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Purposeful Heading in Youth Soccer: A Review

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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.

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References

  1. FIFA. The home of FIFA. 2018. https://www.fifa.com/about-fifa/home-of-fifa/fifa-headquarters.html. Accessed 12 Feb 2020.

  2. US Youth Soccer. Who is US youth soccer? 2020. https://www.usyouthsoccer.org/about/who-is-us-youth-soccer/. Accessed 25 Mar 2020.

  3. 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.

    PubMed  Google Scholar 

  4. 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.

  5. 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.

    PubMed  Google Scholar 

  6. 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.

    PubMed  Google Scholar 

  7. 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.

    PubMed  Google Scholar 

  8. 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.

    Google Scholar 

  9. 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.

    PubMed  Google Scholar 

  10. 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.

    Google Scholar 

  11. Downs DS, Abwender D. Neuropsychological impairment in soccer athletes. J Sports Med Phys Fit. 2002;42:103–7.

    CAS  Google Scholar 

  12. Webbe FM, Ochs SR. Recency and frequency of soccer heading interact to decrease neurocognitive performance. Appl Neuropsychol. 2003;10:31–41.

    PubMed  Google Scholar 

  13. 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.

    PubMed  Google Scholar 

  14. 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.

    Google Scholar 

  15. Putukian M. Heading in soccer: is it safe? Curr Sports Med Rep. 2004;3:9–14.

    PubMed  Google Scholar 

  16. Spiotta AM, Bartsch AJ, Benzel EC. Heading in soccer: dangerous play? Neurosurgery. 2012;70:1–11.

    PubMed  Google Scholar 

  17. 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.

    PubMed  Google Scholar 

  18. 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.

    CAS  PubMed  Google Scholar 

  19. Rodrigues AC, Lasmar RP, Caramelli P. Effects of soccer heading on brain structure and function. Front Neurol. 2016;7:1–11.

    Google Scholar 

  20. 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.

    Google Scholar 

  21. 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.

    PubMed  Google Scholar 

  22. 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

  23. 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.

    CAS  PubMed  Google Scholar 

  24. 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.

    CAS  PubMed  Google Scholar 

  25. Hwang S, Ma L, Kawata K, Tierney R, Jeka JJ. Vestibular dysfunction after subconcussive head impact. J Neurotrauma. 2017;34:8–15.

    PubMed  PubMed Central  Google Scholar 

  26. Hunter LE, Branch CA, Lipton ML. The neurobiological effects of repetitive head impacts in collision sports. Neurobiol Dis. 2019;123:122–6.

    PubMed  Google Scholar 

  27. 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.

    PubMed  PubMed Central  Google Scholar 

  28. 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.

  29. 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.

    PubMed  PubMed Central  Google Scholar 

  30. 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.

    PubMed  PubMed Central  Google Scholar 

  31. US Club Soccer. Concussions and head injuries. 2015. https://www.usclubsoccer.org/head-injuries. Accessed 2 Nov 2019.

  32. Salinas CM, Webbe FM, Devore TT. The epidemiology of soccer heading in competitive youth players. J Clin Sport Psychol. 2009;3:15–33.

    Google Scholar 

  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.

    Google Scholar 

  34. 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.

    Google Scholar 

  35. 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.

    Google Scholar 

  36. 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.

    Article  PubMed  Google Scholar 

  37. 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.

    PubMed  Google Scholar 

  38. 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.

    PubMed  PubMed Central  Google Scholar 

  39. Patton DA. A review of instrumented equipment to investigate head impacts in sport. Appl Bionics Biomech. 2016. https://doi.org/10.1155/2016/7049743

  40. Rowson B, Tyson A, Rowson S, Duma S. Measuring head impacts: accelerometers and other sensors. Handb Clin Neurol. 2018;158:235–43.

    PubMed  Google Scholar 

  41. 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.

    Google Scholar 

  42. Kalichová M, Lukášek M. Soccer heading evaluation during learning process using an accelerometer. J Phys Educ Sport. 2019;19:335–43.

    Google Scholar 

  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.

    PubMed  Google Scholar 

  44. Hanlon EM, Bir CA. Real-time head acceleration measurement in girls’ youth soccer. Med Sci Sports Exerc. 2012;44:1102–8.

    PubMed  Google Scholar 

  45. 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.

    PubMed  Google Scholar 

  46. 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.

    PubMed  Google Scholar 

  47. 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.

    Google Scholar 

  48. 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.

    Google Scholar 

  49. 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.

    Google Scholar 

  50. 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.

    PubMed  Google Scholar 

  51. Lukášek M, Kalichová M. Injury risks of heading in young football players. J Hum Sport Exerc. 2015;10:S490–9.

    Google Scholar 

  52. 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.

    Google Scholar 

  53. 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.

    PubMed  Google Scholar 

  54. 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.

    Google Scholar 

  55. 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.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. 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.

    CAS  PubMed  Google Scholar 

  57. Faude O, Rößler R, Junge A. Football injuries in children and adolescent players: are there clues for prevention? Sport Med. 2013;43:819–37.

    Google Scholar 

  58. 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.

    PubMed  Google Scholar 

  59. 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.

    PubMed  Google Scholar 

  60. Covassin T, Swanik BC, Sachs ML. Sex differences and the incidence of concussions among collegiate athletes. J Athl Train. 2003;38:238–44.

    PubMed  PubMed Central  Google Scholar 

  61. 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.

    PubMed  PubMed Central  Google Scholar 

  62. 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.

    PubMed  PubMed Central  Google Scholar 

  63. 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.

    PubMed  PubMed Central  Google Scholar 

  64. 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.

    Google Scholar 

  65. 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.

    CAS  PubMed  Google Scholar 

  66. 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.

    PubMed  PubMed Central  Google Scholar 

  67. 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.

    PubMed  Google Scholar 

  68. 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.

    PubMed  Google Scholar 

  69. Matser EJT, Lezak MD, Jordan BD, Traumatic H, In B. Neuropsychological impairment in amateur soccer players. Neuropsychology. 2011;282:971–3.

    Google Scholar 

  70. 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.

    PubMed  Google Scholar 

  71. 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.

    PubMed  Google Scholar 

  72. 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.

    CAS  PubMed  PubMed Central  Google Scholar 

  73. 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.

    PubMed  Google Scholar 

  74. 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.

    Google Scholar 

  75. 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.

    PubMed  Google Scholar 

  76. United Soccer Coaches. Get aHEAD safely in soccer. https://unitedsoccercoaches.org/education/get-ahead-safely-in-soccer/. Accessed 17 July 2020.

  77. 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.

    PubMed  Google Scholar 

  78. 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.

    PubMed  Google Scholar 

  79. 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.

    PubMed  PubMed Central  Google Scholar 

  80. Withnall C, Shewchenko N, Wonnacott M, Dvorak J. Effectiveness of headgear in football. Br J Sports Med. 2005;39:i40–8.

    PubMed  PubMed Central  Google Scholar 

  81. Broglio SP, Ju YY, Broglio MD, Sell TC. The efficacy of soccer headgear. J Athl Train. 2003;38:220–4.

    PubMed  PubMed Central  Google Scholar 

  82. 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.

    PubMed  PubMed Central  Google Scholar 

  83. 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.

    PubMed  Google Scholar 

  84. 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.

    PubMed  Google Scholar 

  85. 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

  86. Green JI. The role of mouthguards in preventing and reducing sports-related trauma. Prim Dent J. 2017;6:27–34.

    PubMed  Google Scholar 

  87. 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.

    PubMed  Google Scholar 

  88. 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.

    PubMed  PubMed Central  Google Scholar 

  89. 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.

    PubMed  Google Scholar 

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VW wrote the first draft of the manuscript. VW and TK revised the original manuscript. VW and TK read and approved the final manuscript.

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Correspondence to Victoria E. Wahlquist.

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No sources of funding were used in the preparation of this review.

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Victoria Wahlquist and Thomas Kaminski declare that they have no conflicts of interest that are relevant to the content of this review.

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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

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