Background Restrictions on heading in youth football have been implemented in the U.S. to limit head-impact exposure up until the age of 13. However, current interventions remain poorly guided by evidence, and providing more accurate data on heading exposure is key to assess risk.
Objective To quantify heading exposure in youth football, assessing the effects of sex and age.
Design Prospective cohort study, based on direct observation of a convenience sample of football matches played during an international youth football tournament. The tournament was played without heading restrictions, with separate sex and age groups.
Setting Youth football.
Participants Male and female teams with players aged 11–19 years. A total of 267 matches was observed.
Independent Variables Sex and age. The elite senior level was included for comparison, using video analysis.
Main Outcome Measurements All heading events were registered, classified and assigned to individual players. Heading rates were calculated for each sex and age group.
Results We observed a total of 4011 player hours (1927 player hours for females, 2083 player hours for males). Males headed more frequently than females (2.7 vs. 1.8 headers/player hour; p<0.001). Heading rates increased with age (ANOVA, p<0.001), approaching the elite senior level for players 16 years and older. There was substantial variation within teams for all age and sex groups, with the widest range (1–18 headers) observed for girls aged 19. Girls younger than 12 years had the lowest exposure, with an average of less than two players per team heading the ball, each with 1–2 headers.
Conclusions Age and sex influence head-impact exposure in youth football, and warrants careful consideration when introducing injury prevention measures. Males are more frequently exposed than females, heading rates increase with age, and there is substantial variation between players. Heading is a rare event in the youngest age groups, especially among females.
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