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Heading and Injuries in Youth Soccer

Nicholas Pimlott MD, CCFP
Medical Advisor and Coach, Power Player Academy and
Power Soccer School of Excellence
Published in Inside Soccer Magazine April 2006

In the last year or more there has been a lot of media attention on the relationship between heading in soccer and the risk of both short-term and long-term injuries. Of particular concern is the relationship between heading and the risk of concussion, and long-term consequences such as cognitive impairment (memory, concentration and other related problems). Many parents are especially concerned that youth players might suffer serious consequences from heading the ball. They want to know if it is safe for children to head the ball, at what age should they start to head the ball and what is the best technique for heading.

Although the final answers to these questions are not yet available, coaches and parents have some reassuring research information and some clear recommendations from experts in the field to guide them. Soccer is unique amongst competitive team sports in that it involves the purposeful, unprotected use of the head to direct the ball.  Researchers estimate that older players on average head the ball between 5 and 8 times per game and 7 and 9 times per practice. Youth players may head the ball less. Heading occurs least frequently in indoor soccer.

There are four main types of heading that occur in the game – the defensive header, used to clear the ball from the defensive area; the glancing header, used as a “pass” to advance the ball; the flick-on header which uses the back of the head to direct the ball; and the dramatic diving header, used to attack or to score a goal. All require the development of good technique.

Most of the concern about concussions and cognitive impairment from heading came from studies done in the 1990s using former professional players as research subjects. Most of these studies were relatively small and not well-designed to answer the question.  More recent, well-designed studies have failed to show that heading causes significant short-term changes in brain function or structure. However, these studies have involved collegiate or adult players, not children.

Children may be at greater risk of problems from heading because of their immature anatomy, larger heads but thinner skulls, weaker neck muscle and poor technique. The Canadian Academy of Sports Medicine (CASM) has taken these factors in to account in their 2004 position paper on heading and concussions in soccer.  To reduce the risk of short and long-term injury from heading in children, CASM recommends:

*    Appropriate ball size (U10, size 3; U14, size 4, 15 and up, size 5)
*    Proper inflation (8-10 PSI)
*    Decreased inflation when first learning
*    Modern synthetic coated ball, ensure good condition
*    Finally, many professional coaches recommend the following:

*    Appropriate age (10 and up)
*    Teach proper technique
*    Do not force players to head the ball
*    Limit amount of time spent on heading
*    Progressive instruction

Heading is an important and dramatic element of the game of soccer. By teaching young players proper technique and using age appropriate balls coaches can reduce the risk of injury in youth players while still providing them with this important tool of the game.