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Is Heading In Soccer Dangerous?

In boys’ and girls’ soccer, most concussions happen during collisions between two players—not between a player and a ball—often while the players wrangle for a header in the air.

“Usually it’s not heading the ball—it’s during the aerial challenge,” explains Margot Putukian, M.D., director of athletic medicine at Princeton University and a member of U.S. Soccer’s medical advisory board.

Soccer is the world’s most popular sport, and kids who play it enjoy many of the benefits of participation in athletics. These include improved strength, mood, and heart and lung fitness; better weight control, thinking and mental performance; enhanced self-esteem and social skills; lower risk of inactivity-related diseases such as diabetes, asthma and depression; and fewer serious diseases over the entire lifespan.

But sports have risks, too, and soccer is no exception. Concussions change the way the brain works, and each one is potentially serious. In some studies of high school athletes, the chance of having a concussion while playing girls’ soccer is comparable to the risk in football or boys lacrosse. Although symptoms usually go away within days, returning to practice and games can take weeks, and sometimes longer.

“It’s a significant issue,” says Putukian. “But I don’t think it takes away from the value of participating in sport.”

Flying Elbows

To tease out the causes of head injuries in soccer, researchers from the University of Colorado examined conditions surrounding more than a thousand concussions that occurred during nearly 3 million boys’ and girls’ high school soccer practices and games over nine years. The data, from High School RIO, a national sports injury surveillance system, showed that the majority of concussions occurred during contact with another player.

“Heading generally accounts for approximately 30% of soccer concussions across sexes and in high school and middle school players,” according to the research team. The remaining 70% of concussions occur during other activities, such as defending, goal tending or chasing loose balls.

“It’s when players jump up to head the ball that they get hit with a head or hit with an elbow or another body part, or they fall and hit their head onto the ground,” explains Putukian. Balls deform and have some give, making them less threatening.

As part of a comprehensive effort to make youth soccer safer, in 2015 U.S. Soccer banned heading among players younger than age 10, and limited the amount of heading in practice among players ages 11 to 13.

Whether the heading rules will lead to fewer concussions remains to be seen. “Although banning heading from youth soccer would likely prevent some concussions, reducing athlete-athlete contact across all phases of play would likely be a more effective way to prevent concussions as well as other injuries,” the Colorado researchers speculated.

Evidence of temporary or lasting problems?

There is little research on the risk of concussion in youth soccer players or the impact of heading and concussions on their health. A few small studies have examined the potential short-term effects of heading among teenage players. Most reported that heading did not cause concussion symptoms, weaken the muscles that provide stability to the neck and head, influence coordination, or affect the way players think, remember or behave.

A 2016 analysis found no evidence linking heading in youth soccer to permanent brain damage. That followed an earlier assessment by the American Academy of Pediatrics, which concluded that “the literature does not support the contention that purposeful heading contacts are likely to lead to either acute or cumulative brain damage.”

“When we look at the body of literature that’s out there, there’s really no great data to tell us it’s dangerous,” says Putukian.

While research efforts continue, most doctors agree that it makes sense to reduce unnecessary head contact in all sports. If a head injury is suspected, athletes should see a health professional trained in the diagnosis and treatment of concussions.