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Soccer Heading Is Associated with White Matter Microstructural and Cognitive Abnormalities
Open accessAbstract
PURPOSE: 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/mm(2); 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. RESULTS: 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. CONCLUSION: Heading is associated with abnormal white matter microstructure and with poorer neurocognitive performance. This relationship is not explained by a history of concussion.
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“Recently, soccer players who head the ball more than 1,800 times per year were found to have microstructural abnormalities in the temporo-occipital white matter on DTI that correlated with poorer memory scores [111].”
From The neuropathology of sport (2014) · cites this paper as [111]
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“…in female players than in males (Basinas et al. 2022); second, female players may be more sensitive to subtle brain injury from football heading (Lipton et al. 2013); third, female football participation is the fastest-growing segment among football populations, with projections of 60 million…”
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“…to repetitive heading and the appearance of neuropsychological impairment (Matser et al. 1998 ; Downs and Abwender 2002 ; Rutherford et al. 2005; Lipton et al. 2013 ; Levitch et al. 2018 ; Bruno and Rutherford 2022 ), whereas others report no such association (Janda et al. 2002 ;…”
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“We utilized data obtained from 91 healthy individuals from the greater New York City area (Table 1); who were initially recruited for their participation in recreational soccer as part of the Einstein Soccer Study (Lipton et al., 2013; Rubin et al., 2018) to study repetitive head impacts.”
Self-citationGoeckner, B. D., Beltz, A. M., Teague, T. K., Savitz, J. B., Banerjee, A., Mannix, R., Brett, B. L., & Meier, T. B. (2026) · Neurotrauma Reports · doi:10.1177/2689288x261473764
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“Long-term heading exposure has been linked to poorer verbal learning and memory [14], as well as white matter microstructural alterations [20], including lower fractional anisotropy in temporo-occipital white matter areas [21].”
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Short Term Effects of Football Headers on Reaction Time and Symptomology in Males and Females
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“Both Koerte, and Lipton and colleagues have reported former professional footballers experience cortical thinning and white matter micro-structure abnormality in the temporo‐occipital region, respectively (Koerte et al. 2022; Lipton et al. 2013).”
Sulaiman, R. S. T. (2026) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2026.1908733
Metadata
- Authors
- Lipton, M. L., Kim, N., Zimmerman, M. E., Kim, M., Stewart, W. F., Branch, C. A., & Lipton, R. B.
- Affiliations
- Albert Einstein College of Medicine (US)
- Sutter Health (US)
- ORCID
- Venue
- Radiology
- Published
- 2013-09
- Volume
- 268
- Issue
- 3
- Pages
- 850-857
- ISSN
- 0033-8419 (ISSN-L)
- 1527-1315
- PMC
- PMC3750422
- OpenAlex
- W2170100452
- Cited by
- 376
- References
- 30
- Citations by year
- 2026: 20 · 2025: 20 · 2024: 20 · 2023: 30 · 2022: 30 · 2021: 30 · 2020: 47 · 2019: 40 · 2018: 37 · 2017: 27 · 2016: 36 · 2015: 15 · 2014: 18 · 2013: 5
- FWCI
- 17.97
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Radiology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Dana Foundation
- Yeshiva University
- National Institutes of Health (5k23ns051409-02, 5r01ag025119-05, K23NS05140901A1, AG03949, RO1AG025119, RO1AG12101, PO1 AG03949, PO1AG027734)
- Albert Einstein College of Medicine, Yeshiva University
- National Institute on Aging (R01-AG025119, R01AG022374, P01AG03949, P01AG027734, P01AG003949, R01AG034119, R01AG012101, K23AG030857, R01-AG-12101)
- National Institute of Neurological Disorders and Stroke (K23NS047256, R01NS082432, K23 NS47256, K23NS051409-01A1)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Keywords
- soccer heading, white matter microstructure, fractional anisotropy, diffusion tensor imaging, cognitive performance, memory, amateur football players, concussion
- MeSH terms
- Adult, Brain Injuries, Cognition Disorders, Female, Humans, Magnetic Resonance Imaging, Male, Nerve Fibers, Myelinated, Sensitivity and Specificity, Soccer, Wounds, Nonpenetrating, Reproducibility of Results
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