Neurocognitive function following sub-concussive head impacts in Football

Although there are concerns about the neurological risks of heading in football, research has produced mixed findings. Some studies link frequent heading to declines in memory and executive function, while others report little to no effect. These inconsistencies may reflect differences in heading exposure across age groups, sexes, and playing levels.

Moreover, much of the existing work relies on retrospective testing long after heading has occurred, making it vulnerable to recall bias. Even in recent prospective studies, there are equivocal findings regarding the short‑term effects of heading on aspects of working memory and learning.

Our project sought to add to understanding by carefully controlling exposure to heading, using 20 consecutive headers with a soft (8.8 psi), hard (16.2 psi), or control football, and by performing a comprehensive assessment of cognitive abilities that are essential to daily living (working memory, visuomotor skills, and processing speed).

Key findings were that consecutive heading negatively influenced an indicator of suspected concussion (King-Devick), as well as working memory. These findings contribute to the growing debate surrounding heading safety.

As a result of increasing concern about the potential cognitive effects of heading in soccer, we examine the immediate impact of repeated headers on cognitive performance. Thirty recreational male players were assigned to complete 20 consecutive headers with either a soft ball, a hard ball, or no ball.

Before and after heading, they completed a series of neuropsychological tests, including the King‑Devick, Trail Making, and digit and spatial span tasks.

Irrespective of ball type, heading altered performance of several of the tests. Additional reductions in spatial span backward and digit span (forward and backward) were found only in the hard‑ball condition.

These results indicate that even outside normal match play, heading can immediately impair a measure commonly used in concussion screening and reduce aspects of working memory important for everyday functioning. The findings add to ongoing discussions about the safety of repetitive heading in soccer.

Read more about the Immediate effects of an acute bout of repeated soccer heading

Concerns about the cognitive risks of heading in youth soccer have grown, prompting the English FA to introduce limits on heading in training. However, it is unclear how well these guidelines are understood and applied by the coaches responsible for implementing them.

To investigate this, we surveyed grassroots youth coaches across Local County FAs about their heading practices, perceptions of safety, and awareness and compliance with the guidelines. Most coaches reported rarely (21%) or never (73%) practising heading, and generally viewed it as moderately safe.

Although many were only somewhat aware of the guidelines (43%), they reported high perceived (92%) and actual (87%) compliance. Views on whether the guidelines had changed practice were mixed, but most coaches considered them safe (86%) and appropriate (81%).

Potential barriers were only weakly endorsed and mainly related to match‑play rules. Overall, while the guidelines appear feasible to implement, gaps remain between recommended safety practices and coaches’ knowledge.

Read more on the survey on the English FA heading guidelines