Advanced Imaging Shows Heading Soccer Ball May Lead to Brain Injury

CHICAGO - Heading a soccer ball may cause serious brain injury visible through an advanced magnetic resonance technique, according to a new study presented Tuesday at RSNA.

A study from the Albert Einstein College of Medicine on amateur soccer players revealed that those who practiced heading - a common maneuver where the player drives the ball with a forceful blow from his head - the most often had brain abnormalities on par with traumatic brain injury patients.

Michael Lipton, MD, and colleagues used diffusion tensor imaging (DTI), an advanced magnetic resonance technique, to study changes in the brain's white matter of 32 amateur soccer players (average age 30.8 years). DTI measures the direction of water movement along axons, called fractional anisotropy (FA).

In normal white matter, water follows “a very unidirectional, uniform diffusion,” indicating high anisotropy, said Lipton at the RSNA meeting. “Everybody here, hopefully, has very high levels of anisotropy,” he added to the audience.

However, random water movement, or low FA, is associated with cognitive impairment in traumatic brain injury patients. Lipton and colleagues found that the players with the highest frequency headings had significantly lower FA than players with lower frequency of headings.

The players' frequency of heading ranged from zero to 5,000 headings per year. Further analysis revealed a threshold level – players who practiced a frequency above 1,000 to 1,500 headings per year showed significant decrease in FA, while players below that level did not.

“The implications of this finding is that the lower FA indicates that there is something missing or wrong with the white matter in that location, which is consistent with what we've seen in people with concussions or minor brain injuries,” Lipton said. These minor injuries can escalate over time.

“We have to realize that even very small scale injury can have major functional repercussions because you disrupt not just that one small spot in the brain, but a large, interconnected network,” of neurons in the brain, Lipton said.

The study authors warned against the repetitive heading common during soccer practice sessions. As Lipton explained, small injuries occurring rapidly within a short period of time were more likely to lead to serious damage to the brain then the same amount spread over a longer period of time.

Lipton emphasized that the study is not calling for a ban on heading. The bulk of heading occurs in practice, and Lipton suggested reducing the amount of heading in practice safely below the threshold level.