Soccer is normally considered a safe sport, relatively speaking. Compared to football players, for example, soccer players are thought to be less vulnerable to head injury. When concussions occur in soccer, they are usually blamed on player collisions. However, one study suggests that heading the soccer ball could itself result in concussion symptoms (Stewart et al, Frontiers in Neurology, online, April 24, 2018). A study from Scotland goes further. It links soccer to dementia (JAMA Neurology, Aug 2, 2021).
Professional Soccer Players, Heading and Memory Problems:
Some scientists are concerned that using the head to hit a soccer ball at high speed might also cause brain injury that could go undetected at the time. Now researchers have made an attempt to estimate the consequences of heading the ball (JAMA Network Open, July 17, 2023).
They recruited 459 retired professional soccer players from the Professional Footballers’ Association or the League Club Players’ Association in the UK. These men, average age 64, completed questionnaires including specific details about their careers and how often they recalled heading the ball during a game or training session. In addition, they responded to cognitive assessment by telephone.
The investigators found that those who headed the ball 6 to 15 times per game, on average, were more than twice as likely to have memory problems as those who headed less frequently. The most frequent headers, more than 15 times a match, were more than three times as likely to have signs of cognitive impairment.
The researchers conclude:
“The findings of this study suggest that repetitive heading during a professional soccer career is associated with an increased risk of cognitive impairment in later life.”
Should Soccer Balls Come With Warning Labels?
I attended a small public high school in Eastern Pennsylvania. My graduating class at New Hope-Solebury High School was about 35 students. You can understand why the school did not have a football team with those kinds of numbers.
We did play soccer, though. I wasn’t very good. I was especially bad at heading the ball. Just as well. New research suggests that soccer balls should carry health warnings.
Does Heading the Ball Damage the Brain?
A leading Scottish neuropathologist has studied more than 7,000 professional soccer players (JAMA Neurology, Aug. 2, 2021). He concluded that these men are three and a half times more likely to develop dementia before they die than the general public.
Professor Willie Stewart told Reuters (Aug. 2, 2021):
“With the current data, we’re now at the point to suggest that football should be sold with a health warning saying repeated heading in football may lead to an increased risk of dementia.
“The data from this paper is the missing link in trying to understand this connection between sport and dementia… There is no other proposed risk factor and this is one we could really address and eliminate this disease.
“I think football has to ask the difficult questions: is heading absolutely necessary to the game of football? Is potential exposure to degenerative brain disease absolutely necessary? Or can some other form of the game be considered?”
Soccer Balls and Warning Labels:
In Europe, the term “football” refers to the game Americans call soccer. We suspect that devoted soccer players and fans will shun the idea of warning labels on soccer balls. And giving up “heading” the ball is likely a non-starter.
But there is growing evidence that these repeated blows to the head impact the brain. One need only look at American football to realize that repetitive head injuries are not good for cognitive function.
An Overview of Brain Bumps:
Here is the introduction to an article in Frontiers in Neurology (July 3, 2019).
“Chronic Traumatic Encephalopathy (CTE) is a distinctive tau-protein associated neurodegenerative disease. There has been a rise of CTE diagnosis in athletes, especially American football players, as well as in military veterans in combat settings. Although CTE has been publicly recognized relatively recently, it was first described as ‘punch drunk’ syndrome in a classic article by Martland et al. The report was focused on a number of boxers who had suffered repetitive head blows throughout their careers, and were presenting with both psychiatric symptoms as well as severe memory and neurocognitive deficits, analogous to typical dementia patients. The disease nomenclature evolved into ‘dementia pugilistica’, and finally CTE in 1949.”
The Scottish researchers who suggest soccer balls should come with warning labels note:
“The data demonstrate an association between soccer career length and risk of neurodegenerative disease, with highest risk among those with the longest playing careers. A similar association between career length and risk of autopsy-confirmed CTE neuropathologic change has been noted among former American football athletes.”
Not Your Problem?
OK, I can imagine that by now you have determined that this is not your problem. You are not heading a soccer ball or playing football. But have you considered your children or your grandchildren? Are they playing sports that might impact their brains later in life? If soccer players are at greater risk, then a developing brain might be especially vulnerable to heading injuries.
The Scottish scientists conclude:
“There is a need for further studies to interrogate the association between soccer and neurodegenerative disease, including risks in amateur and youth soccer. Meanwhile, adopting a precautionary principle approach to mitigate risk of neurodegenerative disease by reducing exposure to TBI and head impacts in soccer and wider sports might be advised.”
Soccer Players Are Vulnerable:
In the study from 2018 mentioned at the top of this article, scientists recruited over 300 amateur soccer players between 18 and 55 years of age. The volunteers filled out detailed questionnaires about their participation in soccer during the preceding two weeks. They also took a variety of tests to measure memory, verbal learning, attention and processing speed.
Players who reported heading the ball most frequently performed worse on many of these cognitive tests. Psychomotor speed was also affected.
Although the results were subtle, the investigators are concerned that many months or years of repeated ball heading might lead to irreversible changes in brain function.
Previous Studies on Heading a Soccer Ball:
There are other studies that suggest that heading the ball could be bad for soccer players. One study published in 2017 found that players who did this more often appeared more vulnerable to concussions. An earlier study, published in 2013, also raised red flags for soccer players:
Heading the Ball:
Heading a soccer ball repeatedly may injure the brain (Radiology, Sep. 2013). Researchers detected microscopic changes in brain structure among players who headed the ball more than 1,000 times in a year. Memory scores were also lower in those who headed the ball more than 1,800 times annually.
During practice, players may head a ball 30 times or more in quick succession. During a game, a soccer ball is often moving at 50 miles per hour. Some players may head the ball a dozen times or more. The investigators call for research to develop strategies to protect the brain during soccer practice and games.
Keep in mind that these were not pro soccer players. They were high-level amateurs who loved the game. They had been playing for an average of 22 years.
What concerns me is that a lot of young children are now soccer enthusiasts. Don’t get me wrong, I think soccer is a wonderful sport and I love it that kids are playing. But what is the long-term impact of repeated ball heading on a young brain? Until we know more about this, perhaps kids should be encouraged to do less heading in practice.