highly valued skill in soccer because it demands excellent technique and precise timing.
But can repeated execution of this skill of heading cause brain damage, or traumatically
induced alteration in brain function, in footballers? In an attempt to answer this question,
Kirkendall and Garrett (2001) and Kirkendall, Jordan and Garrett (2001) reviewed
available research evidence from over fifty studies on the nature and causes of head
injuries in soccer. At least four key conclusions emerged from these reviews. To begin
with, Kirkendall and his colleagues established that head injuries are most likely to occur
within the penalty-area when defenders and attackers compete for crosses or corner-kicks
or around the half-way line when midfield players challenge each other for aerial
clearances from the goalkeeper. Next, they found some evidence that the higher the skill-
level of the players involved, the more frequent were the incidents in which concussion
occurred. Third, they concluded that although a significant number of retired soccer
players show signs of cognitive dysfunctions and various neuropsychological
impairments, the causes of these problems are difficult to determine. For example, these
maladies may be caused by accidental collisions with other players or with stationary
objects (e.g., the goalposts, advertising hoardings) rather than by repeated heading of the
ball Finally, they concluded that the research literature
on heading and brain damage is marred by a host of methodological weaknesses. To
illustrate, many studies in this field have failed to control for such factors as
inconsistencies in the criteria used to define brain damage, unreliable estimates of the
frequency of heading engaged in during a match and variations in the age, neurological
histories and possible alcohol intake of the players involved. In summary, Kirkendall et
al. (2001) conclude that “the use of the head for controlling and advancing the ball is not
likely to be a significant factor in mild traumatic brain injury” (p. 384) in soccer players.
In spite of this conclusion, a recent neuropsychological study by Witol and Webbe (2003)
found that cumulative experience (or lifetime frequency) of heading among male soccer
players was associated with poor performance on tests of attention/ concentration,
cognitive flexibility and general intellectual functioning. Therefore, these researchers
argued that “players who head the ball frequently may carry a higher risk of
neurobehavioural sequelae” (p. 414).
Critical thinking questions
Do you think that the statistics on head injuries in professional soccer are accurate?
After all, many players may be unwilling to report symptoms arising from such injuries
in order to avoid being dropped from their teams. How many times in a game do you
think that defenders, midfielders and attackers head the ball during a competitive match?
Check your guess by videotaping a match and then counting the appropriate totals for a
random fifteen-minute sequence of play. Given the fact that young soccer players are less
skilled technically and have less developed brains, do you think that heading should be
banned in children’s football?
In summary, the preceding strands of anecdotal and descriptive evidence suggest that
sports injuries pose significant national public health concerns. Naturally, such problems
have serious economic consequences. For example, it has been estimated that in Britain
alone, soccer injuries cost the taxpayer about £1 billion through direct treatment costs and
Helping athletes to cope with injury: from theory to practice 243