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It was a moment American soccer fans had almost come to expect. In the 104th minute of the Women’s World Cup final, Abby Wambach headed in a go-ahead goal. That was her third goal by soccer headers in the last three matches, and all were either game tying or go ahead goals. Even ESPN’s J.A. Adande tweeted, “Abby Wambach’s headers…most reliable shots since Michael Jordan’s fadeaways?” And while the goal didn’t prove to be enough, the U.S. Women’s National Team still returns home as heroes to millions of young female soccer players.

The risks of soccer headers

But are Wambach’s soccer headers a skill that should be emulated by young players? Or are they potentially dangerous, eventually leading to chronic brain injuries?

I think that by now most sports fans understand the serious nature of concussions. They might be surprised that they occur so frequently in soccer, a sport that predominantly involves running and kicking. Barnes et al. analyzed the concussion histories of elite male and female soccer players. They determined that a male player has a 50% chance of having a concussion over a 10-year period, while a female player has a 22% chance in that 10-year period. And these are often not mild injuries. Yard et al. showed that 40% of concussions in high school soccer resulted in the player being out 1-3 weeks, and over 7% were season-ending.

Are soccer headers dangerous?

Heading and concussions

A large portion of these injuries is in fact related to the act of heading the ball. While heading the ball accounts for about 6% of all injuries in soccer, they account for about 36% of concussions. But the vast majority of the head injuries caused by going for a header came from player-to-player contact or contact with the ground. And while contact with the ball has been shown to be a cause in some studies, it was always related to balls kicked at close range with full force. Routine heading of the ball was not found to be a factor.

Long-term effects of soccer headers

So why do many people assume that repetitive heading is dangerous? Is it comparable to a boxer taking punches to the head, as some suggest? Several early studies did suggest that it was a problem. But many researchers later showed that these studies had flaws such as a lack of control groups and failing to account for alcohol consumption or history of concussions.

A study focused on U.S. National Team players might have best refuted the theory. Sheldon Jordon et al. looked at acute and chronic brain injury in these players. They examined the MRI scans of the brains of these players and tried to correlate the findings with exposure to repetitive headers over time. If repetitive heading caused chronic brain injuries, then the MRI’s of more experienced players who headed the ball more should have shown more findings. But they found no such evidence. Instead they found that any evidence of encephalopathy correlated only with a history of acute traumatic head injuries.

Prevent all brain injuries in soccer

I won’t definitely claim that repetitive heading of the ball couldn’t cause brain injury. Our efforts to prevent head trauma might be better spent trying to decrease the chance of acute injuries. For instance, while contact with the goalpost isn’t among the most common causes of concussions, it was implicated as the cause of 18 deaths from soccer in the U.S. over a 13-year period. Using padded goalposts might be worth studying.

Heading in soccer might lead to brain injury.
Does heading the ball lead to brain damage?

Perhaps more important is teaching youth and high school players proper heading technique. Learning proper landing (which might prevent the even more common ACL tears) and proper head and neck positions and mechanics are essential prior to starting heading drills. These drills should be mastered before young players try soccer headers against full competition. And while concussions can still occur, young female soccer players can learn to safely emulate their heroes.

Note: The following column appears in the July 20, 2011 issue of The Post and Courier.