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Florida Tech Studies Raise Concern About Soccer Heading

Heading Effects Cognitive Functioning

Two 2003 studies suggest that heading in soccer may result in weaker mental performance, including a decline in cognitive function, difficulty in verbal learning, planning and maintaining attention and reduced information processing speed.

Researchers at Florida Tech considered the short and long term effects of frequent headings, the first comparing brain function of players who had recently played soccer with those who had not, the second comparing brain function among soccer players who had played for varying number of years with the brain function of subjects who had never played.

Frequent Heading May Lower Test Scores

The short term study found that recent heading by players who headed with "moderate-to-high frequency" led in some cases to weaker neurocognitive performance. "What we found is that if Bill plays soccer on a Thursday night, and is a frequent header, he's more likely to score lower on a neurocognitive test Friday morning than a similar player who heads the ball only occasionally," said lead researcher, Dr. Frank Webbe.

While recent heading is not guaranteed to decrease functionality, Webbe said it presents a strong enough risk factor to warrant further study.

Long Term Effects Less Clear

The long-term effects are less clear. One study found that lifetime heading had "no significant or strong effect... on neuropsychological performance." But the other reached a different conclusion, noting "players with the highest lifetime estimates of heading had poorer scores on scales measuring attention, concentration, cognitive flexibility and general intellectual functioning."

Dr. Webbe acknowledged the apparent contradiction, but said that the overall research does support the concept of long-term harm.

"Inside the groups of testers, we found that more individuals were likely to be impaired in the frequent heading groups than in the less frequent heading and control groups," he said. "The difference was three or five out of 20 impaired among the lifelong frequent headers as opposed to one or zero out of 20 in the control groups."

Incorrect Heading May Be Cause

Dr. Webbe is more convinced than ever, as a result of his studies, that soccer heading damages the brain. He believes that it is largely the result of improper heading technique.

"Generally, we accept the premise that if you head the ball with proper technique, then your risk for brain injury is lower. However, we have to acknowledge that, during a game, things happen to make the heading situation less than ideal," said Webbe. "If you leave your feet, or are challenged by an opponent, you may not be able to head the ball correctly. As a result, when you head the ball you are putting yourself in a position to sustain an insult to the brain."

Update: January 29, 2010 Editor's Note:  A clinical report by an expert panel of the American Academy of Pediatrics reported in the February 2010 journal Pediatrics stated as follows: "A critical review of the literature does not support the contention that purposeful heading contacts are likely to lead to either acute or cumulative brain damage. ..." (emphasis supplied).  The authors did, however, agree with Dr. Webbe that efforts to reduce potential injury from heading the soccer ball were warranted, including teaching proper heading techniques, delaying the teaching of purposeful heading until the child is old enough to learn proper technique and has developed coordinated use of his or her head, neck and trunk, to properly contract the neck muscles and contact the ball with his or her forehead (although they recognized that there was currently no valid evidence to support this recommendation).

Update: February 15, 2012 Editor's Note: Like the 2010 AAP Clinical Report, a 2012 study by researchers at the Cleveland Clinic reported in the journal Neurosurgery,1 found no link between intentional heading and acute brain damage (e.g. concussion), but that it was at least theoretically possible that it could represent a form of repetitive subthreshold mild brain injury over time and could be the cause of chronic traumatic encephalopathy.  With specific reference to the Florida Institute of Technology study, the authors found that that, "although a detailed neuropsychological evaluation may have detected a subtle difference, it was unlikely that the daily lives of the players were at all affected."

Source: Florida Institute Of Technology Press Release 

1. Spiotta A, Bartsch A, Benzel E. Heading in Soccer: Dangerous Play? Neurosurgery 2012;70(1):1-11.