Adverse effects of soccer heading found in the same location as CTE pathology

By Zoe Heart. This article was initially published in the 12/12/24 edition of our Concussion Update newsletter; please consider subscribing.

A study found a link between soccer players with “a higher level of heading” and brain abnormalities in regions where Chronic Traumatic Encephalopathy (CTE) pathology is most often found. Columbia University professor Michael Lipton presented the as-yet-unpublished study at the annual meeting of the Radiological Society, which was announced in a press release. Through a new imaging technique called diffusion MRI, researchers were able to compare the brains of 352 soccer players and 77 non-collision-sport athletes, finding white matter differences in the frontal lobe, an area frequently impacted by heading, in those soccer players doing a high level of heading.

Furthermore, as discussed in a Newsweek article by Sean Duke, Lipton’s team found an association between more repetitive head impacts with poorer verbal memory, poorer verbal learning, and worse cognitive performance. This association suggests a “causal link between heading and worse brain function.” Soccer players who did a high level of heading were found to have brain microstructure abnormalities “at the depths of crevices in the brain surface called sulci." Lipton explains that "The abnormalities occur in the locations most characteristic of CTE, are associated with worse ability to learn a cognitive task and could affect function in the future." 

Participants were male and female athletes aged 18-53. In the soccer players who reported frequent heading of the ball, Lipton reported a high level of abnormality in the white matter of the frontal lobe––a region frequently impacted by soccer heading––and particularly the “white matter adjacent to sulci, which are deep grooves in the brain’s surface.” 

Notably, few of the soccer players studied had reported a history of diagnosed concussion, illuminating the “delayed adverse effects” of repetitive head impacts, including those that do not trigger concussion symptoms. 

Based on current evidence, some level of soccer heading may not lead to the frontal lobe changes found in the study, but the threshold is unknown and will likely vary for each person. But, critically, “If heading is associated with imbalance, nausea, persistent headache, disorientation or trouble functioning, Lipton advised caution, rest and perhaps medical assessment.”