Heading Not the Main Safety Concern for Soccer Players

With the end of summer and return to school, many college, high school, and youth soccer players prepare to return to competition. One of the unique aspects of soccer—heading— raises concerns about its safety and risk for injury. Fortunately, most of the data suggest that heading is not a major safety risk.

Although it is a relatively safe sport, soccer athletes are at risk for injury. Head injuries, including concussions, eye injuries, face cuts, and fractures, are four to 22 percent of soccer injuries. 1 Concussions appear to be more common in higher and more competitive play, usually from contact with other players. Concussions do not result from heading the ball in older players, 2 and rarely occur from heading in younger players. 1 Female soccer players are more likely to suffer concussions than their male counterparts. 1 Enforcing rules to minimize player to player contact when heading may help decrease the risk for concussion.

There have been numerous studies looking at the potential long-term effects of heading on cognition and brain health, with the general consensus being that there is not a link. 1 One recent study did not find any relationship between soccer heading and computerized neurocognitive performance and symptoms. 3 However, a recently presented study did raise the possibility that frequent heading could be associated in changes on brain MRIs. 4 While the majority of the evidence suggests that heading is safe, investigation is ongoing and there may be some subsets of athletes at greater risk from this activity.

Finally, there have been numerous studies looking at the effect of headgear on risk of injury during soccer. 1 Headgear does not appear to alter the impact of head to ball contact but may be helpful in reducing the risk of injury from player to player contact. However, there is some concern that use of headgear could give soccer players a false sense of security and make them more likely to risk collisions, thus negating any protective effect from the gear itself.

Heading a soccer ball does appear to be safe as an isolated activity but associated contact during competitive play does put players at some risk of injury. Proper heading technique and rule enforcement help minimize that risk. For younger players, proper technique and appropriately sized soccer balls can also help minimize the risk of injury when heading. Aerial play should not be encouraged in the very young players for safety reasons and the benefit of focusing on developing their ball skills and footwork.

References

1. Niedfeldt MW. Head Injuries, Heading, and the Use of Headgear in Soccer. Curr Sports Med Rep. 2011. 10:324-9.

2. Boden BP, Kirkendall DT, Garrett WEJ. Concussion incidence in elite college soccer players. Am. J. Sports Med. 1998. 26:238-41.

3. 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(12):1234-41.

4. Punnoose AR. Study raises concerns about “heading” in soccer, but jury is still out on risks. JAMA. 2012. Mar 14;307(10):1012-4.