Until then, recommendations on heading in association football will be driven by opinion, not by scientific evidence. Instead, to inform discussions and assuage anxieties, there is a pressing need for appropriately designed and powered research studies to address questions over dementia risk in former footballers and any long-term consequences of heading. While current evidence does not demand rule change, neither does it provide football with a clean bill of health. Not only is most research to date beset by methodological deficiencies, 1 2 those studies exhibiting methodological deficiencies are most likely to identify neuropsychological impairment. However, in reality there are remarkably few robust and enlightening studies on the long-term neuropsychological health of former footballers, or on the lasting consequences of football heading. Nevertheless, growing public anxiety around the consequences of exposure to brain injury in sport, partly fuelled by increasing recognition of CTE in former athletes, must be acknowledged. Work to do before rule change is informedĬurrent evidence suggests the concerns and anxieties expressed in many quarters of the media around football participation, specifically the act of heading the ball increasing dementia risk, are unsubstantiated.
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2 Intriguingly, an inverse correlation between heading exposure and MRI measures of cortical thickness in former professional footballers has been reported and associated with cognitive performance, 6 but again data are mixed across the few imaging studies to date, with no direct correlation reported in others. No correlation between heading frequency and neurocognitive test performance is reported in a majority of studies, while the remainder report only minor and sometimes questionable influence of heading, 1 2 with surprisingly few studies applying the recommended control for the confounding effects of a greater number of head injuries sustained by those who head more frequently. Regarding late consequences of heading, data are mixed and limited. So, while intriguing, the data provide no insight into any long-term consequences of heading. 5 However, no controls were included and effects normalised within 24 hours. Research on the immediate effects of football heading alone is sparse, with one recent study reporting evidence of short-lived impairment in cognitive and electrophysiological assessments after a single session of 20 headers by young footballers. The Game Changers is a pro-vegan documentary that follows the journey of several elite vegan athletes as they train, prepare for, and compete in major events. (Confounding) Data on the consequences of football heading
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