Soccer Heading Is Associated with White Matter Microstructural and Cognitive Abnormalities

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Our current study results suggest that a nonlinear relationship exists between exposure to heading during the previous year, as measured by the Einstein Heading Questionnaire, and both abnormal white matter microstructure and poorer neurocognitive performance on a memory test.


To investigate the association of soccer heading with subclinical evidence of traumatic brain injury.

Materials and Methods

With institutional review board approval and compliance with HIPAA guidelines, 37 amateur soccer players (mean age, 30.9 years; 78% [29] men, 22% [eight] women) gave written informed consent and completed a questionnaire to quantify heading in the prior 12 months and lifetime concussions. Diffusion-tensor magnetic resonance (MR) imaging at 3.0 T was performed (32 directions; b value, 800 sec/mm2; 2 × 2 × 2-mm voxels). Cognitive function was measured by using a computerized battery of tests. Voxelwise linear regression (heading vs fractional anisotropy [FA]) was applied to identify significant regional associations. FA at each location and cognition were tested for a nonlinear relationship to heading by using an inverse logit model that incorporated demographic covariates and history of concussion.


Participants had headed 32–5400 times (median, 432 times) over the previous year. Heading was associated with lower FA at three locations in temporo-occipital white matter with a threshold that varied according to location (885–1550 headings per year) (P < .00001). Lower levels of FA were also associated with poorer memory scores (P < .00001), with a threshold of 1800 headings per year. Lifetime concussion history and demographic features were not significantly associated with either FA or cognitive performance.


Heading is associated with abnormal white matter microstructure and with poorer neurocognitive performance. This relationship is not explained by a history of concussion.

© RSNA, 2013


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Article History

Received March 2, 2013; revision requested April 22; final revision received May 7; accepted May 10; final version accepted May 14.
Published online: Sept 2013
Published in print: Sept 2013