Heading and Head Injuries in Soccer

United States Soccer Federation, Chicago, Illinois, USA.
Sports Medicine (Impact Factor: 5.04). 02/2001; 31(5):369-86. DOI: 10.2165/00007256-200131050-00006
Source: PubMed


In the world of sports, soccer is unique because of the purposeful use of the unprotected head for controlling and advancing the ball. This skill obviously places the player at risk of head injury and the game does carry some risk. Head injury can be a result of contact of the head with another head (or other body parts), ground, goal post, other unknown objects or even the ball. Such impacts can lead to contusions, fractures, eye injuries, concussions or even, in rare cases, death. Coaches, players, parents and physicians are rightly concerned about the risk of head injury in soccer. Current research shows that selected soccer players have some degree of cognitive dysfunction. It is important to determine the reasons behind such deficits. Purposeful heading has been blamed, but a closer look at the studies that focus on heading has revealed methodological concerns that question the validity of blaming purposeful heading of the ball. The player's history and age (did they play when the ball was leather and could absorb significant amounts of water), alcohol intake, drug intake, learning disabilities, concussion definition and control group use/composition are all factors that cloud the ability to blame purposeful heading. What does seem clear is that a player's history of concussive episodes is a more likely explanation for cognitive deficits. While it is likely that the subconcussive impact of purposeful heading is a doubtful factor in the noted deficits, it is unknown whether multiple subconcussive impacts might have some lingering effects. In addition, it is unknown whether the noted deficits have any affect on daily life. Proper instruction in the technique is critical because if the ball contacts an unprepared head (as in accidental head-ball contacts), the potential for serious injury is possible. To further our understanding of the relationship of heading, head injury and cognitive deficits, we need to: learn more about the actual impact of a ball on the head, verify the exposure to heading at all ages and competitive levels, determine stable estimates of concussive injury rates across the soccer spectrum, conduct prospective longitudinal studies on soccer players focusing on exposure, injury and cognition, and determine the minimum safe age to begin instruction on the skill of heading. Only then will we be able to speak with some authority on the issue of heading and head injuries in soccer.

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    • "20,21,27-30,38 Heading is not associated with highest risk of head injury (concussion) in experienced players. 2,6,10,11,20,21,38,39 However, there remains a risk for the less experienced, novice population. 18,22 In particular, children learning the game have a greater head to ball size ratio and lower neck strength, putting them at risk for head injury. "
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    ABSTRACT: Background: Soccer heading is using the head to directly contact the ball, often to advance the ball down the field or score. It is a skill fundamental to the game, yet it has come under scrutiny. Repeated subclinical effects of heading may compound over time, resulting in neurologic deficits. Greater head accelerations are linked to brain injury. Developing an understanding of how the neck muscles help stabilize and reduce head acceleration during impact may help prevent brain injury. Hypothesis: Neck strength imbalance correlates to increasing head acceleration during impact while heading a soccer ball. Study Design: Observational laboratory investigation. Methods: Sixteen Division I and II collegiate soccer players headed a ball in a controlled indoor laboratory setting while player motions were recorded by a 14-camera Vicon MX motion capture system. Neck flexor and extensor strength of each player was measured using a spring-type clinical dynamometer. Results: Players were served soccer balls by hand at a mean velocity of 4.29 m/s (±0.74 m/s). Players returned the ball to the server using a heading maneuver at a mean velocity of 5.48 m/s (±1.18 m/s). Mean neck strength difference was positively correlated with angular head acceleration (rho = 0.497; P = 0.05), with a trend toward significance for linear head acceleration (rho = 0.485; P = 0.057). Conclusion: This study suggests that symmetrical strength in neck flexors and extensors reduces head acceleration experienced during low-velocity heading in experienced collegiate players. Clinical Relevance: Balanced neck strength may reduce head acceleration cumulative subclinical injury. Since neck strength is a measureable and amenable strength training intervention, this may represent a modifiable intrinsic risk factor for injury.
    Full-text · Article · Jul 2013 · Sports Health A Multidisciplinary Approach
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    • "Ziejewski (2000), using a computer-simulated model, concluded that the impact of the ball on the head produces a force of 150–200 pounds (666–888 N); however, this is less than estimates calculated from real data. Importantly, a brain injury resulting from ball-to-head contact can occur at a force of 400–1000 N (7,9). "
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    ABSTRACT: Soccer is a contact sport in which the players are frequently faced with the risk of injury. It has been shown that the force exerted on the head during heading can be as much as 500-1200 Newton (N). The main objective of this study was to determine whether there was any relationship between the force exerted on the head and several biomechanical and anthropometrical parameters related to heading free kicks. A total of 16 semi-professional soccer players with at least 5 years experience participated in this study. The mean age, height, and weight of the study participants were 21.36 ± 5.67, 178 ± 5.99 cm, and 70.55 ± 8.55 kg, respectively. To measure the force exerted on the heads of the players, a pressure gauge was installed on their foreheads. Each participant was asked to defend the ball using the heading technique three times. A camera with a sampling frequency of 150 frames per second was used to record the moment of impact between the ball and head during each heading event. For each participant and replicate, the ball and head velocity (m/s) as well as the angular body changes (degrees) were calculated using MATLAB and AutoCAD softwares, respectively. Descriptive statistics, including means and standard deviations were used to describe the data. Pearson correlation coefficient (alpha = 0.05) was used to examine potential relationships between the variables of interest. Significant correlations existed between the force exerted on the head during heading, participant age, body mass, body fat percentage, and head perimeter (P < 0.05). The study revealed the significance of anthropometric variables related to heading, such as age and head perimeter. Therefore, it was concluded that these variables should be considered when teaching and practicing the heading technique with players of different ages and anthropometric sizes.
    Full-text · Article · Mar 2012
    • "Early studies reported decreased levels of neurocognitive performance observed in retired soccer players[9,10]. However, these studies did not account for learning disabilities, alcohol abuse, malnutrition, and previous concussion history, which may have confounded these results111213. Other studies accounted for these confounding variables and reported decreased neurocognitive performance for both amateur and professional soccer players when compared to controls[14,15]. "
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    ABSTRACT: The purpose of this study was to investigate the relationship between soccer heading and computerized neurocognitive performance and symptoms in female and male youth soccer players. Cross-sectional and prospective design. A total of 63 (27 females, 36 males) youth soccer players aged 13-18 years (M = 15.89, SD = 1.17) participated in the study. Participants completed the Immediate Post-concussion Assessment and Cognitive Test (ImPACT) and symptom report. Main outcomes: Computerized neurocognitive performance (e.g., verbal and visual memory, motor processing, and reaction time) and symptoms. There were no differences in neurocognitive performance or symptoms among low-, moderate-, and high-exposure header groups. The current sample outperformed the 10th percentile norms for neurocognitive and symptom scores. Males headed the ball more frequently and reported lower verbal and visual memory and motor processing speed scores than females. The current findings did not support a relationship between soccer heading and computerized neurocognitive performance and symptoms. The researchers suggest that any purported effects of soccer heading in youth are subtle and may affect only a small number of athletes. The reported sex differences in heading exposure warrant further attention.
    No preview · Article · Sep 2011 · Brain Injury
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