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Heading in soccer: Is it safe?


Soccer is the world’s game, played by 120 million people around the world and 16 million in the United States. It is unique in that it forbids the use of the upper extremity, other than by the goalkeeper or when throwing the ball into play from the sideline. It is also unique in that it is the only sport in which the head is purposefully used to strike the ball. As sports medicine has evolved, so has our curiosity about how certain sport-specific skills or protective equipment might change the injury profile of a sport. For soccer, there has been some concern that heading may be associated with the development of cumulative traumatic brain encephalopathy, or the “punch drunk” syndrome described in boxers. This article discusses this question in detail, with a critical look at the literature and an emphasis on the prospective data.

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References and Recommended Reading

  1. 1.

    Bogdanoff B, Natter H: Incidence of cavum septum pellucidum in athletes: a sign of boxer’s encephalopathy. Neurology 1989, 39:991–992.

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Jordan B, Zimmerman R: Computed tomography and magnetic resonance imaging comparisons in boxers. JAMA 1990, 263:1670–1674.

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Jordan B, Jahre C, Hauser A, et al.: CT of 338 active professional boxers. Radiology 1992, 185:509–512.

    CAS  PubMed  Google Scholar 

  4. 4.

    Mortimer JA: Epidemiology of post-traumatic encephalopathy in boxers. Minn Med 1985, 68:299–300.

    CAS  PubMed  Google Scholar 

  5. 5.

    Tysvaer AT, Lochen EA: Soccer injuries to the brain. A neuropsychologic study of former soccer players. Am J Sports Med 1991, 19:56–60.

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Tysvaer AT, Storli OV, Bachen NI: Soccer injuries to the brain: a neurologic and electroencephalographic study of former players. Acta Neurol Scand 1989, 80:151–156.

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Tysvaer AT: Head and neck injuries in soccer. Impact of minor trauma. Sports Med 1992, 14:200–213.

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Sortland O, Tysvaer AT, Storli OV: Changes in the cervical spine in association football players. Brit J Sports Med 1982, 16:80–84.

    CAS  Article  Google Scholar 

  9. 9.

    Sortland O, Tysvaer AT: Brain damage in former association football players. Neuroradiology 1989, 31:44–48.

    CAS  PubMed  Google Scholar 

  10. 10.

    Putukian M, Echemendia RJ, Mackin RS: The acute neuropsychological effects of heading in soccer: a pilot study. Clin J Sports Med 2000, 10:104–109.Prospective pilot study demonstrating no evidence in college players for cognitive dysfunction from heading as assessed by NP tests.

    CAS  Article  Google Scholar 

  11. 11.

    Putukian M, Echemendia RJ, Evans TA, Bruce J: Effects of heading contacts in collegiate soccer players on cognitive function; prospective neuropsychological assessment over a season. Presented at the 10th annual American Medical Society for Sports Medicine meeting. San Antonio, TX; April 9, 2001. Prospective one year study demonstrating no evidence in college players for cognitive dysfunction due to heading as assessed by NP tests.

  12. 12.

    Kirkendall DT, Garrett WE: Heading in soccer: integral skill or grounds for cognitive dysfunction? J Athlet Train 2001, 36:328–334.Excellent review article discussing the issue of heading in soccer, with review of the previous and current literature.

    Google Scholar 

  13. 13.

    Baroff GS: Is heading a soccer ball injurious to brain function? J Head Trauma Rehabil 1998, 13:45–52.

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Levundusky T, Armstrong C, Eck J, et al.: Impact characteristics of two types of soccer balls. In Science and Football: Proceedings of the First World Congress of Science and Football. Edited by ReillyTR, Lees A, Davids K, Murphy W. London: E & FN Spon; 1988.

    Google Scholar 

  15. 15.

    Schneider K, Zernicke R: Computer simulation of head impact: estimation of head injury risk during soccer heading. Int J Sport Biomech 1988, 4:258–271.

    Google Scholar 

  16. 16.

    Bauer JA, Thomas TS, Cauraugh JH, et al.: Impact forces and neck muscle activity in heading by collegiate female soccer players. J Sports Sci 2001, 19:171–179.

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Martland HS: Punch drunk. JAMA 1928, 91:1103–1107.

    Article  Google Scholar 

  18. 18.

    Matthews WB: Footballer’s migraine. BMJ 1972, 2:326–327.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  19. 19.

    Jordan SH, Green GA, Galanty HL, et al.: Acute and chronic brain injury in United States National team soccer players. Am J Sports Med 1996, 24:205–210.Cross-sectional study comparing National team soccer players to track athletes using MRI to demonstrate no differences between groups.

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Haglund Y, Eriksson E: Does amateur boxing lead to chronic brain damage? A review of some recent investigations. Am J Sports Med 1993, 21:97–109.Cross-sectional study of boxers, with soccer players included as controls, demonstrating no evidence of cognitive impairment in soccer players.

    CAS  PubMed  Article  Google Scholar 

  21. 21.

    Matser ET, Kessels AGH, Jordan BD, et al.: Chronic traumatic brain injury in professional soccer players. Neurology 1998, 51:791–796.

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    Matser EJT, Kessels AG, Lezak MD, et al.: Neuropsychological impairment in amateur soccer players. JAMA 1999, 282:971–973.Cross-sectional data demonstrating cognitive impairment in soccer players as assessed by NP tests. The assumption is made that heading is the culprit, though data demonstrate an inverse relationship between history of concussion and performance on NP tests.

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Guskiewicz KM, Marshall SW, Broglio P, et al.: No evidence of impaired neurocognitive performance in collegiate soccer players. Am J Sports Med 2002, 30:157–162.Cross-sectional data demonstrating no difference in cognitive function as assessed by an NP battery in elite college soccer players.

    PubMed  Google Scholar 

  24. 24.

    Echemendia RJ, Putukian M, Mackin RS, et al.: Neuropsychological test performance prior to and following sportsrelated mild traumatic brain injury. Clin J Sports Med 2001, 11:23–31.

    CAS  Article  Google Scholar 

  25. 25.

    Powell JW, Barber-Foss KD: Traumatic brain injury in high school athletes. JAMA 1999, 282:958–963.

    CAS  PubMed  Article  Google Scholar 

  26. 26.

    National Collegiate Athletic Association: NCAA Injury Surveillance Summary Report. Men’s and Women’s Socce. Indianapolis: NCAA Publications.

  27. 27.

    Barnes BC, Cooper L, Kirkendall DT, et al.: Concussion history in elite male and female soccer players. Am J Sports Med 1998, 26:433–438.

    CAS  PubMed  Google Scholar 

  28. 28.

    Boden BP, Kirkendall DT, Garrett WE: Concussion incidence in elite college soccer players. Am J Sports Med 1998, 26:238–241.Prospective research addressing the mechanisms of concussion in collegiate soccer, demonstrating that concussion is not caused by purposeful heading.

    CAS  PubMed  Google Scholar 

  29. 29.

    Gerberich SG, Priest JD, Boen JR, et al.: Concussion incidence and severity in secondary school varsity football players. Am J Public Health 1983, 73:1370–1375.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  30. 30.

    Guskiewicz KM, Weaver NL, Padua DA, et al.: Epidemiology of concussion in collegiate and high school football players. Am J Sports Med 2000, 28:643–650.

    CAS  PubMed  Google Scholar 

  31. 31.

    Hovda DA, Lee SM, Smith ML, et al.: The neurochemical and metabolic cascade following brain injury: moving from animal models to man. J Neurotrauma 1995, 12:143–146.

    Article  Google Scholar 

  32. 32.

    Putukian M, Echemendia RJ: Managing successive minor head injuries; which tests guide return to play? Physician Sports Med 1996, 24:25–38.

    CAS  Google Scholar 

  33. 33.

    Jenkins LW, Moszynski, Lyeth BG, et al.: Increased vulnerability of the mildly traumatized rat brain to cerebral ischemia: the use of controlled secondary ischemia as a research tool to identify common or different mechanisms contributing to mechanical and ischemic brain injury. Brain Res 1989, 477:211–224.

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Levin HS, Amparo E, Eisenberg JM, et al.: Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries. J Neurosurg 1987, 66:706–713.

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Macciocchi SN, Barth JT, Alves W, et al.: Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Neurosurgery 1996, 39:510–514.

    CAS  PubMed  Google Scholar 

  36. 36.

    Lovell MR, Iverson GL, Collins MW, et al.: Does loss of consciousness predict neuropsychological decrements after concussion? Clin J Sport Med 1999, 9:193–198.

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Reed WF, Feldman KW, Weiss AH, Tencer AF: Does soccer ball heading cause retinal bleeding? Arch Pediatr Adolesc Med 2002, 156:337–40.

    PubMed  Article  Google Scholar 

  38. 38.

    Institute of Medicine Report: Is Soccer Bad for Children’s Heads? Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer. Washington, DC: National Academy Press; 2002.Review of the Institute of Medicine’s workshop addressing the issue of heading in soccer.

    Google Scholar 

  39. 39.

    Johnston K, Aubry M, Cantu R, et al.: Summary and agreement statement of the first international conference on concussion in sport, Vienna 2001. Phys Sportsmed 2002, 30:57–63.Revised guidelines for evaluation and treatment of concussion in sport.

    PubMed  Google Scholar 

  40. 40.

    Rahnama N, Reilly T, Lees A: Injury risk associated with playing actions during competitive soccer. Br J Sports Med 2002, 36:354–359.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

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Putukian, M. Heading in soccer: Is it safe?. Curr Sports Med Rep 3, 9–14 (2004).

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  • Soccer Player
  • Head Impact
  • National Collegiate Athletic Association
  • Soccer Ball
  • Soccer Injury