American study links heading a football to increased risk of concussion

A recent US study published in the journal Neurology, supports the link between frequently heading a ball whilst playing football and an increased risk of concussion. 
Children playing football in orange tops
The research was compiled from online questionnaires completed by over 200 predominantly male adult football players, who compete regularly in amateur leagues or clubs, for at least 6 months of the year. The report looked not only at the frequency of headers, but also symptoms felt afterwards and the number of unintentional impacts ie collisions or falls. 

The findings

The results showed that players who head the ball frequently – averaging 125 headers in a fortnight - are 3 times more likely to have concussion than players at the opposite end of the spectrum, for whom the average is 4 headers in the same period. It also showed that unintentional impacts were closely linked with developing symptoms of concussion. The study’s senior author, Dr Michael L. Lipton, a professor of radiology and of psychiatry and behavioural sciences at the Albert Einstein College of Medicine told CNN: "There's over a quarter of a billion people in the world who play soccer, and most of those people are the kind of people we study. It's a huge number of people. So if there is an effect on the brain and as the data comes in, it's increasingly looking like there is - that's potentially a big public health issue."

What is concussion?

Concussion is a type of traumatic brain injury that may alter the way your brain functions. Despite the idea that concussion isn’t serious, it can cause substantial difficulties or impairments that can last a lifetime. You can read more about concussion on our dedicated page here. As Dr Lipton said: "The good news about concussive injuries is that the vast majority of people recover.” However, he further explained: “What's not known is, when you have repeated injuries of this type, what is the long-term cumulative effect?" He did make clear that whilst of great relevance to adults, these results cannot be applied to children, teenagers and professional football players and that the kinds of self-reported data used in this study can have flaws.

Expert view

This stance is supported by Anthony P. Kontos, associate professor at the University of Pittsburgh and research director at the UPMC Sports Medicine Concussion Program, who told CNN: "As a lifetime competitive soccer player, I have no idea how many headers I perform in practices or games, even if you asked me the same day, let alone two weeks later, as in the current study." He also highlighted that in study the researchers were unable to control for the type of header, noting that “not all headers are the same.” However, he went on to explain that other recent research supported the view that unintentional collisions hold the most risk: “Concussions in soccer mostly occur from player-to-player and player-to-ground contact. Heading is involved in only 15% to 30% of concussions in soccer and most of these are as a result of poorly executed headers where two players hit heads,” suggesting that “we need to do more to teach kids how to properly and safely head the ball.”     

The next step

Research of this nature has led to increasing acceptance within the sporting world that brain injuries can and do arise. Dr Sam Gandy, director of the NFL Neurological Center at Mount Sinai Hospital told CNN: "I think one of the major advances is a change in attitude. For a long time, there's been denial that brain injury might have longer-term consequences to players. Now, that's no longer happening." This is demonstrated by US Soccer guidelines implemented in December 2015 which prevent children aged 10 and under from heading the ball, and advise only limited heading for players between 11 and 13. The prevailing view now being that by teaching children the right technique to head a ball and developing appropriate muscle strength the risk of injury will reduce. This lead is now being followed here in the UK with The Professional Footballers’ Association calling for a similar ban on heading for children under 10. They are further supported by evidence undertaken by the University of Stirling that has indicated memory impairment after heading the ball, and persuasive anecdotal evidence of former players suffering with serious brain conditions.
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