Do Headers In Soccer Cause Brain Injury?
Think of head injuries and concussions and people usually imagine impact injuries from sports like football, boxing or hockey. But there’s been an awakening in soccer – both professional and youth soccer – and increasing evidence that there are real risks in the beautiful game too.
Researchers from the Gruss Magnetic Resonance Research Center of the Albert Einstein College of Medicine in New York City presented results of a study that indicates frequent heading in soccer may cause brain injury. Dr. Michael Lipton, lead researcher and associate director, shared the findings at the annual meeting of the Radiological Society of North America in Chicago. This was back in 2011. Has youth soccer taken these risks seriously? Is the word getting out on the sideline with parents of elite players or coaches in youth soccer? Do the people involved in youth soccer realize there really is a risk of traumatic brain injury in soccer?
“This is the first study to look at the effects of heading on the brain using sophisticated diffusion tensor imaging,” said Dr. Lipton in a release to the media in November, 2011. “We found the real implication for players isn’t from hitting headers once in a while, but repetitively, which can lead to degeneration of brain cells.”
Here is a look at that research:
The center performed MRIs on 32 adult amateur soccer players, average age 31, to find if there were measurable changes in their brains. The average number of headers reported for the subjects was 436, with some saying they headed the ball over 1000 times over the course of a year. According to the findings, players who headed the ball at the high end had brain scans that indicated abnormalities on par with the traumatic brain injury from an auto accident.
Those players who passed the 1000 header threshold showed signs of abnormalities in areas of the brain responsible for attention, memory, physical ability and high-level visual function, according to the study. Recently there have been reports concerning the affect of repeated heading and other head injuries on cognitive functioning in players both young and old. Some research has linked poor memory and motor function test results to concussions suffered by players.
The study comes during a time of increased awareness about head injuries to athletes of all ages. In youth soccer, Axon Sports created an on-line cognitive evaluation that players can take at various stages of their sports career. The evaluation can indicate possible concussion-related changes in cognitive functioning. Korrio, a Seattle-based company that offers an online sports management system, has partnered with Axon Sports to provide the Computerized Cognitive Assessment Tool (CCAT) to its clients. The goal is to allow players to create a “baseline” reading that can then be used to compare with testing following any post-concussive incidents.
In spite of the concerns about heading, it has been shown that player-on-player collisions are responsible for a much higher percentage of concussions in soccer. A study by Nationwide Children’s Hospital in Columbus, Ohio, reported on concussions in youth sports. “Heading a ball appears to spectators as one of the most dangerous plays in soccer. However, only 6.6 percent of injuries are caused by this flashy move—and contact with the ball accounted for only 7 percent of concussions, while player-to-player contact resulted in more than 70 percent,” according to the report.
Responding to the results of the Gruss study, Anaheim Hills, California, pediatrician and sports medicine specialist Dr. Chris Koutures said that more data was needed to effectively evaluate and determine whether there should be limits on heading. “We need an approach where we follow players down the road and count the headers in respect to age, head injuries, alcohol use and other factors,” said Dr. Koutures. “This would be valuable information to share with players and their families.”
Dr. Koutures also explained that players should use proper heading techniques to reduce the force of impact on their heads. Players should strike the ball with the forehead, while keeping the head, neck, and torso in a solid line without twisting, according to Dr. Koutures. He also said that he felt children were not developmentally ready to learn this technique before the age of 10, so they should avoid heading before that age.
Dr. Koutures published a review of earlier research on youth soccer injuries in Pediatrics in February 2010. In that report, he indicated there was no documented link between heading the ball and long-term head injury. Dr. Lipton agreed that there are inconsistencies in the medical literature, but pointed out that youth coaches and players are generally not good judges of cognitive problems.
“We can’t tell an individual today not to be heading a ball, but caution is a good thing,” said Dr. Lipton. “We need more research for definitive answers and we have the advanced imaging tools to do it.” He also suggested that public health officials should consider developing guidelines for players once detectable thresholds are identified.
“There are threshold levels where we don’t see brain abnormalities, which means heading is not absolutely bad,” Dr. Lipton said. “Rules could be developed to alleviate adverse affects by limiting the number of headers allowed for certain age groups or skill levels of play.”
All of the data, of course, are preliminary, and the sample of 32 adults should not necessarily be expected to tell the entire story. Much more research is needed, and should include youth players as well as adults to get a more balanced and accurate view of the effect of heading. Soccer players have been heading the ball for generations, and will probably continue to do so for years to come. It may be sensible to put some age restrictions on organized soccer, but that will not stop young players from heading the ball on their own time. It will be interesting to see where the research goes from here.