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Head injuries
  1. J Dvorak1,
  2. A Junge1,
  3. P McCrory2
  1. 1Schulthess Klinik, Zurich, Switzerland
  2. 2University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to:
 Professor J Dvorak
 Schulthess Klinik, Zurich, Switzerland; jiri.dvorakkws.ch

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Do heading and head injuries in football lead to long term cognitive impairment?

In football, contact to the head during tackling duels or when heading the ball has the potential to cause traumatic brain injury. Alongside specific concerns related to individual incidents causing concussion there is also a wider debate of whether repeated concussive and subconcussive head trauma may lead to chronic brain injury.

This issue was first raised in a series of retrospective studies involving retired Scandinavian football players where cognitive deficits were noted.1,2 In these studies, significant methodological problems such as the lack of pre-injury data, selection bias, failure to control for acute head injuries, lack of observer blinding, and inadequate control subjects flawed the results. Although the authors concluded that the deficits noted in the former football players were explained by repetitive trauma such as heading the ball, the pattern of deficits is equally consistent with alcohol-related brain impairment, a confounding variable that was not controlled for.

Matser and colleagues from the Netherlands have also implicated both concussive injury and heading as a cause of neuropsychological impairment in both amateur and professional football players.3–5 Reanalysis of the data from these papers however suggests that purposeful heading may not be a risk factor for cognitive impairment.6 Data from Norway using video analysis of head injury incidents demonstrates that the commonest cause of concussive trauma is …

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