TUKWILA, Wash. — Jimmy Gabriel told the best stories.
The Scottish international thrilled young soccer players on road trips as he recounted closing out a 1966 FA Cup win for his first professional club, English side Everton, by fending off defenders at Wembley Stadium. He'd pull out his false front tooth to show the result of a collision with a crossbar to amuse his three daughters at the kitchen table. And he'd charm Sounders FC supporters by contrasting the "American way" of cheering for players before they even kicked a ball unlike in England where it had to be painstakingly earned.
But Gabriel's most influential story is the one his brain chronicled.
Regarded as the original Mr. Sounder, the defensive midfielder died in July 2021 at age 80. He and his family suspected more was wrong than just the 2012 diagnose of Alzheimer's disease. Gabriel, in a moment of lucidness as the dementia tightened its grip, signed an agreement to donate his brain to research.
Gabriel's wife of 60 years Pat and daughters, Karen, Janet and Samantha, sat with mouths agape during a virtual call with Dr. Ann Mckee last spring as the chief of neuropathology for the VA Boston Healthcare System and director of the Boston University CTE Center and UNITE Brain Bank explained Gabriel's primary neurodegeneration was stage 4 chronic traumatic encephalopathy (CTE).
"Once we found out, we all were a little bit shocked how severe the case was," said Janet Keeney, Gabriel's middle child. "I personally felt really bad that I wasn't aware that Dad had suffered so much."
CTE, a progressive and fatal brain disease associated with repetitive head impacts, has been largely linked as a risk in football players. And as the second anniversary of Gabriel's death passed last week, conversations about CTE in soccer players lags far behind, while misconceptions prevail about the underlying cause of the disease.
Pat wants to share her late husband's story now to help raise awareness about the dangers of head injuries in soccer.
Concussions aren't the leading cause to developing CTE. It's the non-concussive hits and the magnitude of those hits over time that's the major factor in developing the disease, according to the latest study released in June by researchers at Mass General Brigham, Harvard Medical School, and Boston University. In soccer terms, it's repetitive heading of the ball.
"Dad would want the knowledge to be there and people make their decisions as they may," Janet said. "He would want people to be aware of heading as a risk."
'It never has been the concussions'
The NFL was the first U.S. sports league to implement a concussion protocol in 2009. When the organization faced a class-action lawsuit from more than 4,500 former players and their families in 2011 for covering up information related to head trauma — the U.S. Supreme Court resolving the $1 billion payout in 2016 — nearly every other league, including MLS and the NWSL, added their own concussion protocols.
FIFA, through the International Football Association Board (IFAB), updated its governance in December 2020 for soccer globally to allow up to two permanent concussion substitutes that don't count against the five allotted in matches. Men's and women's leagues in the U.S., Japan, England, Portugal and Netherlands are participating, however the "temporary" substitution trial to allow for a more efficient on-field medical evaluation was rejected by IFAB in March.
Yet, nowhere is the specific wording of CTE — which can be only discovered after death — addressed. The latest study, of which McKee is a contributing author, is the largest to date where the brains of 631 deceased football players were examined and showed "years of play is positively associated with CTE pathology, whereas symptomatic concussion is not," according to lead author Dr. Daniel Daneshvar.
"It never has been the concussions; that was the message people got and it was kind of promoted by the NFL," McKee said. "It's distracted people from the main message we had since 2013 — 10 years — it's the number of hits over time. It's the years of exposure to football that's the major risk factor for CTE.
"That paper just shows it's not just the cumulative number of hits, it's also the magnitude of those hits. It's common sense."
American football has dominated the conversation, but there are parallels that can be found in soccer. McKee helped developed the criteria for diagnosing CTE and she said the first discovery in the U.S. was Patrick Grange, a semipro soccer player who died in April 2012 at age 29. He suffered his first concussion at age 3 and was diagnosed with ALS in 2011. After death, researchers determined he had stage 2 CTE.
Brazilian star Bellini, who won the 1958 FIFA men's World Cup, followed as a confirmed case in 2014, dying at age 83. In Scotland, a 2019 study of medical records for more than 7,000 professional men's soccer players found they were three-and-a-half times more likely to have neurodegenerative diseases as a cause of death.
In May, Boston University CTE Center researchers confirmed four former North American Soccer League (NASL) players were diagnosed with stage 4 of the disease. Franny Pantuosco, who was born in Massachusetts and played for the New England Tea, died in 2021 at age 64. Jim Fryatt, an Englishman who played for the Philadelphia Atoms, died in 2020 at age 79. Jimmy Conway, an Irishman who played for the Portland Timbers, died in 2020 at age 73.
And Gabriel.
"FIFA and other soccer organizations are in deep denial about the risks to the players and they have not cared for the players after they've retired," said McKee of the world's most popular sport. "We need more information about soccer. Particularly women and girls playing soccer, we are in desperate need of those brains to understand the gender effects."
Scientists in Australia diagnosed the world's first case of CTE in a woman earlier this month. Heather Anderson, a 28-year-old Australian Football League (AFL) player, had low-stage CTE.
Glasgow Headers
Gabriel was compiling decades of papers on coaching skills techniques into a book when the early signs of Alzheimer's and dementia began to show. "A ball and a wall" was a working title for a developmental section that now foreshadows the dangers of repetitious heading.
Born in Dundee, a coastal city in east Scotland, Gabriel wrote that he carried a tennis ball in his pocket everywhere as a kid. The use was for a drill called the "Glasgow Headers," after the city where the skill was invented or learned.
A player is to stand three feet from a wall and see how many times they can bounce the ball from their head to the wall without it hitting the ground. He preferred small rubber balls so his "head wouldn't hurt at the end."
"Many of my greatest memories are those of aerial duels won both offensively and defensively against some of the best headers of the ball in England," Gabriel wrote. "I must admit some of the greatest thrills I had came from rising into the air to beat a cross with my head to power the ball past the keeper and into the net."
It's estimated a soccer player will head a ball 12 times during a match — approximately 800 times during a season. OL Reign leads the NWSL with 10 headed goals this season.
The higher the level, the ball can collide with the head at up to 20 mph. The average length of a soccer career, according to Penaltylife.com is eight years; Gabriel played for 22 years.
"Before Jimmy was diagnosed, he used to commentate at the Sounders games, and when he got home, he would say, 'You know, I can't remember some of the players' names,' " Pat said of her husband's radio broadcast stint during the 2009-10 Sounders seasons. "That's when I could see that something was wrong. But I never really thought he had something so serious."
Due to the CTE research in Brazil, the U.S. and Scotland, US Youth Soccer in 2015 banned children ages 10 and younger from heading the ball completely. It can be introduced between ages 11-12 and restrictions are lifted by age 13. The Football Associations of Scotland, England, and Northern Ireland adopted similar rules in 2020.
In November 2022, the Scottish Football Association took it a step further and announced a rule change that bans headers before and after matches and limits repetitive heading drills to once a week. The decision was made with consultation from 50 women's and men's clubs, with more than 70% of coaches and more than 64% of players agreeing with the new guidelines.
"As a young defender, we would practice heading where the goalkeeper would punt the ball down the field and you had to head the ball," Sounders coach Brian Schmetzer said of being a pro in the 1980s. "We would never, ever kick 10 high balls in a row to any center back these days because it increases the likelihood of damage to the brain. There are certain moments where the coaches do some crossing just so players can work on their footwork and timing of their aerial challenges. But it's once every three weeks."
No heading allowed
Sounders keeper Stefan Frei grinned at the question.
Could you ever imagine soccer without headers?
"No, that would have to change so many rules," Frei said.
The concept is being tested in Wales. Head for Change, a charitable organization that raises awareness and supports former soccer and rugby players who are affected by neurodegenerative disease, held what is believed to be the first match without headers in 2021, and another last fall.
No heading outside the box was allowed in the first half and none at all in the second half. Those in attendance noticed fewer crosses into the box in the second half, but mainly instead of aerial duels, high passes and long balls were chested down or completely dropped to the field before being played.
McKee said she's "lost optimism" that FIFA and the IFAB will ever implement guidelines to limit or eliminate heading. She's thankful the general public is more receptive.
"They're starting to say we have to treat brain injuries the same way as all of the other injuries," said Frei, who's had multiple concussions, and missed two games this month due to a concussion suffered in training. "My fingers and parts of my body are so banged up, I don't even want to know how it's going to feel when I'm 60. That's kind of how you have to look at the brain, too. You have to really look at it and say, hey, treat this one with the utmost respect because there's probably going to be some sort of consequences for all of the things that we do."
That's all the Gabriel family wants — acknowledgment.
"I'm not 100 percent sure Dad would've changed the way he lived his life because he loved the sport so much," Janet said. "But I think he'd want everyone to be aware that this could happen and responsibility for the league to address it, whether that's giving support to families — especially in that era ... is it something you want for your life?"
