Concerns about heading soccer balls are warranted, say the authors of an article in The Physician and Sportsmedicine.
Earlier studies suggest that heading may be related to:
- Neck pain
- Abnormal EEGs
- Mental impairment
- Personality change
- Lower verbal scores on standardized tests, and
Studies show short term effects of heading on mental performance
A more recent study, presented at August 1999 meeting of American Psychological Association, comparing mental performance of 32 college and professional soccer players with a group of swimmers, found that soccer players scored lower on 5 of the 11 tests.
In September 1999, a group of Dutch researchers suggested in the Journal of the American Medical Association, based on a study of 33 soccer players and 27 control subjects, that participation in amateur soccer may be associated with mild chronic traumatic brain injury. Soccer players were found to have diminished ability on tests of memory and planning when compared to those who did not play soccer.
Studies by researchers at Florida Tech University in 2003 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.
Long terms effects less clear, suggest caution
The long-term effects of heading a soccer ball 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."
No definitive conclusions can be drawn from these studies because of the small number of test subjects and the variables involved (such as the type of ball-head contact, speed of the ball, etc.). Other studies have found no link between heading and brain injuries.
However flawed the studies may be, experts, like Dr. Lyle Micheli of Boston's Children's Hospital and a nationally recognized authority on children and sports medicine, are concerned. "Until further studies clarify the risks, there should be a yellow warning signal going out," says Michelli.
Experts Recommend Safety Measures
Until then, Micheli and others recommend that the following safety precautions be taken:
- Delay teaching soccer players how to head a soccer ball until age 12, when coordination and neck strength have been developed sufficiently to learn proper heading technique;
- Educate players, coaches, parents, referees, and health professionals about the injury potential
- Strictly enforce rules on the distance of players from the ball on restarts (such as free kicks)
- Use balls of the size and weight appropriate for the players' age
- Consider the possibility of concussions.
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, 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."
Update: June 12, 2013 Editor's Note: A new study by researchers at Albert Einstein College of Medicine found an association between heading and abnormal microstructure of white matter of the brain and with poorer neurocognitive performance. For new article, click here.