Sports Medicine Research: In the Lab & In the Field: Higher Heading Counts May Impair Memory and Brain Tissue (Sports Med Res)


Friday, July 12, 2013

Higher Heading Counts May Impair Memory and Brain Tissue

Soccer heading associated with white matter microstructure and cognitive abnormalities

Lipton ML., Kim N., Zimmerman ME., Kim M., Stewart WF., Branch CA.  Radiology. 2013; ahead of print

Take Home Message: Heading was associated with abnormal white-matter microstructure and poorer neurocognitive performance. History of concussion was not associated with altered structure.

Long-term cognitive impairments following repeated sport-related head injury is a major concern. However, the role of subconcussive impacts from soccer heading as an additional mechanism of cumulative brain injury has not been well examined. If repetitive heading causes adverse effects on the brain there could be additional rules put in place to prevent long-term consequences. Therefore, the purpose of this study was to investigate the association of soccer heading with evidence of traumatic brain injury. Twenty-eight male and 9 female amateur soccer players completed the Einstein Heading Questionnaire. The Einstein Heading Questionnaire was used to estimate heading during the prior 12 months as well as ascertain participants’ demographics and lifetime concussion history. Then a licensed neuropsychologist conducted a neuropsychological assessment to measure psychomotor speed, attention, executive function, and memory. Finally, whole-brain magnetic resonance imaging was performed. Using the data taken from the Einstein Heading Questionnaire the authors determined that the number of headings ranged from 32 to 5400 times during the previous year. To assess the relationship of heading and participant characteristics researchers separated the participants into 3 exposure groups: nine participants were in the low-heading group (£ 276 headings a year), 19 participants were classified in the medium-heading group (277 to 1095 headings per year), and nine were placed into the high-heading group (³ 1096 headings per year). Higher levels of heading were associated with more months of playing per year. There was no difference in groups with respect to age, years of education, or concussion history. Imaging revealed an association between heading and amount of white matter microstructure damage within 3 locations of the temporal-occipital region with a threshold value from 885 to 1550 headings per year. There was also an association between heading and memory function with a threshold of approximately 1800 headings per year. There were no other significant relationships found between imaging and cognitive measures.

This study suggests a relationship between the number of self-reported headings with abnormal white matter microstructure and poorer neurocognitive performance on a memory test. Interestingly, there were no relationships associated with previous concussion. Additionally, there were estimated heading thresholds (885-1550 headings associated with abnormal white matter microstructure; 1800 headings associated with memory impairments). It has been proposed that athletes can recover from a concussion given enough time. This study suggests that brain tissue is injured with sub-concussive impacts and that the white matter is unable to repair itself beyond a certain level of heading exposure. There are some notable limitations within this study. For example the heading exposure was self-reported, and there was no consideration for site of impact, velocity, or other individual heading characteristics.

Questions for Discussion: Do you think placing rules on heading count limits would help prevent concussions? How would this be monitored?  Do you think youth athletes are more at risk?

Written by: Jane McDevitt PhD, ATC, CSCS
Reviewed by: Stephen Thomas

Related Posts:

Lipton ML, Kim N, Zimmerman ME, Kim M, Stewart WF, Branch CA, Lipton RB. (2013). Soccer Heading Is Associated with White Matter Microstructural and Cognitive Abnormalities Radiology DOI: 10.1148/radiol.13130545


Shannon Snell said...

I find this research study extremely interesting. I used to be a soccer player who would play year round. At the time when I was playing soccer I never thought about the consequences that heading the ball was taking on my body. Not once did the thought cross my mind that this could be bad and potentially do damage. I really like how they admitted that one weakness with their study is that the headings were self reported and that they took into consideration heading drills and not just heading performed in a game. If you would have asked me how many headers I had performed either after a practice or after a game I would have told you I have no idea because there were heading warm up drills and all the different times during practices or games that I had to head the ball out of the box to stop an attacking opportunity. In future research studies they should have someone counting the number of headers that the person performs through out a practice and game so they get accurate numbers. I think they should also take into account the velocity of the ball when the person is heading the ball. There will be more of an impact when a person is heading a ball that was punted during a game rather than a ball they headed off of a toss during a warm up session. I think more research should be done on this topic in conjunction with the impact on soccer players. There is evidence of the damage that subconcussive forces can do to football players who repeated receive hits to the head.

Tim Gribbin said...

It would be interesting to continue to track these athletes long-term to see if this white matter damage could be associated with CTE. This would also be huge in demonstrating the effects of sub-concussive hits on brain trauma and potentially CTE if it is followed.

I think the more important thing to take from this study is the long term effects on the brain, as opposed to the relatively short term concussive effects. What will this white matter damage lead to 20-30 years down the road?

Jane McDevitt said...

These are really interesting comments. I agree with Shannon. I feel it is very difficult for athletes to remember their heading counts and I believe there is a difference in heading a ball from a goalie punt compared to a header from a light warm up toss. I think one way researchers can do counts reliably would be from video analysis. This way they can get accurate counts and categorize them (e.g., warm up headers, goalie punt headers). Also, Tim brings up a great point does this white matter microtruama continue to worsen it would be interesting to test this same group 5, 15, 30 years later. What happens if they continue to play in adult leagues? Will they still have the same long term effects if they stop playing soccer after college?

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