Heading a football can cause similar damage to concussion

Following our earlier blogs on head injuries, "Rugby players needing their heads examined" (15/11/11) Rugby Players Need Their Heads Examined, and "Concussion in American Sport" (23/8/11) More Concussion Controversy in Top American Sport, & " Ex-Players Sue NFL over Concussion-Related Injuries" (19/8/11) Ex-Players Sue NFL over Concussion-Related Injuries the BBC ran this interesting and timely article looking at the potential impact of heading footballs on brain injury. 


BBC Article - Too many headers can cause brain damage


The article raises again the issue of the premature and high profile death of former West Bromwich Albion and England Footballer Jeff Astle in 2002, who some readers may remember fondly as the guy who sang Karaoke at the end of the BBC's Fantasy Football League show, presented by David Baddiel and Frank Skinner in the 1990's. The article is based around a recent research paper by Dr Michael Lipton of the Montefiore Medical Center, University Hospital for the Albert Einstein College of Medicine. 

Read Fibertrak-lipton article


The article suggests that heading a football 1000+ a year can cause patterns of damage (using a brain scan known as diffusion tensor imaging) similar to that seen in patients with concussion. 
The suggestion is that whilst heading a football as a one off event is unlikely to cause significant brain/neurological damage, the cumulative effect of repeated minor traumas causes, "...a cascade of responses that can lead to degeneration of brain cells." 


This was evident in study volunteers who headed the football frequently performing worse on cognitive, verbal memory and reaction time tests to those who headed footballs less frequently. 


The results of this study are interesting given the potential financial, training and playing ramifications to football, with Jeff Astle's family having already sought legal compensation for the neurological problems and premature death of their relative. 


1000 headers a year whilst initially sounding a lot, in fact equates to only 2.75 headers per day. 


Clearly the potential risks identified in the current paper need to be clarified and recommendations made to those who play/train frequently.

Before recreational footballers panic however, there is currently ongoing debate on this area with the results of numerous studies being equivocal. The article identifies an expert in the field of football related head injury, Dr Andrew Rutherford from the School of Psychology at Keele University who has been researching the possible damage caused by heading for several years. Dr Rutherford is reportedly unconvinced by the current research so far.

A study by the American Academy of Pediatrics' Council on Sports Medicine and Fitness Executive Committee was reported in the February 2010 issue of the journal Pediatrics. The results of the study in Pediatrics is consistent with anecdotal evidence reported by William P. Meehan III, MD,  Director of the Sport Concussion Clinic in the Division of Sports Medicine at Children's Hospital Boston, and author of the book, Kids, Sports, and Concussion.

"Since opening the Sports Concussion Clinic in November 2008, we have cared for nearly a thousand patients with concussions," Dr. Meehan writes.  "Only a few have reported sustaining their concussions from purposeful heading of the ball.  All of them were children." 

Preventing head injuries

While concluding that "the contribution of purposeful 'heading' of the soccer ball to both acute and potential long-term concussive effects, such as cognitive disfunction, seems less controversial today than previously," the authors of the Pediatrics  study nevertheless felt that  efforts to reduce potential injury from heading the soccer ball were still warranted. 

These were the recommendations of the Panel:

• Delayed teaching of heading. The panel recommended that heading of the ball only be taught when the child is  old enough to learn proper technique and has developed coordinated use of his or her head, neck, and trunk to properly contract the neck muscles and contact the ball with the forehead.   In doing so, it noted that the American Youth Soccer Organization  (AYSO), with 650,000 participants, does not teach purposeful heading to players under age 10.  
• Use of age-appropriate balls.  "Although proper technique is foremost in reducing the risk of concussion from heading the ball," the study says, "it is also imperative that soccer balls be water-resistant, sized appropriately for age, and not hyperinflated; and
• Strict rules enforcement.  Citing statistics that foul play has been associated with a significant number of contact-related injuries, with girls' (11.9%) and boys' (11.4%) soccer just behind girls' basketball (14%) as the sports with the highest rates of such injuries, most of which were concussions or other head/facial injuries, the panel joined in the consensus recommendation of experts that proper rules enforcement and limitation of violent contact, with officials controlling the physicality of the game and emphasizing safe play with respect for one's opponents, could play a significant role in reducing contact injuries in soccer.

There are also many potentially influencing factors to be considered. Weights of footballs whilst having reduced dramatically since the 1960/70's playing days of Jeff Astle, still differ between the amateur and professional game, as do ball speeds, which average 34mph in the amateur game and more than double that at professional level. The current article does not identify the level of ability or balls used in the study. 

Additionally the study was far from extensive with only 32 subjects used and a risk of too much power being attributed to the results of one study does exist. What the article succeeds in doing however is raising again the issue of brain injury in sport, and the very real requirement for further research in this area.