An exciting, tactical sport, football is also celebrated for its physicality. The aerial duels between forwards and central defenders for example, have been an exciting feature of British matches for many decades, with players like Alan Shearer and Harry Kane offering an important outlet and route to goal with their heading prowess.
With aerial battles often deciding the outcome of important matches, practising heading technique, timing and set-plays has been an important part of football training for many teams. However, behind the beautiful game lies a growing concern about the risks associated with repeated heading of a football, and head injuries in general.
HEADING – STILL A CONCERN IN THE MODERN GAME
There is a common misconception that early footballs, used in the late 19th and early 20th century, were heavier than modern footballs. Whilst modern footballs are made from synthetic materials that don’t absorb water as much as the old leather “casey” footballs; the dry weight of a football has not changed.
With the size and strength of players increasing over the decades, the speed and power the ball is kicked at by the average professional player has increased significantly too. This increased power, in turn elevates the impact-force a football can apply to a player’s head – including their brain.
In fact, prior to 1937 the dry weight of a football used in regulated matches had to be between 13-15oz, until law 2 was updated; stating that the ball had to be between 14-16oz. This means that there’s a good chance that the football used in the 1930 World Cup Final, was actually lighter than the ball used Qatar World Cup Final of 2022.
HEAD SAFE FOOTBALL
The concern regarding heading and head trauma, has led to the formation of the charity Head Safe Football, who are campaigning to raise awareness of the long term implications that repeated heading of footballs can cause.
Head Safe Football founder Dr Judith Gates, widow of former Middlesbrough player Bill Gates recently appeared on BBC Breakfast, to explain the dangers of heading a football repeatedly, and how it affected her late husband. The main goal of the organisation is to work with the football community, to raise awareness of the long term health concerns related to the repeated heading of footballs, and to reduce heading during training sessions.
HEAD TRAUMA AND FOOTBALL – WHAT WE KNOW
Recent research has highlighted an association between football and degenerative brain conditions including dementia and Chronic traumatic encephalopathy (CTE). A number of recent studies have found a correlation between football participation and degenerative brain conditions; although the exact mechanism and any direct causal link remains unestablished.
A number of in depth studies are currently taking place across the UK, and the latest research from the FIELD study (Football’s Influence on Lifelong Health and Dementia Risk) found that retired professional football players in Scotland, were 3.5 times more likely to die from a brain condition compared to men of a similar age and background.
Whilst the research is not conclusive, many scientists and researchers believe that heading a football repeatedly could be the main cause of brain health and cognitive functioning issues experienced by many football players after retirement.
For example, a study carried out in Manchester Metropolitan University demonstrated that heading ‘real footballs’ created a negative effect on brain and cognitive functioning, compared to a group of players who headed football in a virtual reality simulation. Research from Columbia University also found that football players who engaged in high levels of heading during matches and training sessions, demonstrated a decline in verbal learning performance; whilst those with no heading or head impacts showed an improvement.
In addition to heading a football, there are also concerns related to the rotational forces on the brain that may be incurred during impacts with other players and the ground during matches and training sessions. In fact, it is not yet clear if heading a football or other impacts during football matches and training, are the primary cause of an increased risk of degenerative brain conditions in later life.
FOOTBALL AND HEAD TRAUMA RESEARCH
The table below summarises some of the data and information gathered by researchers regarding football and a potential link with degenerative brain conditions including CTE and dementia.
| Football & Head Trauma Research | ||
|---|---|---|
| Category | Statistic | Source |
| Cognitive Impairment | 3.53-fold risk of cognitive impairment for players heading >15 times/match | JAMA Network Open |
| Cognitive Impairment | 3.40-fold risk of cognitive impairment for players heading >15 times/training | Alzheimer’s Research UK |
| Neurodegenerative Diseases | 3.5 times higher risk of neurodegenerative diseases in former footballers | BBC News |
| Neurodegenerative Diseases | 4-5 times higher risk of neurodegenerative diseases for outfield players | Epidemiological studies |
| Chronic Traumatic Encephalopathy (CTE) | CTE cases in autopsy studies of former football players | UCL News |
| Neuropsychological Deficits | Former players impairments in attention, concentration & memory | Science Direct |
| Cerebral Atrophy | 1/3 of former players show cerebral atrophy | Frontiers in Neurology |
| Immediate Effects of Heading | Immediate alteration in brain function & cognitive task performance | Manchester Metropolitan Study |
| Dementia Risk | Ex-footballers 3.5 times more likely to develop dementia | The Guardian |
| Risk Among Defenders | Central defenders have the highest dementia risk | Science Direct |
BRAIN DEVELOPMENT FROM CHILD TO ADULT
Whilst head trauma and heading a football may cause damage to players at any age, it seems likely that children could be more susceptible to significant and long term damage from heading footballs.
Karen Odell-Barber, CEO of Neurologics explains that under the age of 12, children are particularly susceptible to the damaging side effects of long-term heading of footballs. Caution is still required when coaching and teaching children aged 13-16, as the risk of developing degenerative brain issues in later life is not eradicated at any age.
“Their developing brains are more susceptible to trauma due to less developed neck muscles, thinner skulls, and ongoing brain development (also known as pruning). The brain is still forming neural pathways during these years, and injuries at this stage can have more profound long-term effects. Teens may be slightly more resilient than younger children, but they are still at a higher risk compared to adults.”
| Aspect | Developing/Child Brain | Adult Brain |
|---|---|---|
| Brain Size | Reaches ~90% of adult size by age 6; structural & functional growth ongoing. | Fully developed; structural and functional systems are stable. |
| Myelination | Incomplete nerve fibres lack full insulation, making neural pathways more vulnerable. | Fully myelinated; nerve fibres are well-insulated, providing better protection. |
| Blood-Brain Barrier | Less developed; greater susceptibility to inflammation following trauma. | Fully developed; offers more robust protection from inflammation. |
| Skull Properties | Thinner, softer, and more flexible; bones are not fully fused. Less protection against impacts. | Thicker, rigid, and fully fused; better protection against direct impacts. |
| Fontanelles and Sutures | Present in infants; gaps & soft spots reduce skull rigidity. | Fully fused; no gaps, providing a solid protective structure. |
| Head-to-Body Ratio | Larger relative to the body, increasing the likelihood of head injuries. | Smaller relative to the body, reducing the relative risk of head trauma. |
| Neuroplasticity | High plasticity; adaptable but more susceptible to trauma during developmental periods. | Lower plasticity; less adaptable, but neural pathways are more established and less vulnerable. |
| Concussion Recovery | Slower recovery times; symptoms like headaches & cognitive impairments persist longer. | Faster recovery; symptoms tend to resolve more quickly. |
MANAGING AND PREVENTING HEAD INJURIES IN FOOTBALL
Whilst football offers a wide range of benefits to children and adults, from physical fitness to the development of social skills & teamwork, it is important to acknowledge the dangers associated with head injuries and regular heading of footballs.
As outlined above, children’s brains tend to be more vulnerable for a variety of reasons when compared to adult football players. With this in mind, safety and long term wellbeing of players should be prioritised by coaches and teachers.
PREVENTITIVE MEASURES
To protect children, the English FA has introduced guidelines in relation to the heading of footballs. Heading is to be phased out of grassroots football matches from the Under 7 to Under 11 age ranges. If a player deliberately heads the football during a regulated match, the opposing team is awarded an indirect free kick.
The rule covers all leagues and competitions including affiliated schools. The FA have also introduced guidelines to restrict the amount of heading undertaken by youth players as outlined in the table below:
English FA Heading Guidelines During Training Sessions
| Age Group | Heading Frequency |
|---|---|
| U7, U8, U9, U10, U11 | 0 |
| U12 | Maximum of 1 session per month with 5 headers |
| U13 | Maximum of 1 session per week with 5 headers |
| U14, U15, U16, U18 | Maximum of 1 session per week with 10 headers |
EDUCATION INITIATIVES
In accordance with the ongoing education of football coaches, England Football has introduced a free online course regarding concussion guidelines. The FA has also integrated concussion awareness and management into its coaching courses, to ensure that football coaches at all levels are aware of the dangers and implications associated with concussion and repeated heading of footballs.
Whilst the risks associated with heading can’t be removed, we have taken steps to try and reduce the potential risks and raise awareness of the dangers of excessive heading by designing and producing the first football to feature a prominent warning on the ball.
The FORZA Lightweight Heading Football has a warning sign and the text “DO NOT HEAD BALL EXCESSIVELY” clearly printed on the front of the ball, something that captured the attention of Dr Willie Stewart, professor of psychology and Neuroscience at the University of Glasgow, who praised the ball in an interview on BBC 5 Live.
To reduce the negative impact of heading footballs, the FORZA ball is 40% lighter and softer than standard footballs. During the BBC 5 Live interview Willie stated “I think that it’s a good message to not head the ball excessively. It’s slightly ironic that it’s on a heading practice ball but it’s a start and it would be nice to see it on other balls.”
Launched earlier this year after four months of meticulous development, the ball is already being used by several professional clubs including Aston Villa, Leeds United, Aberdeen and Stockport County.
IDENTIFYING CONCUSSION
Recognising that a player has suffered a concussion is the first step in preventing further damage. Physical symptoms include dizziness, headache, nausea and sensitivity to light and noise. A player with concussion may also have cognitive and emotional symptoms including confusion, memory loss and irritability.
Following a concussion, the player in question may also suffer from sleep disturbances, or find they are falling asleep or sleeping more than usual.
IMMEDIATE ACTION
Ideally a qualified medic would conduct an analysis of a player suspected of having concussion. If there is any doubt about a player, he or she should sit out of the rest of the match.
Preventing head injuries and long term cognitive issues and diseases requires a comprehensive approach that includes education, rule adaptation and enforcement, preventative measures and appropriate first aid and follow up care when required.
With necessary precautions in place, the sport of football can remain an important and enjoyable outlet for players of all ages.
By: Andrew Griffiths