What are the Long-Term Effects of Heading the Ball in Soccer? | Storelli

May 12, 2021

It comes as no surprise that heading the ball in soccer is a controversial topic. There’s a swath of research that demonstrates a link between heading the ball and brain injuries, but it’s notoriously hard to establish a direct link. Although the science behind concussions is still evolving, the evidence remains strong. This post will examine what current research suggests, and what players can do to minimize brain injury risks.

The Theory on Heading the Ball and Long-Term Injury - Demystified

As it stands, new research suggests that heading the ball repeatedly triggers the release of proteins that may contribute to the development of severe brain diseases. A 2018 study, conducted by the University of British Columbia, discovered elevated levels of nerve-damaging proteins in the blood of participants who headed the ball 40+ times.

They are tau and light neurofilament (NF-L) proteins, both of which are biomarkers for neurodegenerative diseases such as dementia, Alzheimer’s disease, multiple sclerosis and others. These proteins “clump” together and form knots and tangles that interrupt the communications between neurons.

The researchers compared the numbers on a day when participants headed the ball versus an alternate day when they did not. On the day the players headed the ball, their NF-L levels were significantly higher one hour after heading the ball than the days they did not head the ball.

Even one month later, the players exhibited higher levels of this protein. More interestingly, participants with higher NF-L levels suffered more concussion-like symptoms including headaches, dizziness and confusion.

None of this should come as a surprise, however, because a soccer ball can strike a player’s head at a whopping 128km/h - faster than the average speed of a car travelling at North American speed limits. Remember too, that your brain isn’t a stationary organ - it floats between your skull in a moat of cerebrospinal fluid (CSF). When the ball hits the skull at such great velocity, the brain bounces against the wall of the skull, leading to bruising (which also affects brain function).

The science is convincing, but not 100% conclusive. However, there are real-world examples of athletes, soccer players included, whose brains have demonstrated exactly the kind of damage these research studies are uncovering.

Long-Term Effects of Heading the Ball in Soccer Legends

In 2002, West Brom legend Jeff Astle died at the age of 59 - a relatively young age for an otherwise healthy man. Except, Astle wasn’t the same after his illustrious career - he had been diagnosed with early-onset dementia years before.

Over a decade later, in 2014, researchers examined Astle’s brain and discovered the presence of chronic traumatic encephalopathy (CTE). This catastrophic brain disorder is typically seen in other sports such as boxing or football, where contact is more direct and pervasive than soccer. Nevertheless, a coroner ruled that the cause of Astle’s CTE to be the consequence of years of ‘heading heavy leather footballs’.

Jeff Astle.

A study conducted by researchers at University College London (UCL) and Cardiff University also discovered the presence of CTE in the brains of four out of six former players’ they examined.

Professor Huw Morris, of UCL, told the BBC: "We saw the sorts of changes that are seen in ex-boxers, the changes that are often associated with repeated brain injury.”

He went to elaborate his findings:

“So really for the first time in a series of players we have shown that there is evidence that head injury has occurred earlier in their life, which presumably has some impact on them developing dementia."

Here’s where the research gets murky.

Does heading the ball (or any head-related sports contact) contribute to brain degeneration, or does it merely aggravate a degenerative brain condition that’s already present? This is what science hasn’t figured out yet. The proteins we mentioned above - tau, light neurofilament - are largely influenced by genetics. It’s known that some people carry gene variants that may lead to excess production of these proteins before an injury occurs.

It just takes a trigger of sorts, such as diet, environment or lifestyle - heading the ball in soccer being a possible trigger - to increase the production of these proteins. It’s a chicken-or-the-egg scenario, of sorts. Regardless of whether it starts from a blow to the head or from within the body itself, players need to take precautions for themselves now and later.

What Can Players, Coaches and Parents Do?

Make no mistake about it - soccer is a contact sport. We’ve addressed the four types of contact before, and it’s clear that the beautiful game can be gruelling. Hits to the head and brain injury can affect soccer players, especially younger ones.

Four Ways to Minimize the Long-Term Effects of Heading the Ball in Soccer

  • Enforce age-restrictions - Currently, there’s an age limit for youth soccer players heading balls during practices - age 12. Enforce this rule. Youth may be more vulnerable to brain injuries and creating a safe playing environment for them is non-negotiable.
  • Protective soccer gear - Studies have demonstrated that wearing soccer headgear may reduce the risk of concussions and head injury. Our very own ExoShield head guard showed an 84% reduction in TBI risk by a Virginia Tech Helmet Lab study. Players of all ages can wear this headgear for added protection, whether it be during a practice session or a tournament game.
  • Teach heading technique - There are right and wrong ways to head the ball. Poor technique not only reduces the effectiveness of a header, but it also exacerbates the risk of a brain injury. It’s important for coaches to teach proper header technique and it’s crucial for players to learn this technique.
  • Strength and conditioning - Poor neck strength and muscular imbalances of the neck have been correlated with an increased risk of brain injury when heading the ball. Coaches and trainers should incorporate neck-strengthening exercises for players who are old enough to head the ball.
  • The Jury’s Out but the Evidence Stands

    Neuroscience has some catching-up to do to determine if heading the ball in soccer directly injures the brain. But the current evidence suggests that the brain injuries may occur as a long-term effect of heading the ball too frequently. The search for a biomarker - in this case, the tau and NF-L proteins - has always been a deciding factor for establishing a link and scientists found it.

    As technology advances, researchers will discover insights that will help us learn more about brain injuries, and how to make soccer players (and other athletes) safer against them. The most effective measures available to players right now, however, are proper header technique, safety gear and regular conditioning.

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