Neuropsychological impairment as a consequence of football (soccer) play and football heading: A preliminary analysis and report on school students (13–16 years)

Abstract

Footballers run the risk of incurring mild head injury from a variety of sources, including the intentional use of the head to play the ball, known as heading. This paper presents a preliminary exploratory analysis of data collected to examine whether cumulative incidence of mild head injury, or cumulative heading frequency, are related to neuropsychological functioning in male adolescent footballers. In a quasi-experimental cross-sectional design, neuropsychological test scores of school team footballers were compared with those of similarly aged rugby players and noncontact sport players. Cumulative mild head injury incidence was estimated using self-reports, and cumulative heading was estimated using a combination of observation and self-reports. No participants had sustained a head injury within 3 months of testing. There was no relationship between head injury and neuropsychological performance, and there were no decrements in either the footballers or the rugby players in comparison with the noncontact sport players. Within the footballers, cumulative heading did not predict any of the neuropsychological test scores. These findings indicate the absence of neuropsychological impairment arising due to cumulative mild head injury incidence, or cumulative heading. Although these null findings may be reassuring to players, parents, and football organizers, we stress that they are preliminary. Further data is being collected from the same populations to provide more reliable effect estimates.

Soccer Heading Is Associated with White Matter Microstructural and Cognitive Abnormalities

“…A recent review noted that "it is impossible to isolate the long-term effects of heading alone [vs. concussion]" (6). Neuropsychological impairment, reported in amateur (9), professional (10), and high school players (11,12), has engendered debate on the role of concussion versus subconcussive heading. A recent research letter attributes brain microstructural differences between a small group of elite soccer players and swimmers to heading (13), but heading has not been directly studied as a predictor of TBI, independent of recognized concussion.…”

Prolonged Neuropsychological Impairments Following a First Concussion in Female University Soccer Athletes

“…Further, increases in S-100B were significantly correlated with the numbers of headers. 43,44 Although heading does not seem to cause cognitive deficits in young teenage athletes, 45,46 many studies report that several seasons of playing soccer and heading the ball has a detrimental effect on brain function. 17,47,48 Therefore, heading in athletes who have accumulated several years of play may maintain or even exacerbate the cognitive deficits caused by even a first concussion.…”

Ethically we can no longer sit on the fence - a neuropsychological perspective on the cerebrally hazardous contact sports

“…3,20,38,48 However, all of these studies demonstrate substantive methodological limitations, and therefore do not provide convincing counterbalancing evidence to refute the presence of deleterious effects affirmed in the other studies. For example, two of these studies had no control for IQ, but in addition they used mixed male and female participants in their studies, constituting a serious confounding factor 3,20 (see discussion below on differential gender effects).…”

“…The other two studies had very small subgroup numbers (mainly in the low to mid 20s) and were therefore prone to type II error (failing to find significance when it does exist). 38,48 Moreover one of these studies 48 was on very young athletes (aged 13 -16 years), and in terms of the cognitive reserve threshold model, any problems in this cohort could be expected to be very subtle and in some cases subclinical.…”