The Somatic Connection  |   July 2017
Heads Up on Headers: Effects of Soccer Ball Heading on Brain Function
Author Notes
  • Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   July 2017
Heads Up on Headers: Effects of Soccer Ball Heading on Brain Function
The Journal of the American Osteopathic Association, July 2017, Vol. 117, 476-477. doi:
The Journal of the American Osteopathic Association, July 2017, Vol. 117, 476-477. doi:
Di Virgilio TG, Hunter A, Wilson L, et al. Evidence for acute electrophysiological and cognitive changes following routine soccer heading. EBioMedicine. 2016;13:66-77. doi:10.1016/j.ebiom.2016.10.029 
Researchers in Scotland conducted a pilot study to measure the immediate electrophysical and cognitive effects of heading, a routine soccer (football in the United Kingdom) activity. Heading has been associated with subconcussive head trauma.1,2 
Amateur soccer players were recruited from local soccer clubs and universities for inclusion in the study. Exclusion criteria included the following: history of head injury causing loss of consciousness, history of a neurologic condition, history of concussion within the past 12 months, family history of epilepsy, and the use of psychoactive or prescription drugs. Each participant underwent a heading protocol that consisted of heading a standard soccer ball at standardized speeds. The primary outcome measure was corticomotor inhibition, which was measured using transcranial magnetic stimulation. This measurement consisted of quantifying the cortical silent period after motor-evoked potentials were delivered to the appropriate primary motor complex. Secondary outcome measures included reaction time, paired associate learning, spatial working memory, attention task switching, and rapid visual processing, all of which were assessed based on the Cambridge Neuropsychological Test Automated Battery. Measurements were taken at baseline and immediately after, 24 hours after, 48 hours after, and 14 days after the heading protocol. 
After performing 20 headers, there was a significant increase (P=.049) in corticomotor inhibition in 14 of 19 participants (74%). Also, after the protocol, the participants had reduced spatial working memory and paired associated learning, demonstrating impaired short-term and long-term memory, respectively. However, all of these changes were proven to be transient. 
This study provides a starting point for quantifiably measuring the effects of subconcussive (and possibly concussive) effects. A crossover study with a control group and metabolic measurements would be the next step along these lines. If these measurement methods prove to be valid and clinically useful, studies using osteopathic manipulative treatment to reverse the effects of concussion, as measured by transcranial magnetic stimulation and the Cambridge Neuropsychological Test Automated Battery, would be of interest to osteopathic physicians in primary care and sports medicine. 
Patlak M, Joy EJ (eds). Is Soccer Bad for Children's Heads? Washington, DC: National Academy Press; 2017.
Pfister T, Pfister K, Hagel B, Ghali WA, Ronksley PE. The incidence of concussion in youth sports: a systematic review and meta-analysis. Br J Sports Med. 2016;50(5):292-297. doi: 10.1136/bjsports-2015-094978 [CrossRef] [PubMed]