Soccer, Sub-Concussive Events and Brain Injury

American football gets most of the press. But soccer is going through self-examination in terms of head injury and concussion. Most of it relates to repeatedly heading the ball.

There’s really important information coming out of Columbia University Medical School. Here’s a summary from Columbia:

• Even with today’s lighter balls, heading still jars the brain and is associated with learning and memory deficits, though the impacts do not cause concussions. But until recently, no studies had identified which part of the brain is most affected by heading and responsible for its cognitive effects.

• Imaging analyses developed by Columbia researchers have now found that the junction between white and gray matter—in the outermost brain layer just behind the forehead—sustains the most damage from heading, and this damage leads to cognitive deficits. The results were reported in two papers, published in the journals Neurology and JAMA Network Open.

• “What’s important about our studies is that they show, really for the first time, that exposure to repeated head impacts causes specific changes in the brain that, in turn, impair cognitive function.” —Dr. Michael Lipton, MD, PhD, professor of radiology and biomedical engineering at Columbia University Vagelos College of Physicians and Surgeons.

This lines up with information coming out of England. I just read about one of my boyhood heroes, Gordon McQueen (despite the fact he played for Manchester United (I didn’t know better then)).


McQueen died in 2023. An inquest was conducted. Senior coroner Jonathan Heath confirmed: “[R]epeatedly heading footballs contributed to his developing chronic traumatic encephalopathy (CTE).”

McQueen was likened to an oak tree. He did not lose consciousness after heading the ball. He did not have amnesia about the game. He did not experience an altered mental state. He would not have qualified for a concussion diagnosis.

But sub-concussive events changed his brain, changed his quality of life and hastened his death.

Pediatric/Senior Significance

In the broadest sense heading the ball has a different impact on kids than it does on adults. That’s why there are limitations in youth soccer based on age group.

There are a a couple of take-aways that apply to all types of TBI. That includes sub-concussive events.

Impacts that may not be significant for adults may be very significant for kids. Ideas about plasticity may be eclipsed by the reality that kids’ brains are still developing and even micro-aggressions against them can have a big long-term effect.

I think it’s also reasonable to understand that even though older people do not have brains that are still developing, they have brains that are more susceptible to the effect or impact of sub-concussive events.

Since my collision in 2023 I have really tried to avoid heading the ball. I want to be able to show Marcellus use proper technique. But the prospect of heading the ball scares me.

Significance of Sub-Concussive Events

I’ve written before about sub-concussive events and the madness of treating TBI like an all or nothing proposition.

Research related to heading the ball totally reinforces the idea that an insult to the brain—that does not necessarily elicit the responses that are part of a concussion diagnosis—still can injure the brain in a way that produces long term limitations.

What remains unknown is the dose necessary to cause injury. But we know from limitations on youth soccer players even small doses can be significant to populations that have some form of vulnerability (age, genetics, concussion history, etc.).

Individual Variability

We talk all the time about individual variability. An impact that may not injury one person will cause a significant injury in someone else.

That’ totally lines up with the research related to heading the ball.

Studies indicate that some amount of heading is likely safe for most soccer players. But thresholds for harm are subject to significant individual variability.

“The impact of heading is likely to vary from person to person, depending on genes, concussion history, and other factors. For example, a person who only occasionally heads the ball, but carries a genetic risk, may experience comparatively large effects, while a person without the genetic risk could head the ball dozens of times a week, but experience few effects.”

Again, it is case-in-point in terms of what we see in motor vehicle collisions. Biomechanists can say that a change of X in Delta V will not cause injury in most people. But we know from the research involving heading that “most people” does not include those people who have genetic risk, a history of concussions, etc.