Medical study suggests possible link between soccer heading and brain disease

Sweat sprays off the head of Aaron Hughes as he goes for the ball with Jobi McAnuff of Reading

Photo by ISIPhotos.com

By DAN KARELL

Soccer might not be considered the most physical sport, but a recently-released study is suggesting that heading a soccer ball over a long period of time could lead to serious brain damage.

Researchers at Boston University discovered the first documented case of chronic traumatic encephalopathy, a degenerative brain disease, in a former soccer player, according to a piece in the New York Times. C.T.E. has been found in the brains of multiple former NFL and NHL players, and the disease is linked with repeated blows to the head, such as concussions or even the simple act of heading a ball.

Patrick Grange, who played for the University of New Mexico and University of Illinois-Chicago, passed away last April from A.L.S., otherwise known as Lou Gehrig’s disease, at the age of 29. On a four-point scale of severity of C.T.E, the researchers graded Grange’s brain at stage two.

Dr. Ann McKee, a neurologist at Boston University who performed a brain scan on Grange, said that she believes Grange’s repeated hits to the head helped the onset of A.L.S.

“We think the precipitating factor in his case was most likely the trauma,” McKee told the New York Times. “First of all, he was absurdly young when he developed this disease. And he had considerable evidence of this trauma-induced tauopathy, or C.T.E.”

McKee was also careful to point out that there is no definitive proof linking Grange’s disease to the heading of a soccer balls.

“We can’t say for certain that heading the ball caused his condition in this case,” McKee said. “But it is noteworthy that he was a frequent header of the ball, and he did develop this disease. I’m not sure we can take it any further than that.”

The ALS Association says that most people diagnosed with A.L.S. are between the ages of 40 and 70, with the median at age 55 (Lou Gehrig began showing signs of the disease at age 35). Grange was 27-years old when he was diagnosed.

The results are part of a documentary called ‘Head Games: The Global Concussion Crisis’, directed by Steve James. This documentary is a follow up to the 2012 documentary, Head Games.

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97 Responses to Medical study suggests possible link between soccer heading and brain disease

  1. Nate Dollars says:

    pshh, whatever. i’ve headed the ball thousands of times, and it hasn’t affected me one bit.

    • KingGoogleyEye says:

      How would you know?

    • Dennis says:

      Of course, the actual studies cannot tell the difference between damage due to heading the ball and damage due to more violent head-to-head, elbow-to-head, head-to-ground collisions. The players who head the ball most often are those who are more likely to suffer the head-to-head and elbow-to-head injuries. There is every reason to believe concussions do damage and concussions in soccer are a result not of heading the ball (though, I have seen players concussed when struck by a kicked ball at close range).

      As I recall, at least as far as concussions go, in US HS sports, where records of such are kept, basketball had a concussion rate similar to soccer.

      Girls soccer has a higher rate of concussions than boys soccer, the purported reason is that the boys have stronger neck muscles that are better able to stabilize the head during impacts both due to twisting motions and due to being snapped back. If you have ever watched HS soccer, it will be no surprise that the boys suffer more collisions and head balls that have been struck harder than the girls, there is something to be learned from that.

  2. Jason says:

    The thing about the skull is that it doesn’t mature until you are, well, an adult. So it is a justifiable concern whether teenagers and especially children should be doing such an activity that involves it.

    • KingGoogleyEye says:

      The kind of brain trauma they’re talking about could happen regardless of the maturity of the skull.

      • Del Griffin says:

        Seeing as even the scientists working on this stuff don’t know the details of these injuries or what affects them, I highly doubt you do.

        • KingGoogleyEye says:

          Hi Del Griffin: “even the scientists working on this stuff don’t know the details of these injuries or what affects them”

          Not knowing the details is not the same as not knowing anything. The fact that they don’t know the details is why they are working on it—but if they didn’t know any details then there would be nothing to work from! I happen to work with scientists who are studying these injuries (and my own research indirectly relates to it). The suspected injuries from heading come not from skull fracture/contusion but rather from high-impact velocity or rapid change in head velocity (DeltaV).

          • Del Griffin says:

            King googley eye: 13 comments on this thread all trying to assert himself as some kind of authority on the subject. lol

            I love the internet.

            • skyman says:

              And you have what to contribute?
              King Googley posted a link so we can learn more about it. Why would you criticize that?

            • skyman says:

              And you have what to contribute?
              King Googley posted a link so we can learn more about it. Why would you criticize that?

            • KingGoogleyEye says:

              Del Griffin: it seems that I have offended and/or annoyed you. I’m sorry.

  3. kyle says:

    this, of course, makes a certain amount of sense but it seems like there must be other factors involved. i’m not an expert, but it seems like there are many thousands of players who head the ball much more often over a longer period of time without getting ALS

    • Dennis says:

      There was no claim this guy got ALS from soccer. He died from ALS and his parents donated his brain to science. It was discovered he had some damage, characterized as stage 2 out of 4. The only proven way to assess this kind of damage is by autopsy, but people are working on ways to make the assessment on living people.

  4. Mike says:

    Soccer “might not be the most physical sport”? Ever play the game?

    Also, this report is inconclusive. I am not sure the regular act of heading the ball a few times a game can cause CTE. Constantly heading hard hit punts may contribute to the development of the disease, but I wonder if anyone has any data on how many times the average player heads the ball. I think the more likely scenario in the development of this problem is related to players going up for a header and knocking heads, or other types of collisions like the one that ended Twellman’s career–when he went for a header in the box and the keeper hit into him.

    • CS says:

      There has been documented evidence of CTE in footballers of a certain generation, found by a leading clinic in Italy.

      The generation in question played in the 60’s, when the ball much more dense than the relative wiffle ball used today. The effort needed to kick the ball and head the ball was a completely different thing at that time.

      Now add in if the playing conditions were wet. It was like crossing a cement block into the box, then someone redirecting with their unprotected skull that same cement block traveling at an exceptional rate of speed….over and over again (practice and games).

      In this group of players, there are the same symptoms found in today’s NFL’ers and, sadly, some of the same endings.

    • Futebol says:

      Yes, it is silly to think that the only impact to the head in soccer comes from heading the ball. Going for high headers often involves collisions between players.

  5. Chris says:

    Society is becoming way too soft

    • drew11 says:

      Careerist scientists chasing grant money. Next we will see: Medical study suggests possible link between living and dying.

    • kyle says:

      this is a ridiculous statement to make and to be honest i’m not even sure what it means. are you saying this person was soft from getting a deadly brain injury or that society is soft because we want to find out what happened? people get chronic brain injuries and it makes sense to study possible reasons why.

      • KingGoogleyEye says:

        kyle: if someone is trying to figure out someone other than me was injured while trying to provide entertainment for me, then that is “soft.” No one should care about the well-being of people other than me.

        • theodore says:

          I’m 150 – 200% in agreement with this statement.

        • skyman says:

          Well stated :)

          BTW, I’m very interested in your research, or any research relating to this. My Googling and reading articles about heading in soccer, and CTE in the most violent of sports, American football, leads me to a few tidbits of advise for coaches and parents:

          1. No heading, none, until after puberty. Impractical, yes, but not impossible to achieve.
          2. Teach youngsters how to head with a nerf like ball, something soft. Strengthening neck muscles, and proper technique are important to decrease risk factors for head and neck injuries.

    • baldomero123 says:

      +1

    • away goals says:

      Agreed this patrick grange character was being pretty dramatic with his paralysis and eventual death.

      It’s like, toughen up, guy.

  6. CL says:

    If his disease was caused by heading a soccer ball shouldn’t all 27 year old football players be dead?

    • Joe says:

      No, not all of us are equally susceptible to CTE or concussive injury.

    • KingGoogleyEye says:

      CL: ask the same question about any other disease. For example, if smoking causes cancer, shouldn’t all smokers have cancer?

    • away goals says:

      Yes spot on. You definitely understand how science works.

    • Dennis says:

      There is no reason to think the damage due to head trauma actually caused ALS, that would be at best an unproven speculation as is the statement that it accelerated the course of ALS.

      What this case does show is that playing soccer may cause brain damage. (It does not show that heading the ball caused that damage, or even that it was a soccer related injury caused the damage, though other studies do support the tie between brain injury and playing soccer at the professional level; there is plenty of anecdotal evidence that some players, especially girls, are more likely to get concussed and suffer more severe and lasting consequences from that).

  7. Joe says:

    The effects of repeated head trauma are real. Researchers, such as the highly respected colleague of mine, Ann McKee, are bringing to the forefront the issues of repeated traumatic brain injury to sports. It isn’t a matter of should children and adults be wearing protective head wear for contact sports such as soccer, its a matter of when they will do so. Research in this area will become so robust and convincing that professional leagues will mandate that all soccer players wear protective headgear to reduce the coup/contrecoup effects of traumatic brain injury. Until that time, be safe, don’t go for headers, and if possible buy some headgear.

    • chris says:

      No not really. Im not going to live in fear of head trauma and shy from any activity because it has the potential to harm my brain. Should we stop driving because we could die in an accident? Should we stop swimming in the ocean because of shark attacks? Just like football players will continue to play the game knowing the risks so will people of every sport

      • Joe says:

        You are distorting my statement entirely, its about reducing risk. Do you wear a seatbelt when driving, right? Sure, anything bad could happen at any moment, but why take an unnecessary risk if it could be avoided.

        You should visit a brain injury unit sometime and you might feel differently about your comments. If given the option between playing sports and being able to speak, write, walk, and talk, most people would chose the latter. Although this is entirely up to you though.

        • CS says:

          I think the study is worthwhile.

          But it is important to remember that measure to improve safety often result in riskier behavior. This is the spiral the NFL is in now, where head trauma could likely be reduced by wearing a less protective helmet and/or no face mask.

          If every player wore something Rooney wore at the beginning of the season, maybe that would be some preventative measure. Or maybe players will go into challenges more recklessly.

          I’m for players accepting the risk of their sport. I’m also for letting them know all the risks that are associated with it.

      • KenC says:

        Actually, when it’s impossible for an individual to internalize the risk of an activity, that’s when it’s most likely for the gov’t to step in.

        Gov’ts mandate seat belts in cars, because the risk of dying in a car accident is so low that most people can’t imagine it, and given the choice underestimate the long-term risk.

        • kyle says:

          people often refuse to accept this concept but it is really important to understand and think about at length. it is a key component of civilization

    • CL says:

      Also, according to a study released by the US Department Of The Obvious, smashing your thumb with a hammer is very painful.
      Nobody is arguing that blows to the head are dangerous. We have known that for a long time and frankly, do we need another study to tell us that?
      If you read the article you’ll notice that the most significant head trauma he suffered wasn’t from heading the ball.
      As tragic as it is, the death is a 29 year old amateur player hardly means a connection between heading the ball and CTE, and if it does in this particular case it has more to do with the invidual’s style of play than with sport itself.

      • KingGoogleyEye says:

        CL: “Nobody is arguing that blows to the head are dangerous. We have known that for a long time and frankly, do we need another study to tell us that?”

        You clearly don’t understand the study or the results. Stop trying to be an expert on something you are not and just admit that you have something to learn from those who are.

      • away goals says:

        Your last paragraph I completely agree with. Even referring to this as a “study” is misleading. It’s a single case anecdotally connected to soccer.

    • KingGoogleyEye says:

      Joe: have any studies suggested that headgear can significantly reduce the kind of brain trauma caused by heading a soccer ball?

      • CL says:

        What an idiotic question. Is this your contribution to the conversation?
        Read the article before posting again and if you have nothing to say, do that.

      • Spencer says:

        You will not find any research that can conclusively say wearing headgear protects them. There is also research that shows that better helmets in football don’t protect them from concussions. It only protects from fractures. Any protection you wear can only protect you cosmetically and has no or minimal effects on protecting you from injury.

        • KingGoogleyEye says:

          Spencer: I am a scientist; no research can “conclusively” say anything. That is why I asked about studies that “suggested” reduction in brain trauma.

          Which, incidentally, I had some time to look up. Here’s a not-so-recent one: link to ncbi.nlm.nih.gov

          But check out the “Cited by 7 PubMed Central articles” column on the right if you’re really interested.

        • KenC says:

          While football helmets were designed to eliminate trauma like fractures, that doesn’t mean there aren’t better helmets to prevent concussion.

      • KenC says:

        Studies have shown that headgear like Rooney’s can reduce the impact spike. Intuition tells you that is better than no protection, but whether that is enough to protect you from concussions or CTE, that will take time.

        • KingGoogleyEye says:

          KenC: the (old) study I linked to above reports that athletes wearing certain kinds of headgear showed higher head acceleration during heading; i.e., potentially more at risk. In other words, I don’t trust my intuition on this subject.

    • Dennis says:

      There is no evidence that any head gear reduces head injury in soccer, that is just something parents wish for and head gear manufacturers want everyone to believe.

  8. PTK says:

    Other than Kyle and Justin, I am completely disgusted by the ignorant responses and lack of respect for the deceased. I don’t think the article was a “what do you think?” More of a “here’s some new research and information.” Maybe you should actually READ the article that yes, other factors are sometimes at play, but it doesn’t help you either if you are an aggressive player in the air after those other factors have taken effect. When you watch your friend and former teammate go from playing 90 minutes, to having to be fed through a tube, to death at 27 in 18 months, the last thing on your mind is ‘what grant, hedge firm, or scientist is involved’ or who stands to gain something by this. Yep, people are getting soft… are you kidding me? If you can’t offer anything constructive, then please by all means shut the hell up.

    • Joe says:

      Quite true PTK. Ignorance is abound on this message board today.

    • kyle says:

      clearly back in the old days people were much tougher so their brains were impervious to being damaged and people knew that pretending there wasn’t a problem would cause the problem to not exist

    • drew11 says:

      I read the article. Somebody made a good comment on it. Cech took a knee. What’s the plan there? Clearly we must ban field players form the box to protect keepers.

      Injuries happen in sports. Always have and always will. Why is none of the holier than thou CTE crowd suggesting a ban on headers but no ban on alcohol due to brain and liver damage, etc.?

      This is just another made up controversy to benefit whoever is pushing it. Grant money to seek, cute and available GA’s to hire, international conferences to attend, etc.

      • away goals says:

        A lot of people advocate the cautious approach because the majority of those at risk are children.

        Your alcohol analogy breaks down at that point since alcohol can’t be sold to children because they aren’t capable of making an informed decision.

      • KingGoogleyEye says:

        drew11: “Why is none of the holier than thou CTE crowd suggesting a ban on headers but no ban on alcohol due to brain and liver damage, etc.?”

        Hmm, let’s see…maybe because the CTE “crowd” prefers to speak authoritatively only about topics on which they are experts. You could learn something from them—well, two things.

      • away goals says:

        And your cech reference makes even less sense. Yes, the risk of a head vs knee or head vs head collision still exists, but that’s a lot different than the intentional, repetitive act of heading a soccer ball.

        Last I checked coaches aren’t designing entire sessions around kneeing the gk in the head.

        • KingGoogleyEye says:

          Not yet, but someday soon, Nigel de Jong will be an assistant coach and all kinds of mixed martial arts will become standard in training sessions.

      • skyman says:

        Please don’t believe everything you “think.” I ask you to question many of the assumptions you regard as truth, relating to science and public health.

  9. wandmdave says:

    Obviously this is concerning but until causality is more firmly established (just like the scientists mentioned) I’m certainly not going to hesitate to let my children play. Even if the a causal link is established this is likely more of a concern for an older, more elite player because in rec leagues heading isn’t as prevalent and the speed of the ball is much lower.

  10. Birgit Calhoun says:

    If you have watched especially American soccer you’ are wondering how there is not damage to the brain. Especially the practice of almost hitting the ball and instead hitting the opponent player’s head instead is probably particularly injurious. That also goes with the common practice of i.e. goalies and also agressive players elbowing an opponent player as if this was just accidental. These moves are practiced moves to injure players.

  11. Kafka says:

    Seems like the perfect opportunity to watch this video again. link to youtube.com

  12. Del Griffin says:

    There is clearly some serious head trauma on display on this board today.

  13. ac31 says:

    This definitely is an inconclusive study. Head trauma in soccer mostly is related to physical contact (elbows, heads, etc). With the recent concern with concussions, our club requires to take an online educational course on the subject in order to coach. Brain injury can be caused indirectly such as hard hit to the body. With American football, it is easier to establish a link as the body takes a beating.

    Interestingly, the official curriculum from USSF written by Reyna recommends heading shouldn’t be stressed as a skill until players are 15 due to developmental reasons. However, there are a lot of coaches and parents concerned with winning that developmental needs of the players are overlooked.

    • Increase0 says:

      From what I have heard on the subject only professional are at any real risk of any sort of damage. The impacts are light enough that it requires 10,000s of impacts to do permanent damage. So it wouldn’t be a major issue for children or those of it as a hobby.

    • SilverRey says:

      +1
      If they truly went into depth on a study about brain trauma and soccer, they would most likely find that it’s more related to the major impacts that happen during the game like an elbow to the head, or a knee to the chin, than to heading the ball.
      But then again, I haven’t done a study.

      • KenC says:

        You haven’t been keeping up with articles on CTE and football. While concussions have been shown to be a leading indicator of potential for CTE, there’s increasing evidence that sub-concussive level hits that linemen have also lead to CTE. They’ve been wearing accelerometers in their helmets at UNC and WVU.

        • Dennis says:

          Of “subconcussive hits” covers a very big range, from the slightest touch of the ball to any hit no matter how hard that fails to produce a concussion. Clearly the big hits are a concern, soldiers do not experience hundreds of hits, their traumas are almost always due to one or a few very violent events, yet there is a steady supply of veterans with brain damage.
          Cheerlieading, by the way is one of the sports in the US with a high incidence of concussions.

    • KenC says:

      It’s not a “study”. It was a report about just one soccer player.

      “Head trauma” comes in different categories. There are skull fractures, and concussions and the repetitive sub concussive level of hits, like heading, that can also lead to CTE.

  14. BK says:

    I can’t believe that this blog would grant this subject any credibility at all, much less an entire posting titled “Medical study suggests possible link between soccer heading and brain disease.” What?! It’s reckless, irresponsible, and leads me to question the author’s competance as a journalist.

    Fact: One doctor “thinks” the patients condition was “most likely” caused from head trauma

    Fact: There is no way to quantify how much of that trauma was caused by heading a ball. It may have just as easily been from rollercoasters, bike accidents, or headbanging at Slayer concerts. The doctor doesn’t know and the author of this piece certainly doesn’t know.

    Fact: It is well known in the medical and scientific community that correlation DOES NOT imply causation. And what we have here is not even correlation. This is ONE data point.

    Out of the millions of soccer players in the history of time, how many of them were ever diagnosed with ALS? How is one patient’s case, not even certain to be attributable to participation in soccer lead the author to proclaim “Medical study suggests possible link between soccer heading and brain disease”?

    Sensationalize much, do we?

    DAN KARELL, this article is a disgrace.

    • James says:

      I usually really don’t like to harp on the writers, but I completely agree. This is two recent articles by Dan where headlines are purposefully misleading or flat out lying in order to get hits.

      Dan, Ives, or any of the SBI crew, please stop doing this. One of the main reason I (and I think many others) come to this site opposed to the countless others, is that most soccer websites repeatedly put ridiculous headlines just for people to click on it, with little to no substance. SBI usually are actual journalists writing real articles, not spinning BS. It may help increase traffic in the short term, but long term you’re going to loose credibility and readers in the long term.

    • KenC says:

      Actually, BU is one of the world leaders in CTE study. Almost all reports of NFL players with CTE have been reported by BU.

      As for the cause, 27 yr olds do not normally develop “tau” protein in their brains. Impacts to the head have been shown to cause early development of “tau”. So, it’s very likely that Grange got “tau” from head trauma. Now, Grange also had a history of concussions, so it’s possible a combination of concussions and sub-concussive impacts, from heading led to the “tau”.

      Actually, researchers at UNC and WVU are using accelerometers in football helmets to do exactly what you ask. How much force are these hits causing. And, they’re finding that sub-concussive hits, experienced by linemen, may be cause for concern. Heading a soccer ball is a sub-concussive hit and can be measured.

      And, the fact that correlation does not mean causation is why the doctor answered in the way she did.

      ALS is just one extreme manifestation of brain disease. One can get CTE without ALS. This was just a unique opportunity to analyze a brain of someone who died young. Most of those athletes who have died of CTE were middle-aged.

      Your rant is a bit of a disgrace.

      • BK says:

        Appreciate the feedback but this is about soccer, not football. If there are similar impact studies for soccer, they weren’t explicitly cited in this blog post and that’s my problem. No where in Dan’s article does he explain the gross and irresponsible assumptions that have to be made in order to title the piece the way he did. It is journalistic sensationalism, plain and simple. If he has facts to support the title, he needs to cite them and provide factual source information as competent journalists used to do rather than running wild with mis-information in his headlines.

  15. Increase0 says:

    I was listening to the radio a while back and it mentioned a study like this.(I can’t remember what, NPR or something.) But essentially the its repetitive nature of the act. You would have to head the ball Tens of thousands of times to commit permanent damage. So essentially, its total safe as a hobby but likely over the career of a professional this damage becomes possible.

    Now with any physical sport you risk injury. The question is how high are the risks?

    PS: Soccer with no heading the ball might actually be kinda cool. Clearing Crosses would be “super fun” for defenders.

    • James says:

      This is not a study, like the one you heard on the radio. This is one doctor, who saw one patient, and said “maybe its because of repeatedly heading the ball.” Even that doctor would be upset over the headline. I’m not saying it can’t be true, but no one should take anything from this article other than sadly, a young soccer player died from a brain disease.

      • KenC says:

        This is NOT just one doctor. Ann McKee is THE doctor when it comes to CTE and the brain. If you’ve read anything about CTE in the past few years, you’d know she is the leading researcher in the US on CTE.

        • Dennis says:

          Still the statement linking ALS with CTE is misleading. It is at best an educated supposition. I say that only because there is simply not enough data to support the statement in any rigorous way.

  16. KingGoogleyEye says:

    For those interested in learning about the science, here is a great review: link to ncbi.nlm.nih.gov

    Sorry if access to the article is behind a pay-wall; your local library may have access though. Almost certainly a local university library would.

    Well worth a read—unless you either don’t really care about the subject or don’t really care to become informed about the subject.

  17. umeweall says:

    First, yes, results are primarily inconclusive at this point, with the theory being that it impacts might potentially affect professional players, who have been playing for years. This is the running theory. However, there are also a large number of youth players who start playing soccer competitively, at a very young age, heading the ball. If is not uncommon for some of these players to play spring & fall seasons, with some continuing to play indoor soccer during the summer. To date, I have not seen a study that tracks this group of players, from early youth, to soccer in college. The issue being the number of sub-concussive hits that that have taken over the years, which includes both practices & games, heading the ball. Having been diagnosed with a concussion is not the over-riding factor, as most may have never been diagnosed with a concussion. It is the number of sub-concussive hits that have accumulated over time, for which there may be not initially displayed symptoms. The CTE factor comes in at a later point, in slowly developing stages. Want some info. on concussions, check out link to yatahoy.com .

  18. Patrick2 says:

    There was a time it was a rare site to see Hockey players with helmets. Maybe in 10 years the headband style protectors like the one Rooney was wearing a while back will simply be standard equipment. No big deal.

    • umeweall says:

      Yep, the same with face shields in hockey. While guys donned the helmets, they were against the face shields, as being ‘unnecessary’, or ‘interfering with play’, or just simply ‘unmanly’. They then started noticing careers that were shortened/ended due to pucks/sticks into the eye. The majority of players now wear face shields, for good reason. The NHL had to even adapt the fist fighting rules, to account for face shields.