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Fresh research unveiled this week at the annual meeting of the Radiological Society of North America (RSNA) establishes a connection between soccer heading, where players strike the ball with their heads, and a noticeable decline in brain microstructure and function over a span of two years.
Senior author Dr. Michael L. Lipton, M.D., Ph.D., professor of radiology at Columbia University’s Vagelos College of Physicians and Surgeons and affiliate professor of biomedical engineering at Columbia University, highlighted the global worry over brain injuries, especially regarding the potential long-term effects of soccer heading on brain health. Dr. Lipton emphasized the concern about changes during young adulthood potentially posing risks for neurodegeneration and dementia in later life.
While previous studies focused on the immediate impact of soccer heading on the brain, this new research tracked brain changes over a two-year period.
The study involved 148 young adult amateur soccer players (average age 27, including 26% women). Researchers devised a specialized questionnaire to gauge how frequently these players headed the soccer ball.
“At the outset, there wasn’t a standardized way to measure head impacts in players,” noted Dr. Lipton. “So, we developed a structured questionnaire, validated through multiple studies.”
The questionnaire consisted of inquiries about playing frequency, practice routines, heading frequency, and specific game scenarios. Heading exposure over two years was classified as low, moderate, or high.
Players underwent assessments for verbal learning and memory, as well as diffusion tensor imaging (DTI), an MRI technique, upon enrollment and again two years later. DTI tracks the brain’s microstructure by monitoring the movement of water molecules through the tissue.
Compared to initial test results, the high-heading group (over 1,500 headers in two years) displayed increased diffusivity in frontal white matter regions and reduced orientation dispersion index (indicating less brain organization) in certain areas after two years of heading exposure. The analysis factored in variables such as age, sex, education, and concussion history.
“Our analysis revealed that extensive heading over this period correlated with brain microstructure changes akin to those seen in mild traumatic brain injuries,” stated Dr. Lipton. “Moreover, high levels of heading were linked to a decline in verbal learning performance. This study marks the first to demonstrate long-term structural brain changes associated with sub-concussive head impacts in soccer.”
Dr. Lipton and colleagues also presented another study utilizing DTI to explore the relationship between repetitive soccer heading and verbal learning performance. Analyzing data from 353 amateur players (ages 18-53, with 27% women) over 12 months, this research employed a novel technique, using DTI parameters to evaluate the interface between the brain’s gray and white matter near the skull.
“Our new approach tackles a vulnerable brain region often overlooked due to limitations in existing methods,” Dr. Lipton explained. “Applying this technique could reveal the extent of injury from repetitive heading, concussion, and traumatic brain injury in ways previously unachievable.”
The study found that the typically well-defined gray matter-white matter interface was dulled in proportion to high repetitive head impact exposure.
“We used DTI to gauge the sharpness of the transition between gray and white matter,” Dr. Lipton elaborated. “In various brain conditions, the usual clear distinction between these tissues becomes more gradual or blurred.”
He suggested that the integrity of the gray matter-white matter interface might influence the link between repetitive head impacts and cognitive performance.
“These findings contribute to the ongoing debate on whether soccer heading is innocuous or poses significant risks,” he concluded.
The co-authors on the studies include several researchers collaborating on these investigations, bringing expertise from various disciplines.
