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[Effect of heading in soccer on the head--a quantifying EEG study of soccer players].

We observed a patient with epileptic seizures as a consequence of an occipital contre coup injury, due to heading in football. We decided to investigate the EEGs of ten healthy football players by computerized EEG analysis during their "header training". One player's EEG showed focal slowing, there were no clinical symptoms. The EEG of the other players showed only signs of relaxation after training. These results lead us to the following conclusions: - Cerebral damage due to heading in football cannot be assumed in general. - In predisposed persons, however, the microtrauma caused by heading can lead to clinical manifestation. - Subclinical cerebral disfunction due to heading is possible. However, long term studies should be performed to prove that there might be a risk of permanent cerebral damage in football players, as has already been established in boxing.

Adult↗

[Soccer--more than a game! About development of social aspects of soccer among children and adolescents in Norway].

The three most important social aspects of children's sports are: the social aspect, the preventive aspect, and the social network aspect. In 1981, The Norwegian football Association decided to make general improvements to the sport of football for children and youths. The idea was that all children who wanted to, could join in a game of football in a friendly sporting environment where everybody enjoyed participating. To find out the best way of doing this, we conducted three research projects: an epidemiological study, an outcome study, and a study on new ways of recruiting players and leaders in the local community. The following type of questions were explored: What are the social characteristics of 12 to 16-year old children who play football? Does football recruit children with behavioural or emotional problems? Who are the drop-outs, and why? This paper summarises some of the research findings and describes some of the main changes that were made in rules, organisation of the game, training of leaders, and attitudes and values.

Adolescent↗

Risk factors for injury in indoor compared with outdoor adolescent soccer.

BACKGROUND: There are limited data on the epidemiology of indoor soccer injuries. PURPOSE: Injury rates and risk factors for injury in adolescent indoor and outdoor soccer in the same cohort of players will be identified and compared. STUDY DESIGN: Cohort study (prevalence); Level of evidence, 2. METHODS: The study population was a random sample of 21 adolescent (ages 13-17 years) outdoor soccer teams (N = 317). The subcohort included players continuing to play in the indoor soccer season (n = 142). The injury definition included any injury occurring in soccer that resulted in medical attention, the inability to complete a session, and/or missing a subsequent session. RESULTS: The overall injury rate found in indoor soccer over 20 weeks was 4.45 injuries per 1000 player hours (95% confidence interval, 3.1-6.19). The overall injury rate found in the 13-week outdoor soccer season among a similar cohort was 5.59 injuries per 1000 player hours (95% confidence interval, 4.42-6.97). The relative risk of injury suggests that there was no significant difference between injury rates by age group or gender in indoor soccer compared with outdoor soccer. The risk of injury in the most elite division of play was greater in outdoor compared with indoor soccer (relative risk, 3.22; 95% confidence interval, 1.8-6.12). The most commonly injured body part in both indoor and outdoor soccer was the ankle, followed by the groin in indoor and the knee in outdoor soccer. CONCLUSION: There were no significant differences in overall injury rates found by gender or age group for indoor compared with outdoor soccer. Future research should focus on injury prevention strategies to reduce lower extremity injury in indoor and outdoor adolescent soccer.

Adolescent↗

Concussions among university football and soccer players.

OBJECTIVE: A study to examine the incidence and characteristics of concussions among Canadian university athletes during 1 full year of football and soccer participation. DESIGN: Retrospective survey. PARTICIPANTS: Three hundred eighty Canadian university football and 240 Canadian university soccer players reporting to 1999 fall training camp. Of these, 328 football and 201 soccer players returned a completed questionnaire. MAIN OUTCOME MEASURES: Based on self-reported symptoms, calculations were made to determine the number of concussions experienced during the previous full year of football or soccer participation, the duration of symptoms, the time for return to play, and any associated risk factors for concussions. RESULTS: Of all the athletes who returned completed questionnaires, 70.4% of the football players and 62.7% of the soccer players had experienced symptoms of a concussion during the previous year. Only 23.4% of the concussed football players and 19.8% of the concussed soccer players realized they had suffered a concussion. More than one concussion was experienced by 84.6% of the concussed football players and 81.7% of the concussed soccer players. Examining symptom duration, 27.6% of all concussed football players and 18.8% of all concussed soccer players experienced symptoms for at least 1 day or longer. Tight end and defensive lineman were the positions most commonly affected in football, while goalies were the players most commonly affected in soccer. Variables that increased the odds of suffering a concussion during the previous year for football players included a history of a traumatic loss of consciousness or a recognized concussion in the past. Variables that increased the odds of suffering a concussion during the previous year for soccer players included a past history of a recognized concussion while playing soccer and being female. CONCLUSIONS: University football and soccer players seem to be experiencing a significant amount of concussions while participating in their respective sports. Variables that seem to increase the odds of suffering a concussion during the previous year for football and soccer players include a history of a recognized concussion. Despite being relatively common, symptoms of concussion may not be recognized by many players.

Adult↗

Neuropsychological impairment in amateur soccer players.

CONTEXT: Soccer players incur concussions during matches and training sessions, as well as numerous subconcussive blows to the head from impacts with the soccer ball (headers). The combination of soccer-related concussions and the number of headers may be a risk for chronic traumatic brain injury (CTBI). OBJECTIVE: To determine whether amateur soccer players have evidence of CTBI. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 33 amateur soccer players and 27 amateur athletes involved in swimming and track (controls) in the Netherlands who underwent interviews and neuropsychological testing. MAIN OUTCOME MEASURES: Performance of soccer players vs controls on 16 neuropsychological tests having 27 outcomes. RESULTS: Compared with control athletes, amateur soccer players exhibited impaired performance on tests of planning (39% vs 13%; P=.001) and memory (27% vs 7%; P=.004). Among soccer players, 9 (27%) had incurred 1 soccer-related concussion and 7 (23%) had had 2 to 5 concussions during their career. The number of concussions incurred in soccer was inversely related to the neuropsychological performance on 6 of the neuropsychological tests. CONCLUSIONS: Our results indicate that participation in amateur soccer in general and concussion specifically is associated with impaired performance in memory and planning functions. Due to the worldwide popularity of soccer, these observations may have important public health implications.

Adult↗

Bone mass and muscle strength in young female soccer players.

In this cross-sectional study, bone mass and muscle strength of the thigh were investigated in 51 female soccer players, age 16.3 +/- 0. 3 years, who had been playing soccer for 8.1 +/- 2.1 years and were at the time of the study in soccer training for 5.0 +/- 1.7 hours/week. They were compared with 41 nonactive females, age 16.2 +/- 1.3 years. The groups were matched according to age, weight, and height. Areal bone mineral density (BMD) was measured of the total body, head, lumbar spine, femoral neck, Ward's triangle, and the greater trochanter using dual energy X-ray absorptiometry (DXA). Isokinetic muscle strength of the quadriceps and hamstrings muscles was measured using an isokinetic dynamometer. Compared with the nonactives, the soccer players had significantly higher BMD of the total body (2.7%), lumbar spine (6.1%), the dominant and nondominant hip (all sites). The largest differences were found in the greater trochanter on both sides (dominant, 16.5%, nondominant, 14.8%). The soccer players had significantly higher concentric and eccentric peak torque of the thigh muscles. In the soccer group, there was only a positive association between thigh muscle strength and BMD of the adjacent hip, and in the nonactive group there were several positive associations between muscle strength and BMD. However, when adjusting for the variation in weight and height all these associations became nonsignificant. Using multiple linear regression, the type of activity (soccer player, nonactive) independently predicted BMD of all dominant hip sites (beta = 0.32-0.48, P < 0.01). No other variable was found to independently predict BMD of any site. In the younger subjects (</=16 years) only BMD of the greater trochanter was significantly higher in the soccer players. In the older subjects (>16 years) the soccer players had significantly higher BMD in all measured sites except for the nonweight-bearing head. The differences in muscle strength between soccer players and nonactives were already seen in the young age group. In conclusion, girls who train and play soccer in adolescence have a higher bone mass in the hip and lumbar spine, and a higher muscle strength of the thigh compared with nonactive controls, indicating a site-specific skeletal response of weight-bearing and impact-loadng acting on the skeleton. The differences in bone mass were already apparent in early adolescence, but became more pronounced in late adolescence, probably explained by a longer exposure to soccer training with time. Our results also indicate that muscle strength in itself might not be of decisive importance for bone mass in the hip of adolescent females.

Absorptiometry, Photon↗

Anterior cruciate ligament injury in national collegiate athletic association basketball and soccer: a 13-year review.

BACKGROUND: Female collegiate athletes have been reported to have a higher rate of anterior cruciate ligament injury compared to male collegiate athletes. This finding has spawned a branch of research focused on understanding and preventing this injury pattern. PURPOSE: To determine if the trends reported in 1994 have continued. STUDY TYPE: Descriptive epidemiology study. METHODS: The National Collegiate Athletic Association Injury Surveillance System database was reviewed for all data relating to men's and women's basketball and soccer anterior cruciate ligament injuries for 1990 to 2002. RESULTS: No significant difference was seen in basketball comparing frequency of contact versus noncontact injuries between men (70.1%) and women (75.7%). Male basketball players sustained 37 contact injuries and 78 noncontact injuries. Female basketball players sustained 100 contact injuries and 305 noncontact injuries. In soccer, there was a significant difference in frequency of injury for male (49.6%) and female (58.3%) athletes when comparing contact and noncontact injuries (chi2=4.1, P<.05). Male soccer players sustained 72 contact injuries and 66 noncontact injuries. Female soccer players sustained 115 contact injuries and 161 noncontact injuries. The magnitude of the difference in injury rates between male and female basketball players (0.32-0.21, P=.93) remained constant, whereas the magnitude of the difference in the rate of injuries between male and female soccer players (0.16-0.21, P=.08) widened. Comparing injury within gender by sport, soccer players consistently sustained more anterior cruciate ligament injuries than did basketball players. The rate of anterior cruciate ligament injury for male soccer players was 0.11 compared to 0.08 for male basketball players (P=.002). The rate of anterior cruciate ligament injury for female soccer players was 0.33 and for female basketball players was 0.29 (P=.04). The rates for all anterior cruciate ligament injuries for women were statistically significantly higher (P<.01) than the rates for all anterior cruciate ligament injuries for men, regardless of the sport. In soccer, the rate of all anterior cruciate ligament injuries across the 13 years for male soccer players significantly decreased (P=.02), whereas it remained constant for female players. CONCLUSIONS: In this sample, the rate of anterior cruciate ligament injury, regardless of mechanism of injury, continues to be significantly higher for female collegiate athletes than for male collegiate athletes in both soccer and basketball. CLINICAL RELEVANCE: Despite vast attention to the discrepancy between anterior cruciate ligament injury rates between men and women, these differences continue to exist in collegiate basketball and soccer players. Also demonstrated is that although the rate of injury for women is higher than for men, the actual rate of injury remains low and should not be a deterrent to participation in sports.

Analysis of Variance↗

Soccer injuries. II: Aetiology and prevention.

Current knowledge about the aetiology of the soccer injuries is limited. The presumed complex interaction of various risk factors requires in-depth statistical analysis of techniques to identify dependent and independent variables, and to describe the extent, direction and strength of the relationship between the independent predictor variables and soccer injuries. However, in the majority of the studies, the application of statistical analysis was restricted to descriptive and univariate analysing techniques. Moreover, the results of studies on the aetiology of soccer injuries are biased by selection according to age, gender and level of competition. Identified intrinsic risk factors are joint flexibility including pathological ligamentous laxity and muscle tightness, functional instability, previous injuries and inadequate rehabilitation. Extrinsic risk factors include the exercise load in soccer (competition and practice), inadequate equipment (shinguards, taping, shoes), playing field conditions and foul play. Also, the number of well controlled experimental studies on the prevention of soccer injuries is very limited. In different selected homogenous subgroups of the soccer population in Sweden and Denmark, different types of prevention proved to be successful in reducing the incidence and severity of soccer injuries. Selection bias should be considered in the interpretation of these results. Generally, the epidemiological information of the sport medical aspects of soccer injuries appears to be inconsistent and far from complete. The aetiology of soccer injuries may differ between different subgroups of the soccer population. As a consequence, different subgroups of soccer players may need different prophylactic programmes to achieve a major reduction in incidence and severity of soccer injuries. More research is needed to identify high risk groups and independent predictor variables of injury within those subgroups. The outcome of these studies must lead to the development of effective prophylactic programmes. Preferably, such studies should include uniform definitions of injury and should be based on sound epidemiological methodological principles.

Athletic Injuries↗

The physiology of soccer--with special reference to intense intermittent exercise.

The present thesis is based on 14 original articles published in international journals (I-XIV, see page 8) and a summarizing review. The thesis deals with the physiological demands of soccer, with a particular focus on the physiological response to repeated intense exercise. In chapter I the specific issues are presented and in chapter II the physiological demands in soccer are discussed based on the results of the studies performed. Chapter III contains a short survey of the experiments performed to study specifically muscle metabolism and muscle fatigue with repeated intense muscle contractions. With reference to the topics covered in chapters II and III, fatigue during a soccer match is discussed in chapter IV, and chapter V deals with applications for physical training in soccer. Measurements have been performed during soccer matches and training, as well as in experiments simulating the activities of a soccer match. The information obtained has been compared to results from studies of the physical capacity of top-class soccer players and from laboratory experiments aimed at investigating metabolism and fatigue in intermittent exercise. Studies with whole-body and single muscle group exercises have been performed, the latter mainly with the application of a knee-extension model. In the studies on isolated muscle groups, biopsies taken from exercising muscles as well as arterial and femoral venous blood samples have allowed for detailed analysis of muscle ionic transportation and metabolism. In addition, the magnetic resonance technique has been used for the continuous determination of changes in muscle metabolites and pH during intermittent exercise. Analysis of activities during soccer matches showed that a top-class soccer player covers an average distance of approximately 11 km during a match. The distance differs highly between players and is partly related to the position in a team. Midfield players run more at low speed than defenders and forwards, whereas no difference appears to exist between groups when comparing the distance covered at high speed. The distance covered at high speed is the same in the beginning as in the end of a match. The total distance covered by a player during a soccer match is only to a limited extent a measure of the physiological demands on the player during the match. In addition to running, a player is engaged in many other energy demanding activities, i.e. tackling, jumping, accelerating and turning. A more precise evaluation of the total energy demand during a soccer match may be achieved by performing physiological measurements in connection with soccer matches (I).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

Competence, perceived importance of competence and drop-out from soccer: a study of young players.

The purpose of this study was to examine the psychological centrality hypothesis and the selectivity/discounting hypothesis advanced by Rosenberg and Harter and the motivational consequences thereof within the context of soccer. A representative sample of 223 young soccer players aged 12-16 who were interviewed twice within a period of 16 months served as subjects. Within the younger as well as the older group of players, the psychological centrality hypothesis received support in that the influence of perceived soccer competence upon soccer-related self-esteem was shown to be dependent upon the personal importance of one's own soccer competence. The psychological selectivity/discounting hypothesis, stating that players actively value or devalue how personally important they consider soccer competence to be as a result of changes in the perception of such competence, was also supported. Additional results showed that perceived importance of soccer competence did neither mediate nor moderate soccer drop-out among players with low perceived soccer competence. Low perceived soccer competence, on the other hand, clearly mediated the relationship between low actual soccer competence and increased drop-out within the group of older players.

Adolescent↗

Suitability of soccer training drills for endurance training.

Recent evidence suggests that certain soccer drills produce exercise intensities suitable for physical conditioning. However, it remains debatable whether soccer drills can provide a sufficiently unified exercise intensity among different players and on repetition of a drill, because movement patterns cannot be externally controlled during soccer drills. Good reliability and low variability of exercise intensity would enable all players to receive an appropriate training stimulus. The purpose of this study was to investigate intersubject variability and intrasubject reliability in exercise intensity during soccer drills. It was hypothesized that soccer drills that involve the highest exercise intensities would demonstrate the lowest intersubject variability and the highest intrasubject reliability. Heart rates of 23 professional soccer players were recorded during a range of soccer training drills. The drills consisted of 2 vs. 2 to 8 vs. 8 normal scoring games and 2 further possession games. Heart rate responses were examined for variability, reliability, and suitability for soccer endurance training. Coefficients of variation across players were less than 3% for all drills. Paired t-tests showed no significant differences in heart rate on repetition of the drills and 95% ratio limits of agreement were 1.8-3.8%. There were no significant correlations between exercise intensity and the statistical measures of variability and reliability. Several drills produced exercise intensities suitable for soccer endurance training with mean heart rate responses ranging from 87-91% HRmax. Soccer drills such as those used in the present study appear to be an adequate substitute for physical training without the ball and thus provide simultaneous skill and fitness training. The increase in training time spent developing technical ability and/or a reduction in total training time required may be useful for soccer teams.

Adult↗

Eye-hand and eye-foot visual reaction times of young soccer players.

PURPOSE: The aim of this study was to investigate the eye-hand and eye-foot visual reaction time among young soccer players and to compare those with non-soccer players in order to evaluate possible differences. METHODS: A vision screening of 53 young male soccer players belonging to the Valencia Soccer Club was done. Soccer players were divided in three categories, with mean ages of 8.2 +/- 0.5 years (range, 8- to 9-year olds), 10.6 +/- 0.2 years (range, 10- to 11-year-olds), and 12.7 +/- 0.3 years (range, 12- to 13-year-olds). An age-matched sample of 60 young male non-soccer players served as a control population. Mean ages in this population were 8.3 +/- 0.6 years, 10.5 +/- 0.4 years, and 12.6 +/- 0.2 years for each category, respectively. Eye-hand and eye-foot visual reaction times were determined in players and non-players by means of a computer-controlled stimuli device. RESULTS: We obtained a mean and standard deviation value (in seconds) of eye-hand reaction time in soccer players of 0.301 +/- 0.037, 0.256 +/- 0.040, and 0.207 +/- 0.031, respectively, for each category, and for non-soccer players of 0.382 +/- 0.061, 0.320 +/- 0.063, and 0.282 +/- 0.043, respectively. The values for eye-foot reaction time in players were: 0.412 +/- 0.062, 0.406 +/- 0.046, and 0.387 +/- 0.034, respectively, for each category, and for nonplayers of 0.496 +/- 0.081, 0.460 +/- 0.026, and 0.446 +/- 0.054, respectively. There are statistically significant differences between eye-hand and eye-foot reaction times between players and nonplayers (p < 0.05). There was no correlation between visual reaction times and age (p > 0.05). CONCLUSIONS: Eye-hand and eye-foot visual reaction times were found to be different between the two populations evaluated. The results show differences between soccer and non-soccer players, with the soccer players demonstrating faster reaction times.

Adolescent↗

Physiological responses to laboratory-based soccer-specific intermittent and continuous exercise.

The aim of this study was to devise a laboratory-based protocol for a motorized treadmill that was representative of work rates observed during soccer match-play. Selected physiological responses to this soccer-specific intermittent exercise protocol were then compared with steady-rate exercise performed at the same average speed. Seven male university soccer players (mean +/- s: age 24 +/- 2 years, height 1.78 +/- 0.1 m, mass 72.2 +/- 5.0 kg, VO2max 57.8 +/- 4 ml x kg(-1) x min(-1)) completed a 45-min soccer-specific intermittent exercise protocol on a motorized treadmill. They also completed a continuous steady-rate exercise session for an identical period at the same average speed. The physiological responses to the laboratory-based soccer-specific protocol were similar to values previously observed for soccer match-play (oxygen consumption approximately 68% of maximum, heart rate 168 +/- 10 beats x min(-1)). No significant differences were observed in oxygen consumption, heart rate, rectal temperature or sweat production rate between the two conditions. Average minute ventilation was greater (P < 0.05) in intermittent exercise (81.3 +/- 0.2 l x min(-1)) than steady-rate exercise (72.4 +/- 11.4 l x min(-1)). The rating of perceived exertion for the session as a whole was 15 +/- 2 during soccer-specific intermittent exercise and 12 +/- 1 for continuous exercise (P < 0.05). The physiological strain associated with the laboratory-based soccer-specific intermittent protocol was similar to that associated with 45 min of soccer match-play, based on the variables measured, indicating the relevance of the simulation as a model of match-play work rates. Soccer-specific intermittent exercise did not increase the demands placed on the aerobic energy systems compared to continuous exercise performed at the same average speed, although the results indicate that anaerobic energy provision is more important during intermittent than during continuous exercise at the same average speed.

Adult↗

Peer relationships in adolescent competitive soccer: associations to perceived motivational climate, achievement goals and perfectionism.

The aim of this study was to examine the relationship between the perceived motivational climate, achievement goals, perfectionism and indices of peer relationships in a sample of young male and female Norwegian soccer players. The sample consisted of 1719 experienced soccer players (1231 males, 488 females) aged 12-19 years (mean = 14.9 years) participating in the Norway Cup international youth soccer competition. The players responded to a questionnaire measuring perceived peer acceptance and quality of friendship in soccer, perceived motivational climate, achievement goals and perfectionism in soccer. Canonical correlation analyses revealed that young female players who perceived the motivational climate as predominantly mastery oriented, and who were moderately task oriented and scored negatively on maladaptive perfectionism, reported better relations with their peers in soccer. Constructive peer relations were evident in that they scored positively on companionship with their best friend in soccer; they perceived this friend as being loyal and allowing of free discussion, and they reported being socially accepted by their peers in soccer. Mirroring these findings, young male players who perceived the motivational climate as predominantly performance oriented, who had a moderately negative score on task orientation but a quite strong positive score on maladaptive perfectionism, reported negative relationships with peers in terms of these aspects. They also reported being in conflict with their best soccer friend. The findings suggest that the qualities of motivation have a systematic relationship with peer acceptance and the quality of friendship in male and female youth soccer.

Achievement↗

Concussions among university football and soccer players: a pilot study.

OBJECTIVE: A pilot study to examine the incidence and characteristics of concussions for one season of university football and soccer. DESIGN: Retrospective survey. PARTICIPANTS: 60 football and 70 soccer players reporting to 1998 fall training camp. Of these, 44 football and 52 soccer players returned a completed questionnaire. MAIN OUTCOME MEASURES: Based on self-reported symptoms, calculations were made to determine the number of concussions experienced during the previous season, the duration of symptoms, the time for return to play and any associated risk factors for concussions. RESULTS: Of all the athletes who returned completed questionnaires, 34.1% of the football players and 46.2% of the soccer players had experienced symptoms of a concussion during the previous season. Only 16.7% of the concussed football players and 29.2% of the concussed soccer players realized they had suffered a concussion. All of the concussed football players and 75.0% of the concussed soccer players experienced more than one concussion during the season. The symptoms from the concussion lasted for at least 1 day in 28.6% of the football players and 18.1% of the soccer players. Variables that increased the odds of suffering a concussion during the previous season for football and soccer players included a past history of a recognized concussion. CONCLUSION: More university soccer players than football players may be experiencing sport related concussions. Variables that seem to increase the odds of suffering a concussion during the previous season for football and soccer players include a history of a recognized concussion. Despite being relatively common, many players may not recognize the symptoms of a concussion.

Adult↗

No evidence of impaired neurocognitive performance in collegiate soccer players.

A high incidence of cerebral concussion has been reported among soccer players. We studied whether long-term or chronic neuropsychological dysfunction was present in collegiate soccer players. Two hundred forty subjects from a National Collegiate Athletic Association division I institution were stratified into three groups: soccer athletes (91), nonsoccer athletes (96 women's field hockey, women's lacrosse, and baseball players), and controls (53 college students). Subjects completed a concussion history questionnaire and underwent preseason baseline neuropsychological testing before the start of either the freshman or sophomore year. Data were collected on the results of six neuropsychological tests and from a concussion history questionnaire for number of previous concussions, Scholastic Aptitude Test results, and exposure to soccer and heading. Despite an average of 15.3 seasons of soccer exposure and a higher prevalence of previous concussions, the soccer athletes did not demonstrate impaired neurocognitive function or scholastic aptitude when compared with the nonsoccer athletes or the student nonathletes. Additionally, there was no significant relationship between a history of soccer-related concussion and either neurocognitive performance or scholastic aptitude. Neither participation in soccer nor a history of soccer-related concussions was associated with impaired performance of neurocognitive function in high-level United States soccer players.

Adolescent↗

Acute and chronic brain injury in United States National Team soccer players.

We designed a study to determine whether chronic encephalopathy occurs in elite, active soccer players resulting from repetitive heading of the soccer ball. Studies have suggested that the cumulative effects of heading a ball can cause a chronic brain syndrome similar to dementia pugilistica, which is seen in professional boxers. Twenty of 25 members of the U.S. Men's National Soccer Team training camp (average age, 24.9; average years of soccer, 17.7), who completed a questionnaire on head injury symptoms and had magnetic resonance imaging of the brain, were compared with 20 age-matched male elite track athletes. The soccer players were surveyed about playing position, teams, number of headers, acute head injuries, and years of playing experience. An exposure index to headers was developed to assess a dose-response effect of chronic heading. The soccer and track groups were questioned regarding alcohol use and history of acute head traumas. Questionnaire analysis and magnetic resonance imaging demonstrated no statistical differences between the two groups. Among the soccer players, symptoms and magnetic resonance imaging findings did not correlate with age, years of play, exposure index results, or number of headers. However, reported head injury symptoms, especially in soccer players, correlated with histories of prior acute head injuries (r = 0.63). These findings suggest that any evidence of encephalopathy in soccer players relates more to acute head injuries received playing soccer than from repetitive heading.

Acute Disease↗

"Heading" and neck injuries in soccer: a review of biomechanics and potential long-term effects.

BACKGROUND: Although soccer has a lower injury rate than does American football, injuries to the head and neck do occur. Indeed, soccer is classified as a contact sport. The potential for cervical injuries from the maneuver known as "heading" are of particular concern. This review provides a synopsis of soccer-related head and neck injuries, an overview of the biomechanics of trauma, and a rational approach to evaluating patients. OBJECTIVE: This review was conducted to assess and evaluate existing literature on the biomechanics of the act of heading in soccer and the potential for acute and long-term injury to the head and neck. DESIGN: The resulting work is based on literature searches of the PubMed and Medline databases, textbook reviews, and bibliographies of articles and textbooks obtained during the search. Findings from several studies were summarized and critiqued. Biomechanics, anatomy, pathophysiology, and their relation to the act of heading in soccer were also synthesized into the discussion. Relevant studies of athletes in other sports where activity can affect the neck and head in a manner similar to heading were also considered. RESULTS: The act of heading in soccer involves the athlete's entire body, and studies have used electromyography to define the activity of neck musculature during heading. The majority of head and neck injuries in soccer occur secondary to impacts other than those that occur during heading, however, rare case reports of serious injury exist. Degenerative bony changes in the cervical spine of soccer players have been noted in a few studies, but the connection with heading is not well established. Data from research in other sports, particularly American football and rugby, suggest a predisposition to degenerative disease of the neck secondary to axial loading mechanisms; the exact relevance of these studies to heading and soccer is unclear. CONCLUSIONS: The complex biomechanics of heading in soccer are not completely defined, especially with regard to long-term effects on the neck and cervical spine. Existing studies of long-term effects suggest a predisposition to degenerative changes of the cervical spine, though they are somewhat limited, even when coupled with data regarding athletes in other sports. Further research in this area is needed with studies that assess biomechanical forces under simulated play conditions and control for impacts and stresses to the neck and spine that occur from non-heading activity.

Journal Article↗