A 2010 study finds no support that purposeful "heading" of a soccer ball leads to either short-term (acute) or cumulative brain damage, such as cognitive dysfunction.
The authors called for additional study to provide proof of neuropsychological consequences of subconcussive soccer-related head injuries.
The study, by the American Academy of Pediatrics' Council on Sports Medicine and Fitness Executive Committee, is reported in the February 2010 issue of the journal Pediatrics.
The research contradicts the findings of earlier studies, including one by researchers at Florida Tech in 2003, which suggested that heading in soccer may result in the short term in weaker mental performance, including a decline in cognitive function, difficulty in verbal learning, planning and maintaining attention and reduced information processing speed.*
The results of the study in Pediatrics is consistent with anecdotal evidence reported by William P. Meehan III, MD, MomsTeam concussion expert, Director of the Sport Concussion Clinic in the Division of Sports Medicine at Children's Hospital Boston, and author of the new book, Kids, Sports, and Concussion.
"Since opening the Sports Concussion Clinic in November 2008, we have cared for nearly a thousand patients with concussions," Dr. Meehan writes. "Only a few have reported sustaining their concussions from purposeful heading of the ball. All of them were children."
Preventing head injuries
While concluding that "the contribution of purposeful 'heading' of the soccer ball to both acute and potential long-term concussive effects, such as cognitive disfunction, seems less controversial today than previously," the authors of the Pediatrics study nevertheless felt that efforts to reduce potential injury from heading the soccer ball were still warranted.
Echoing the advice of other experts, the panel recommended:
- Delayed teaching The panel recommended that heading of the ball only be taught when 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 the forehead. In doing so, it noted that the American Youth Soccer Organization (AYSO), with 650,000 participants, does not teach purposeful heading to players under age 10.
- Use of age-appropriate balls. "Although proper technique is foremost in reducing the risk of concussion from heading the ball," the study says, "it is also imperative that soccer balls be water-resistant, sized appropriately for age, and not hyperinflated; and
- Strict rules enforcement. Citing statistics that foul play has been associated with a significant number of contact-related injuries, with girls' (11.9%) and boys' (11.4%) soccer just behind girls' basketball (14%) as the sports with the highest rates of such injuries, most of which were concussions or other head/facial injuries, the panel joined in the consensus recommendation of experts that proper rules enforcement and limitation of violent contact, with officials controlling the physicality of the game and emphasizing safe play with respect for one's opponents, could play a significant role in reducing contact injuries in soccer.
Dr. Meehan concurs with these recommendations, but only in part. "Some have suggested that perhaps children should not be allowed to head the ball until they reach a certain age and have become stronger and better coordinated. I believe, however, this would be a mistake. As children become stronger and better coordinated, they are able to kick the ball at a much greater velocity. It seems unwise," he writes, "to have their first time trying to head a ball occur at an age when the ball can be kicked with significant speed and force."
"Instead," Dr. Meehan suggests, "using smaller, softer balls that weigh less while children are younger allows them to develop the skills necessary for proper heading of the ball. This seems like a safer approach. They can learn proper technique, develop strength, and master the timing and coordination necessary for proper heading of the ball when young, before they begin to play with an adult-size ball that can be kicked with significant force." Learning to head with a dry, soft, foam ball may be another useful way to start, he says.
Soccer helmets: recommendation premature
The panel acknowledged that one study had found that found that an association between the use of soft soccer helmets and a reduction in concussions and soft tissue injuries compared with no helmet, without increasing the risk of injury to areas not covered by the head gear.
It nevertheless concluded that the currently available data, combined with a lack of uniform safety standards and regulations, were "insufficient" to support a finding that soft helmets prevented head injuries such that universal support of soft helmets was "premature at this time."
* Update: A 2012 study in the journal Neurology by researchers at the Cleveland Clinic1 also found no link between intentional heading and acute brain damage (e.g. concussion), but said 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: Pediatrics, February 2010; 410-414
Posted January 29, 2010; revised and updated July 25, 2011; further revised and updated February 15, 2012
1. Spiotta A, Bartsch A, Benzel E. Heading in Soccer: Dangerous Play? Neurosurgery 2012;70(1):1-11.