May 2001

From University of North Carolina at Chapel Hill

Review study of 'heading' ball finds no injury boost in soccer

CHAPEL HILL - Contrary to many parents' concerns, soccer players who cause the ball to bounce forcefully off their heads in games or practices -- a technique called "heading" -- do not risk brain injuries, a new University of North Carolina at Chapel Hill review study shows.

And the younger a player is, the less chance he or she has of getting hurt "heading" because young opponents cannot put much force behind their kicks, the lead researcher says.

"Based on the literature, we'd say that purposeful heading of a ball is not something parents should be concerned about," said Dr. Donald T. Kirkendall, clinical assistant professor of orthopedics at the UNC School of Medicine. "In fact, parents of children under age 12 have little reason to be concerned because heading in children's games tends to be a novelty, usually off a bounced or thrown ball, and kids just can't kick the ball that hard."

Kirkendall reviewed every study he could find on the subject. A report on the work appears in the May issue of Sports Medicine, a scientific review journal.

"In the late 1960s or early 1970s people started talking for the first time about what they called 'footballers' migraine,'" Kirkdendall said. "Back then, this could have been a problem because when the old leather ball got wet, it could become as much as 20 percent heavier. The modern soccer ball doesn't absorb water even if you play in the rain."

Later, in the 1980s Norwegian scientists published several papers implicating heading in neurological deficits, he said. That work did not account for other factors that could have contributed to the deficits such as previous head injuries, drug or alcohol problems, learning disabilities and other factors.

"The consensus of what we see today is that the force of impact from heading a soccer ball is fairly low," Kirkendall said. "Players prepare for heading the ball by tensing up their neck muscles and, in effect, put their entire body into the heading motion. We're not talking here about accidents in which the ball strikes someone's unprepared head."

Head injuries are possible in soccer, of course, but they result chiefly from players falling down, kicking one another, colliding with someone or running into a goal post, he said. Compared with tackle football, soccer usually produces minor injuries. Most involve bruises or lacerations, and other studies have shown that most of the few concussions fall into the mildest category. All players who strike their heads hard against anything and feel or look groggy should be removed from play for at least 15 to 20 minutes for trainers to check for lingering symptoms of concussion. Such trauma can alter mental function, producing grogginess and need not involve unconsciousness.

People who suspect a player might be concussed should not ask about deep-seated memories, such as what school they attend or what their name is, but about things that happened just before the event, Kirkendall said. If a player can't say what happened moments earlier, he or she might have an injury and should be removed from play and checked by a physician. Himself a longtime soccer player, Kirkendall once suffered a partially detached retina from a ball hitting him on the eye.

"A neurologist friend of mine, who also is a coach, once was ejected from a game for trying to get a referee to stop play so that he could get one of his players off the field for a head injury," he said. "He did the right thing for the girl and didn't care that he was thrown out."

Note: Kirkendall can be reached at (919) 843-9481.











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