Abstract
Recent public concern over the short- and long-term effects of repetitive head impacts (RHI) associated with purposeful heading in soccer has led researchers to study a multitude of variables related to this important aspect of the game. Of particular interests are the effects of soccer heading in the youth population (≤ 13 years old) whose brains are undergoing rapid development. We conducted a review on youth soccer heading that includes purposeful heading frequency, head impact biomechanics, head injuries, clinical outcomes, and modifying factors. We have concluded that youth soccer players head the ball at a low frequency that typically increases with age and with a finding that boys head the ball more often than girls do. Interestingly, although girls head the ball less frequently than boys do, they tend to sustain higher head impact magnitudes. Head injuries are more likely to occur in girls versus boys and during games because of contact with another player. Clinical outcome measures of concussion are often utilized to study the effects of soccer heading, in both field and laboratory environments. Immediately following soccer heading, youth often report having a headache and demonstrate some deficits in balance measures. Modifying factors that may benefit soccer players participating in purposeful heading activities include stronger neck musculature, wearing headgear, and the use of mouthguards. Research involving youth soccer players needs to be expanded and funded appropriately to better understand the consequences of RHI in both the short and long term.
Similar content being viewed by others
References
FIFA. The home of FIFA. 2018. https://www.fifa.com/about-fifa/home-of-fifa/fifa-headquarters.html. Accessed 12 Feb 2020.
US Youth Soccer. Who is US youth soccer? 2020. https://www.usyouthsoccer.org/about/who-is-us-youth-soccer/. Accessed 25 Mar 2020.
Bailes JE, Petraglia AL, Omalu BI, Nauman E, Talavage T. Role of subconcussion in repetitive mild traumatic brain injury. J Neurosurg. 2013;119:1235–45.
Alosco ML, Healy RC, Stern RA. Chronic traumatic encephalopathy and the long-term consequences of repetitive head impacts in sports. In: Arnett PA, editor. Neuropsychol sport concussion. American Psychological Association; 2019. pp. 151–82.
Kawata K, Rubin LH, Lee JH, Sim T, Takahagi M, Szwanki V, et al. Association of football subconcussive head impacts with ocular near point of convergence. JAMA Ophthalmol. 2016;134:763–9.
Mainwaring L, Ferdinand Pennock KM, Mylabathula S, Alavie BZ. Subconcussive head impacts in sport: a systematic review of the evidence. Int J Psychophysiol. 2018;132:39–54.
Pellman EJ, Viano DC, Tucker AM, Casson IR, Waeckerle JF. Concussion in professional football: reconstruction of game impatcs and injuries. Neurosurgery. 2003;53:799–814.
Shewchenko N, Withnall C, Keown M, Gittens R, Dvorak J. Heading in football. Part 1: development of biomechanical methods to investigate head response. Br J Sports Med. 2005;39:10–25.
Chrisman SPD, Donald CLM, Friedman S, Andre J, Rowhani-Rahbar A, Drescher S, et al. Head impact exposure during a weekend youth soccer tournament. J Child Neurol. 2016;31:971–8.
Zhang MR, Red SD, Lin AH, Patel SS, Sereno AB. Evidence of cognitive dysfunction after soccer playing with ball heading using a novel tablet-based approach. PLoS ONE. 2013;8:8–11.
Downs DS, Abwender D. Neuropsychological impairment in soccer athletes. J Sports Med Phys Fit. 2002;42:103–7.
Webbe FM, Ochs SR. Recency and frequency of soccer heading interact to decrease neurocognitive performance. Appl Neuropsychol. 2003;10:31–41.
Janda DH, Bir CA, Cheney AL. An evaluation of the cumulative concussive effect of soccer heading in the youth population. Inj Control Saf Promot. 2002;9:25–31.
Meyer T, Reinsberger C. Do head injuries and headers in football lead to future brain damage? A discussion lacking appropriate scientific diligence. Sci Med Footb. 2018;2:1–2.
Putukian M. Heading in soccer: is it safe? Curr Sports Med Rep. 2004;3:9–14.
Spiotta AM, Bartsch AJ, Benzel EC. Heading in soccer: dangerous play? Neurosurgery. 2012;70:1–11.
Kontos AP, Braithwaite R, Chrisman SPD, McAllister-Deitrick J, Symington L, Reeves VL, et al. Systematic review and meta-analysis of the effects of football heading. Br J Sports Med. 2017;51:1118–24.
Tarnutzer AA, Straumann D, Brugger P, Feddermann-Demont N. Persistent effects of playing football and associated (subconcussive) head trauma on brain structure and function: a systematic review of the literature. Br J Sports Med. 2017;51:1592–604.
Rodrigues AC, Lasmar RP, Caramelli P. Effects of soccer heading on brain structure and function. Front Neurol. 2016;7:1–11.
Kaminski TW, Thompson A, Wahlquist VE, Glutting J. Self-reported head injury symptoms exacerbated in those with previous concussions following an acute bout of purposeful soccer heading. Res Sport Med. 2019;00:1–14.
Kontos AP, Dolese A, Elbin RJ, Covassin T, Warren BL. Relationship of soccer heading to computerized neurocognitive performance and symptoms among female and male youth soccer players. Brain Inj. 2011;25:1234–41.
Caccese JB, Buckley TA, Tierney RT, Rose WC, Glutting JJ, Kaminski TW. Postural control deficits after repetitive soccer heading. Clin J Sport Med. 2018. https://doi.org/10.1097/JSM.0000000000000709
Schmitt DM, Hertel J, Evans TA, Olmsted LC, Putukian M. Effect of an acute bout of soccer heading on postural control and self-reported concussion symptoms. Int J Sports Med. 2004;25:326–31.
Haran FJ, Tierney R, Wright WG, Keshner E, Silter M. Acute changes in postural control after soccer heading. Int J Sports Med. 2013;34:350–4.
Hwang S, Ma L, Kawata K, Tierney R, Jeka JJ. Vestibular dysfunction after subconcussive head impact. J Neurotrauma. 2017;34:8–15.
Hunter LE, Branch CA, Lipton ML. The neurobiological effects of repetitive head impacts in collision sports. Neurobiol Dis. 2019;123:122–6.
Mez J, Daneshvar DH, Kiernan PT, Abdolmohammadi B, Alvarez VE, Huber BR, et al. Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA. 2017;318:360–70.
Britten N. Jeff Astle killed by heading ball, coroner rules. Telegr. 2002. https://www.telegraph.co.uk/news/uknews/1412908/Jeff-Astle-killed-by-heading-ball-coroner-rules.html. Accessed 6 Apr 2020.
Hales C, Neill S, Gearing M, Cooper D, Glass J, Lah J. Late-stage CTE pathology in a retired soccer player with dementia. Neurology. 2014;83:2307–9.
Ling H, Morris HR, Neal JW, Lees AJ, Hardy J, Holton JL, et al. Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players. Acta Neuropathol. 2017;133:337–52.
US Club Soccer. Concussions and head injuries. 2015. https://www.usclubsoccer.org/head-injuries. Accessed 2 Nov 2019.
Salinas CM, Webbe FM, Devore TT. The epidemiology of soccer heading in competitive youth players. J Clin Sport Psychol. 2009;3:15–33.
Harriss A, Walton DM, Dickey JP. Direct player observation is needed to accurately quantify heading frequency in youth soccer. Res Sport Med. 2018;26:191–8.
Harriss A, Johnson AM, Walton DM, Dickey JP. The number of purposeful headers female youth soccer players experience during games depends on player age but not player position. Sci Med Footb. 2019a;3:109–14.
Sandmo SB, Andersen TE, Koerte IK, Bahr R. Head impact exposure in youth football—are current interventions hitting the target? Scand J Med Sci Sport. 2020;30:193–8.
Beaudouin F, Gioftsidou A, Larsen MN, Lemmink K, Drust B, Modena R, et al. The UEFA Heading Study: heading incidence in children’s and youth’ football (soccer) in eight European countries. Scand J Med Sci Sports. 2020. https://doi.org/10.1111/sms.13694.
Chrisman SPD, Ebel BE, Stein E, Lowry SJ, Rivara FP. Head impact exposure in youth soccer and variation by age and sex. Clin J Sport Med. 2019;29:3–10.
Lamond LC, Caccesse JB, Buckley TA, Glutting J, Kaminski TW. Linear acceleration in direct head contact across impact type, player position, and playing scenario in collegiate women’s soccer. J Athl Train. 2018;53:115–21.
Patton DA. A review of instrumented equipment to investigate head impacts in sport. Appl Bionics Biomech. 2016. https://doi.org/10.1155/2016/7049743
Rowson B, Tyson A, Rowson S, Duma S. Measuring head impacts: accelerometers and other sensors. Handb Clin Neurol. 2018;158:235–43.
Hecimovich M, King D, Dempsey A, Gittins M, Murphy M. Youth Australian footballers experience similar impact forces to the head as junior- and senior-league players : a prospective study of kinematic measurements. J Sport Sci Med. 2018;17:547–56.
Kalichová M, Lukášek M. Soccer heading evaluation during learning process using an accelerometer. J Phys Educ Sport. 2019;19:335–43.
Harriss A, Johnson AM, Walton DM, Dickey JP. Head impact magnitudes that occur from purposeful soccer heading depend on the game scenario and head impact location. Musculoskelet Sci Pract. 2019b;40:53–7.
Hanlon EM, Bir CA. Real-time head acceleration measurement in girls’ youth soccer. Med Sci Sports Exerc. 2012;44:1102–8.
Caccese JB, Buckley TA, Tierney RT, Rose WC, Glutting JJ, Kaminski TW. Sex and age differences in head acceleration during purposeful soccer heading. Res Sports Med. 2018;26:64–74.
Sandmo SB, McIntosh AS, Andersen TE, Koerte IK, Bahr R. Evaluation of an in-ear sensor for quantifying head impacts in youth soccer. Am J Sports Med. 2019;47:974–81.
Miller LE, Pinkerton EK, Fabian KC, Wu LC, Espeland MA, Lamond LC, et al. Characterizing head impact exposure in youth female soccer with a custom-instrumented mouthpiece. Res Sport Med. 2020;28:55–71.
Rich AM, Filben TM, Miller LE, Tomblin BT, Van Gorkom AR, Hurst MA, et al. Development, validation and pilot field deployment of a custom mouthpiece for head impact measurement. Annu Biomed Eng. 2019;47:2109–21.
Caccese JB, Buckley TA, Tierney RT, Arbogast KB, Rose WC, Glutting JJ, et al. Head and neck size and neck strength predict linear and rotational acceleration during purposeful soccer heading. Sport Biomech. 2018;17:462–76.
Tierney RT, Sitler MR, Swanik CB, Swanik KA, Higgins M, Torg J. Gender differences in head-neck segmnet dynamic stabilization during head accelaration. Med Sci Sports Exerc. 2005;37:272–9.
Lukášek M, Kalichová M. Injury risks of heading in young football players. J Hum Sport Exerc. 2015;10:S490–9.
Caccese JB, Lamond LC, Buckley TA, Kaminski TW. Reducing purposeful headers from goal kicks and punts may reduce cumulative exposure to head acceleration. Res Sport Med. 2016;24:407–15.
Giannotti M, Al-Sahab B, McFaull S, Tamim H. Epidemiology of acute head injuries in Canadian children and youth soccer players. Injury. 2010;41:907–12.
Leininger RE, Knox CL, Comstock RD. Epidemiology of 1.6 million pediatric soccer-related injuries presenting to US emergency departments from 1990 to 2003. Am J Sports Med. 2007;2007(35):288–93.
Pickett W, Streight S, Simpson K, Brison RJ. Head injuries in youth soccer players presenting to the emergency department. Br J Sports Med. 2005;39:226–31.
Faude O, Rössler R, Junge A, aus der Fünten K, Chomiak J, Verhagen E, et al. Head injuries in children′s football-results from two prospective cohort studies in four European countries. Scand J Med Sci Sports. 2017;27:1986–92.
Faude O, Rößler R, Junge A. Football injuries in children and adolescent players: are there clues for prevention? Sport Med. 2013;43:819–37.
O’Kane JW, Spieker A, Levy MR, Neradilek M, Polissar NL, Schiff MA. Concussion among female middle-school soccer players. JAMA Pediatr. 2014;168:258–64.
Comstock RD, Currie DW, Pierpoint LA, Grubenhoff JA, Fields SK. An evidence-based discussion of heading the ball and concussions in high school soccer. JAMA Pediatr. 2015;169:830–7.
Covassin T, Swanik BC, Sachs ML. Sex differences and the incidence of concussions among collegiate athletes. J Athl Train. 2003;38:238–44.
Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among United States high school and collegiate athletes. J Athl Train. 2007;42:495–503.
Kerr ZY, Roos KG, Djoko A, Dalton SL, Broglio SP, Marshall SW, et al. Epidemiologic measures for quantifying the incidence of concussion in national collegiate athletic association sports. J Athl Train. 2017;52:167–74.
O’Connor KL, Baker MM, Dalton SL, Dompier TP, Broglio SP, Kerr ZY. Epidemiology of sport-related concussions in high school athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 through 2013–2014. J Athl Train. 2017;52:175–85.
O’Kane JW, Levy MR, Neradilek M, Polissar NL, Schiff MA. Evaluation of the Zachery Lystedt law among female youth soccer players. Phys Sports Med. 2014;42:39–44.
Delaney JS, Al-Kashmiri A, Drummond R, Correa JA. The effect of protective headgear on head injuries and concussions in adolescent football (soccer) players. Br J Sports Med. 2008;42:110–5.
Sufrinko AM, Mucha A, Covassin T, Marchetti G, Elbin RJ, Collins MW, et al. Sex differences in vestibular/ocular and neurocognitive outcomes after sport-related concussion. Clin J Sport Med. 2017;27:133–8.
Covassin T, Elbin RJ, Harris W, Parker T, Kontos A. The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. Am J Sports Med. 2012;40:1303–12.
Broshek DK, Kaushik T, Freeman JR, Erlanger D, Webbe F, Barth JT. Sex differences in outcome following sports-related concussion. J Neurosurg. 2005;102:856–63.
Matser EJT, Lezak MD, Jordan BD, Traumatic H, In B. Neuropsychological impairment in amateur soccer players. Neuropsychology. 2011;282:971–3.
Murdaugh DL, Ono KE, Morris SO, Burns TG. Effects of developmental age on symptom reporting and neurocognitive performance in youth after sports-related concussion compared to control athletes. J Child Neurol. 2018;33:474–81.
Massingale S, Alexander A, Erickson S, McQueary E, Gerkin R, Kisana H, et al. Comparison of uninjured and concussed adolescent athletes on the concussion balance test (COBALT). J Neurol Phys Ther. 2018;42:149–54.
Broglio SP, Guskiewicz KM, Sell TC, Lephart SM. No acute changes in postural control after soccer heading. Br J Sports Med. 2004;38:561–7.
Kaminski TW, Wikstrom AM, Gutierrez GM, Glutting JJ. Purposeful heading during a season does not influence cognitive function or balance in female soccer players. J Clin Exp Neuropsychol. 2007;29:742–51.
Wahlquist VE, Glutting JJ, Kaminski TW. Examining neurocognitive performance and heading in interscholastic female football players over their playing careers. Sci Med Footb. 2019;3:115–24.
Kaminski TW, Cousino ES, Glutting JJ. Examining the relationship between puposeful heading in soccer and computerized neuropsychological test performance. Res Q Exerc Sport. 2008;79:235–44.
United Soccer Coaches. Get aHEAD safely in soccer. https://unitedsoccercoaches.org/education/get-ahead-safely-in-soccer/. Accessed 17 July 2020.
Gutierrez GM, Conte C, Lightbourne K. The relationship between impact force, neck strength, and neurocognitive performance in soccer heading in adolescent females. Pediatr Exerc Sci. 2014;26:33–40.
Collins CL, Fletcher EN, Fields SK, Kluchurosky L, Rohrkemper MK, Comstock RD, et al. Neck strength: a protective factor reducing risk for concussion in high school sports. J Prim Prev. 2014;35:309–19.
Eckner JT, Goshtasbi A, Curtis K, Kapshai A, Myyra E, Franco LM, et al. Feasibility and effect of cervical resistance training on head kinematics in youth athletes: a pilot study. Am J Phys Med Rehabil. 2018;97:292–7.
Withnall C, Shewchenko N, Wonnacott M, Dvorak J. Effectiveness of headgear in football. Br J Sports Med. 2005;39:i40–8.
Broglio SP, Ju YY, Broglio MD, Sell TC. The efficacy of soccer headgear. J Athl Train. 2003;38:220–4.
Tierney RT, Higgins M, Caswell SV, Brady J, McHardy K, Driban JB, et al. Sex differences in head acceleration during heading while wearing soccer headgear. J Athl Train. 2008;43:578–84.
McGuine T, Post E, Pfaller AY, Hetzel S, Schwarz A, Brooks MA, et al. Does soccer headgear reduce the incidence of sport-related concussion? A cluster, randomised controlled trial of adolescent athletes. Br J Sports Med. 2020;54:408–13.
Mihalik JP, McCaffrey MA, Rivera EM, Pardini JE, Guskiewicz KM, Collins MW, et al. Effectiveness of mouthguards in reducing neurocognitive deficits following sports-related cerebral concussion. Dent Traumatol. 2007;23:14–20.
Chisholm DA, Black AM, Palacios-Derflingher L, Eliason PH, Schneider KJ, Emery CA, et al. Mouthguard use in youth ice hockey and the risk of concussion: nested case-control study of 315 cases. Br J Sports Med. 2020;54:866–70
Green JI. The role of mouthguards in preventing and reducing sports-related trauma. Prim Dent J. 2017;6:27–34.
Bartsch A, Samorezov S, Benzel E, Miele V, Brett D. Validation of an “intelligent mouthguard” single event head impact dosimeter. Stapp Car Crash J. 2014;58:1–27.
Camarillo DB, Shull PB, Mattson J, Shultz R, Garza D. An instrumented mouthguard for measuring linear and angular head impact kinematics in American football. Ann Biomed Eng. 2013;41:1939–49.
Narimatsu K, Takeda T, Nakajima K, Konno M, Ozawa T, Ishigami K. Effect of clenching with a mouthguard on head acceleration during heading of a soccer ball. Gen Dent. 2015;63:41–6.
Author information
Authors and Affiliations
Contributions
VW wrote the first draft of the manuscript. VW and TK revised the original manuscript. VW and TK read and approved the final manuscript.
Corresponding author
Ethics declarations
Funding
No sources of funding were used in the preparation of this review.
Conflict of interest
Victoria Wahlquist and Thomas Kaminski declare that they have no conflicts of interest that are relevant to the content of this review.
Rights and permissions
About this article
Cite this article
Wahlquist, V.E., Kaminski, T.W. Purposeful Heading in Youth Soccer: A Review. Sports Med 51, 51–64 (2021). https://doi.org/10.1007/s40279-020-01376-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40279-020-01376-8