Heading and head injuries in soccer

In the world of sports, soccer is unique because of the purposeful use of t he unprotected head for controlling and advancing the ball. This skill obvi ously places the player at risk of head injury and the game does carry some risk. Head injury can be a result of contact of the head with another head (or other body parts), ground, goal post, other unknown objects or even th e ball. Such impacts can lead to contusions, fractures, eye injuries, concu ssions or even, in rare cases, death. Coaches, players, parents and physici ans are rightly concerned about the risk of head injury in soccer, Current research shows that selected soccer players have some degree of cognitive d ysfunction. It is important to determine the reasons behind such deficits. Purposeful heading has been blamed, but a closer look at the studies that f ocus on heading has revealed methodological concerns that question the vali dity of blaming purposeful heading of the ball. The player's history and ag e (did they play when the ball was leather and could absorb significant amo unts of water), alcohol intake. drug intake. learning disabilities, concuss ion definition and control group use/composition are all factors that cloud the ability to blame purposeful heading. What does seem clear is that a pl ayer's history of concussive episodes is a more likely explanation for cogn itive deficits. While it is likely that the subconcussive impact of purpose ful heading is a doubtful factor in the noted deficits, it is unknown wheth er multiple subconcussive impacts might have some lingering effects. In add ition, it is unknown whether the noted deficits have any affect on daily li fe. Proper instruction in the technique is critical because if the ball con tacts an unprepared head (as in accidental head-ball contacts), the potenti al for serious injury is possible. To further our understanding of the rela tionship of heading, head injury and cognitive deficits, we need to: learn more about the actual impact of a ball on the head, verify the exposure to heading at all ages and competitive levels, determine stable estimates of c oncussive injury rates across the soccer spectrum, conduct prospective long itudinal studies on soccer players focusing on exposure, injury and cogniti on, and determine the minimum safe age to begin instruction on the skill of heading. Only then will we be able to speak with some authority on the iss ue of heading and head injuries in soccer.