Neuropsychological consequence of soccer play in adolescent U.K. school team soccer players

To assess mild head injury effects in adolescent soccer players, neuropsychological performance across school team soccer players, rugby players and noncontact sport players was assessed in a quasi-experimental cross-sectional design. One hundred eighty-five males were tested (ages 13—16; response rate 55%) and 86 contributed data to the analyses after exclusion for recent concussion and overlapping sports participation. Soccer players showed lower premorbid intellectual functioning, but neither soccer players nor rugby players showed neuropsychological decrement compared with noncontact sport players. Cumulative heading did not predict neuropsychological performance. While no specific attribute of soccer was linked with neuropsychological impairment, head injury predicted reduced attention for all participants. Abstract Teaser
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ssociation Football (soccer) is a massive participatory sport with 265 million players1 worldwide. An emerging view in the early 2000s was that head trauma sustained playing soccer could cumulate to cause neuropsychological impairment. A distinction was drawn between concussion, usually due to unintentional impacts with other players,2 and subconcussive head trauma,3,4 usually due to "heading"—intentionally playing the ball using the head. However, this view was recently discounted due to methodological problems including inappropriate control groups, questionable representativeness of study samples, overreliance on self-report to quantify soccer heading, failure to separate head injury from heading effects, and multiple statistical testing with inadequate control of type I error inflation.5 Several recent adult neuropsychological studies6—12 found no decrements related to soccer heading.

Forty-five percent of U.K. males ages 16—19 years old playing soccer monthly13 shows soccer’s popularity among young people. However, besides our preliminary report,11 no neuropsychological investigations of head trauma sustained by adolescent soccer players appear to exist. In the present study we compare neuropsychological test scores of school team soccer players, rugby players and noncontact sport players. Concussive head injury data were collected by self-report. Our definition of concussion included head injuries without loss of consciousness.14 Headers were assumed to be subconcussive head injuries, defined as any blow to the head without overt concussive symptoms. Focusing on cumulative heading effects necessitated controlling for acute and chronic concussive head injury effects. The former was achieved by excluding participants reporting concussion within 3 months of testing.3,15—17 The latter was achieved through statistical control of concussions sustained.

Three hypotheses were tested: (a) that the number of head injuries would predict poorer neuropsychological performance in all participants; (b) due to the cumulative subconcussive forces arising from regular soccer heading, that soccer players’ neuropsychological performance would be poorer than rugby and noncontact sport players after controlling for head injuries; and (c) that the total amount of soccer heading would predict soccer players’ neuropsychological performance.