Soccer Heading Puts More Women at Risk for Brain Injury Than Men

Highlights:

Women soccer players may be at an increased risk of suffering head-impact related brain injury
Heading, or hitting the soccer ball with the head is an important feature of soccer
Impacts due to heading the ball have been found to result in abnormalities in the white matter of the brain similar to that seen in persons with traumatic brain injury

Brain injuries due to the repeated heading of the soccer ball more likely to affect women soccer players than men, finds a recent study that appears in the journal Radiology.

Soccer is the most popular competitive sport globally, and more and more women are participating in this sport. There are over 30 million women soccer players worldwide, according to a Fédération Internationale de Football Association (FIFA) 2014 Women's Football survey.

With the huge popularity of soccer across the world, and more women starting to play the game, the authors of the study wanted to examine whether women players react differently to the repeated heading of the ball over a period of time.

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‘Gender-specific guidelines and recommendations may become necessary in future to ensure safety of women soccer players.’

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"In general, men do a lot more heading than women, but we wanted to specifically examine if men and women fare similarly or differently with a similar amount of exposure to repeated impacts to the head," said the study's lead author, Michael L. Lipton, M.D., Ph.D., professor of radiology at the Gruss Magnetic Resonance Research Center at the Albert Einstein College of Medicine and medical director of MRI at Montefiore Medical Center in New York City.

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Details of the Study

The participants of the study included 49 men and 49 women--with a mean age of 25.8 years and similar demographic (age, race, social background) characteristics.
All participants had been playing soccer for several years and had been exposed to the repeated heading of the ball, more frequently during the 12 months prior to this study.
On an average, there were 487 headers reported per year for the men and 469 per year for the women
The study team used diffusion tensor imaging (DTI), an advanced MRI (magnetic resonance imaging) method, to analyze microscopic changes in the white matter of the brain in the study participants

In DTI, a parameter called fractional anisotropy (FA) is measured, which describes the movement of water molecules in the brain. In a healthy brain’s white matter, the direction of water movement is fairly uniform and high FA values are obtained. When the movement of water molecules is more unpredictable and random, FA values decrease.

"A decline in FA is an indicator of changes in the white matter microstructure that may be indicative of inflammation or loss of neurons, for example," said Dr. Lipton.

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Comparison between Male and Female Soccer Players

The FA values of the male and female soccer players were compared using diffusion tensor imaging technique. The key findings were as follows

Both men and women soccer players showed lower FA values due to the repeated heading of the ball
Women players exhibited lower FA levels (five times more microscopic abnormalities in the white matter of the brain) for similar amounts of exposure to headers compared to male soccer players
The team also identified specific regions of the brain where repeated heading was associated with decreased FA values - three brain regions in men and eight brain regions in women.

Thus, the findings of the study suggest that women may be more susceptible to the cumulative effects of heading and associated brain injury with the risk of development of gradual deterioration of brain function later in life.

"The important message from these findings is that there are individuals who are going to be more sensitive to heading than others," said Dr. Lipton. "Our study provides preliminary support that women are more sensitive to these types of head impacts at the level of brain tissue microstructure."

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Repeated Heading Leads to Brain Injury

Several previous studies have shown that repeated heading of the soccer ball by players over a long period of time could injure the brain. Post-mortem examination of some of the brains showed changes of traumatic encephalopathy (CTE).

CTE is a progressive brain condition in which there is an accumulation of abnormal protein clumps in the brain cells (neurons) damaging them and causing neuronal death. Brain damage in CTE can cause depression, memory loss, dementia and has also been found to occur in other contact sports such as boxing as well as military veterans in which repeated head trauma occurs.

In conclusion, the authors feel that more studies may be needed in the future to validate the findings of the current study and to characterize the nature of traumatic brain injuries related to soccer heading. Although the findings of the current study may be insufficient to establish gender-specific safety guidelines now, the authors hope that their study lends support to the idea of drafting gender-specific safety guidelines sometime in the future.

Source-Medindia