Through the early part of medical school, the sheer number of things that can go wrong with the human body, together with the habit of lecturers to over-estimate the prevalence of the conditions in their field, leads to the unavoidable conclusion that you and everyone around you will die very soon. More formally, it’s known as hypochondriasis of medical students, and it can be rather serious. For most, it’s merely a passing phase of paranoia. Unfortunately, whilst the specific paranoia passes, paranoia in general remains, and for many, myself included, it moves to one’s children, who will undoubtedly suffer from severe congenital abnormalities, and despite being mute, blind and retarded, proceed to abuse all known substances, contract the whole spectrum of sexually transmitted diseases and then, somehow, enter a locked-in-state. In between, they will suffer the most severe injuries their chosen sport has to offer.
And given this fact, as future parent, one has to decide (as if your decision will make much of a difference) what sport your child will partake in. Some aren’t even under consideration! They can’t do anything involving the ocean, as they’ll be eaten by sharks, and in fact, any water sport is out of the question – they’ll drown. American football, rugby and ‘Aussie’ rules are a sure way of having a paralyzed child, whereas ice hockey is merely an interesting way of having their carotid severed. Field hockey has killed many a child, tennis and volleyball will lead to melanomas, cycling will see them either crashing horribly, becoming anorexic or abusing EPO. In fact, athletics and gymnastics suffer from similar problems. Golf is too expensive, as is anything involving animals. Cricket and basketball are, let’s face it, boring. To my mind, all that remains is squash (or, if you so choose, racquetball) and football (soccer). The former will be a nice individual sport, and the latter can be a good team sport. But, you may ask, won’t the constant heading in soccer definitely result brain damage??
This is a genuine concern, and an issue filled with controversy. Given the problems boxers run into, it was assumed that a long football career will have similar complications. A well struck shot can travel up to 100km/h, goal kicks or long balls ranges from around 70-80km/h, but the speed at which most headers occur rarely exceeds 65km/h. The forces involved are around half those often quoted as being necessary to result in concussion (22 Newton-seconds), are linear and as they are expected, can be better accommodated. So what’s the fuss? There’s an extensive body of literature that suggests that heading does result in reduced attention, ‘trauma-induced migraine’, impaired memory and concentration, and several other problems, and hence parental concern is justified.
Thankfully, much of the available literature is old, and severely flawed. In the past, balls weren’t waterproof, and became waterlogged, dramatically increasing the forces involved. Furthermore, these studies often assumed which positions would involve more heading, or used poorly matched controls. They seldom accounted for the most obvious confounders – football players have a higher risk of bumping their heads against other things, from players to posts, and among those studies, there was a high prevalence of alcohol and other substance abuse. As such, we have to turn to more recent, and preferable prospective studies.
A few articles published in the 90s included more thorough screening for confounders, and more detailed imaging and neuropsychological assessment. In one, the only predictor of poor test performance was a history of acute head injury, which shouldn’t occur much more frequently in non-professional soccer than in everyday life. Another compared amateur boxers, track athletes and soccer players, and didn’t find any signs of chronic brain injury among soccer players. It’s not surprising that one of the few that did suggest damage from heading was flawed – assumptions were made about heading frequency, alcohol usage was not factored in and acute brain injuries weren’t considered. Most reassuring was a study done on ‘top’ student players, whom had had around 15 seasons of competitive play, which failed to show any neurological deficits despite having suffered more concussions than controls.
But by far and away the most convincing evidence comes from a large prospective study that followed groups of men and women players over the course of a season. Baseline neuropsychological testing was done, and throughout the season the frequency and type of heading for each player was recorded. Despite heading being frequent (around 0.7 per minute) there were no ill effects from heading at all. Another smaller study of adolescent players, published earlier this year, which I can’t access, concluded that: “The current findings did not support a relationship between soccer heading and computerized neurocognitive performance and symptoms.” In keeping with this, recommendations by most governing bodies is that heading is safe. There is a caveat to this. Heading below the age of 10 does not appear to be safe, and whilst it rarely happens, it is worth pointing out. Soon thereafter, one should begin mastering the technique, which will be protective later when heading is unavoidable. What coaches might have learnt only from their coaches – that one should ‘strike through the ball’ – makes perfect sense in terms of physics and biomechanics.
So, if your child is going to play a team sport, it should be soccer, and they should be allowed to header the ball after the age of ten. I might still consider wrapping the posts and all the players’ elbows with foam, but perhaps I’m just being paranoid.
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