old girl Souder tutored that July morning, said her trust in Souder made her comfortable with allowing her daughter back on the field. Allyssa, who suffered a concussion while on a roller coaster three years ago and aggravated it at soccer practice soon after, has dreams of earning a college soccer scholarship. She is Souder’s most delicate student and a chance to put to the test everything Souder learned through her own struggle.
“Brittni is our hero,” Jennifer said.
Most of Souder’s students don’t know what their teacher goes through on a daily basis. She often jokes with her fiance that he is about to marry an 80-year-old woman, because she forgets almost everything, including directions around her own neighborhood. Her life must be scripted on her iPhone calendar. Her Apple Watch reminds her to eat. The migraines still pop up frequently.
Souder and her mother rarely talk about the possibility of her having CTE, but both think about it often.
“It’s at the forefront of all of our minds, hers included, just because we see the signs,” Johnston said. “She doesn’t let it consume her life, even though I know we all have that fear.”