Heading and risk of injury situations for the head in professional German football: a video analysis of over 150,000 headers in 110,000 match minutes

ABSTRACT

To provide detailed epidemiological data on situations with a propensity of head injuries due to heading in professional football. In a prospective cohort study including the four highest professional football leagues in Germany, headers carried out in 1244 official matches and critical situations (CI) with a potential risk for injuries over one season were assessed by video analysis and a standardised video protocol. Results: 154,766 headers in 111,960 match minutes were recorded (1.4 headings/min). Video analysis showed a mean of 6.2 headers per field player and match (SD: 2,9; min: 0; max: 19) in the entire study population with a peak in the third league (7.1 per player and match). Headers were predominantly carried out with the forehead (78.5%), and nearly two-thirds occurred during defence (64.3%). 49.9% of all headers occurred during tackling, of which 78.3% involved body contact with an opponent. Video analysis yielded 848 CI. 74.5% of all critical incidents occurred during heading duels as a part of tackling (odds ratio: 3.6, 95%-CI: 2.4–5.2), and 99.4% involved body contact (odds ratio: 5.9, 95%-CI: 2,8–12,7). This study is the first to provide detailed epidemiological data on heading and critical incidences with high risk for head injuries in professional football. Heading duels bear a high risk of head injury and thus represent a key target for prevention strategies. The impacts of headers should be critically investigated regarding neurological consequences in further studies, by including the mean heading rate per mal field player and match.

KEYWORDS:

• Heading
• header
• head injury
• concussion
• football
• soccer
• video analysis

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the University of Regensburg (no. 18-846-101).

Informed consent

Not necessary, as study was performed on video material in which no patient-specific data was obtained.

References

• Anderson TE, Arnason A, Engebretsen L, Bahr R. 2004. Mechanisms of head. Injuries in elite football. Br J Sport Med. 38(6):690–696. doi:10.1136/bjsm.2003.009357.
   PubMed Web of Science ®Google Scholar
• Beaudouin F, Aus der Fünten K, Tröß T, Reinsberger C, Meyer T. 2018 Jan 19. Match situations leading to head injuries in professional male football (Soccer) - a video-based analysis over 12 years. Clin J Sport Med. doi:10.1097/JSM.0000000000000572. [Epub ahead of print].
   Web of Science ®Google Scholar
• Beaudouin F, Aus der Fünten K, Tröß T, Reinsberger C, Meyer T. 2019. Head injuries in professional mal football (soccer) over 13 years: 29% lower incidence rates after a rule change (red card). Br J Sport Med. 53(15):948–952. doi:10.1136/bjsports-2016-097217. Epub 2017 Jun 23.
   PubMed Web of Science ®Google Scholar
• Bjørneboe J, Bahr R, Einar Andersen T. 2014. Video analysis of situations with a high-risk for injury in Norwegian male professional football; a. comparison between 2000 and 2010. Br J Sports Med. 48(9):774–778. doi:10.1136/bjsports-2012-091856. Epub 2013 Jan 11.
   PubMed Web of Science ®Google Scholar
• Broglio SP, Vagnozzi R, Sabin M, Signoretti S, Tavazzi B, Lazzarino G. 2010. Concussionb occurrence and knowledge initial football (soccer). J Sports Sci Med. 9(3):418–430. eCollection2010.
   PubMed Web of Science ®Google Scholar
• Di Virgilio TG, Hunter A, Wilson L, Stewart W, Goodall S, Howatson G, Donaldson DI, Ietswaart M. 2016. Evidence for acute electrophysiological and cognitive changes following routine soccer heading. EBioMedicine. 13:66–71. Epub 2016 Oct 23. doi:10.1016/j.ebiom.2016.10.029.
   PubMed Web of Science ®Google Scholar
• Dick R, Putukian M, Agel J, Evans TA, Marshall SW. 2007. Descriptive epidemiology of collegiate women’s soccer injuries: national collegiate athletic association injury surveillance system. 1988-1989 through. 2002-2003. J Athl Train. 42(2):278–285.
   PubMed Web of Science ®Google Scholar
• Dorminy M, Hoogeveen A, Tierney RT, Higgin M, McDevitt JK, Kretzschmar J. 2015. Effect of soccer heading ball speed on S100B, sideline concussion assessments and head impact kinematics. Brain Inj. 29(10):1158–1164. doi:10.3109/02699052.2015.1035324. Epub 2015 May 25.
   PubMed Web of Science ®Google Scholar
• Emery CA, Black AM, Kostad A, Martinez G, Nettel-Aguirre A, Engebretsen L, Johnston K, Kissick J, Maddocks D, Tator C, et al. 2017. What strategies. can be used to effectively reduce the risk of concussion in. sport? A systematic review. Br J Sports Med. 51(12):978–984. 10.1136/bjsports-2016-097425. Epub 2017 Mar 2.
   PubMed Web of Science ®Google Scholar
• Haran FJ, Thierney R, Wright WG, Keshner E, Silter M. 2013. Acute changes in postural control after soccer heading. Int J Sports Med. 34(4):350–354. doi:10.1055/s-0032-1304647. Epub 2012 Nov 22.
   PubMed Web of Science ®Google Scholar
• Helmich I, Saluja RS, Lausberg H, Kempe M, Furley P, Berger A, Chen JK, Ptito A. 2015. Persistent postconcussive symptoms are accompanied by decreased functional brain oxygenation. J Neuropsychiatry Clin Neurosci. 27(4):287–298. doi:10.1176/aapi.nbeurosych.14100276. Epub 2015 Mar 24.
   PubMed Web of Science ®Google Scholar
• Jansen P, Lehmann J. 2017. Investigating cognitive performance deficits in male and female soccer players after a 4-week heading-training programme: a controlled study. Brain Impair. 4:1–8. doi:10.102017/BrImp.2017.4.
   Google Scholar
• Koerte IK, Ertl-Wagner B, Reiser M, Zafonte R, Shenton ME. 2012. White matter integrity in the brains of professional soccer players without a symptomatic concussion. JAMA. 308(18):1859–1861. doi:10.1001/jama.2012.13735.
   PubMed Web of Science ®Google Scholar
• Koerte IK, Lin AP, Muehlmann M, Merugmala S, Liao H, Starr T, Kaufmann D, Mayinger M, Steffinger D, Fisch B, et al. 2015. Altered neurochemistry in former professional soccer player without a history of concussion. J Neurotrauma. 32(17):1287–1293. doi:10.1089/neu.2014.3715. Epub 2015 May 14.
   PubMed Web of Science ®Google Scholar
• Kontos AP, Braithwaite R, Chrisman SPD, McAllister-Deitrick J, Symington L, Reeves VL, Collins MW. 2017. Systematic meta-analysis of the effects of football heading. Br J Sport Med. 51(15):1118–1124. doi:10.1136/bjsports-2016-096276. Epub 2016 Dec 21.
   PubMed Web of Science ®Google Scholar
• Krutsch V, Gesslein M, Loose O, Weber J, Nerlich M, Gaensslein A, Bonkowsky V, Krutsch W. 2018. Injury mechanism of midfacial fractures in football causes in over 40 % typical neurological symptoms of minor brain injuries. Knee Surg Sports Traumatol Arthrosc. 26(4):1295–1302. doi:10.1007/s00167-017-4431-z. Epub 2017 Feb 8.
   PubMed Web of Science ®Google Scholar
• Ling H, Morris HR, Neal JW, Lees AJ, Hardy J, Holton JL, Revesz T, Williams DD. 2017. Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players. Acta Neuropathol. 133(3):337–352. doi:10.1007/s00401-017-1680-3. Epub 2017 Feb 15.
   PubMed Web of Science ®Google Scholar
• Lipton ML, Kim N, Zimmerman ME, Kim M, Stewart WF, Branch CA, Lipton RB. 2013. Soccer heading is associated with white matter microstructural and cognitive abnormalities. Radiology. 268(3):850–857. doi:10.1148/radiol.13130545. Epub 2013 Jun 11.
   PubMed Web of Science ®Google Scholar
• Mackay DF, Russell ER, Stewart K, MacLean JA, Pell JP, Stewart W. 2019. Neurodegenerative disease mortality among former professional soccer players. N Engl J Med. 381(19):1801–1808. doi:10.1056/NEJMoa1908483. Epub 2019 Oct 21.
   PubMed Web of Science ®Google Scholar
• Maher ME, Hutchinson M, Cusimano M, Comper P, Schweizer TA. 2014. Concussions and heading in soccer: a review of the evidence of incidence, mechanisms, biomarkers and neurocognitive outcomes. Brain Inj. 28(3):271–285. doi:10.3109/02699052.2013.865269. Epub 2014 Jan 29.
   PubMed Web of Science ®Google Scholar
• Matser EJ. 1999. Neuropsychological impairment in amateur soccer players. JAMA. 282(10):971–973. doi:10.1001/jama.282.10.971.
   PubMed Web of Science ®Google Scholar
• Naunheim RS, Bayly PV, Standeven J, Neubauer JS, Lewis LM, Genin GM. 2003. Linear and angular head accelerations during heading of a soccer ball. Med Sci Sports Exerc. 35(8):1406–1412. doi:10.1249/01.MSS.0000078933.84527.AE.
   PubMed Web of Science ®Google Scholar
• Patricios J, Fuller GW, Ellenbogen R, Herring S, Kutcher JS, Loosemore M, Makdissi M, McCrea M, Putukian M, Schneider KJ. 2017. What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion? A systematic review. Br J Sports Med. 51(11):888–894. doi:10.1136/bjsports-2016-097441. Epub 2017 Mar 7.
   PubMed Web of Science ®Google Scholar
• Putukian M, Echemendia RJ, Mackin S. 2000. The acute neuropsychological effects of heading in soccer: a pilot study. Clin J Sport Med. 10(2):104–109. doi:10.1097/00042752-200004000-00004.
   PubMed Web of Science ®Google Scholar
• Rieder C, Jansen P. 2011. No neuropsychological consequence in male and female soccer players after a short heading training. Arch Clin Neuropsychol. 26(7):583–591. doi:10.1093/arclin/acr055. Epub 2011 Jul 12.
   PubMed Web of Science ®Google Scholar
• Rodrigues AC, Lasmar RP, Caramelli P. 2016. Effects of soccer heading on brain structure and function. Front Neurol. 7:38. doi:10.3389/fneur.2016.00038. eCollection 2016.
   PubMed Web of Science ®Google Scholar
• Rubin TG, Catenaccio E, Fleyscher R, Hunter LE, Lubin N, Stewart WF, Kim M, Lipton RB, Lipton ML. 2018. MRI-defined white matter microstructural alteration associated with soccer heading is more extensive in woman than men. Radiology. 289(2):478–486. doi:10.1148/radiol.2018180217. Epub 2018 Jul 31.
   PubMed Web of Science ®Google Scholar
• Shewchenko N. 2005. Heading in football. Part 2: biomechanics of ball heading and head response. Br J Sports Med. 39(suppl I):i26–i32. doi:10.1136/bjsm.2005.019042.
   PubMedGoogle Scholar
• Spiotta AM, Bartsch AJ, Benzel EC. 2012. Heading in soccer: dangerous play? Neurosurgery. 70(1):1–11. discussion. 11. doi:10.1227/NEU.0b013e31823021b2.
   PubMed Web of Science ®Google Scholar
• Stephens R, Rutherford A, Potter D, Fernie G. 2010. Neuropsychological consequence of soccer play in adolescent U.K. School team soccer players. J Neuropsychiatry Clin Neurosci. 22(3):295–303. doi:10.1176/appi.neuropsych.22.3.295.
   PubMed Web of Science ®Google Scholar
• Strauma-Naesheim TM, Andersen TE, Dvorak J, Bahr R. 2005. Effect of heading exposure and previous concussions on neuropsychological performance among Norwegian elite footballers. Br J Sport Med. 39(Suppl I):i70–i77. doi:10.1136/bjsm.2005.019646.
   PubMedGoogle Scholar
• Tarnutzer AA, Straumann D, Brugger P, Feddermann-Demont N. 2017. Persistent effects of playing football and associated (subconcussive) head trauma on brain structure and function: a systematic review of the literature. Br J Sports Med. 51(22):1592–1604. Epub 2016 Nov 4. Erratum in: Br J Sports Med. 2018 M. ar 24. doi:10.1136/bjsports-2016-096593.
   PubMed Web of Science ®Google Scholar
• White PE, Newton JD, Makdissi M, Sullivan SJ, Davis G, McCrory P, Donaldson A, Ewing MT, Finch CF. 2014. Knowledge about sports-related concussion: is the message getting through coaches and trainers? Br J Sports Med. 48(2):119–124. doi:10.1136/bjsports-2013-092785. Epub 2013 Sep 16.
   PubMed Web of Science ®Google Scholar
• Williams JM, Langdon JL, McMillan JL, Buckley TA. 2016. English professional. football players concussion knowledge and attitude. J Sport Health Sci. 5(2):197–204. doi:10.1016/j.jshs.2015.01.009. Epub 2015 May 23.
   PubMed Web of Science ®Google Scholar

Additional information

Funding

Study was funded monetarily by the German Federal Institute for Sports Science.