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How many headers are too many? Evolving our understanding of heading in English professional football
  1. Joseph Evans1,2,
  2. Adam Crossley2,
  3. Richard Collinge2,
  4. Daniel Broman2,
  5. Osman Hassan Ahmed3,4,5,
  6. Richard Weiler2,6,7,8
  1. 1 Department of Sport and Event Management, Bournemouth University, Poole, UK
  2. 2 Department of Medicine and Sports Science, West Ham United Football Club, Romford, Essex, UK
  3. 3 Department of Physiotherapy, University Hospitals Dorset NHS Foundation Trust, Poole, UK
  4. 4 School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
  5. 5 The FA Centre for Para Football Research, The Football Association, Burton-upon-Trent, UK
  6. 6 Fortius Clinic, London, UK
  7. 7 Department of Medicine and Science, Para Football Foundation, Amsterdam, The Netherlands
  8. 8 Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centres – Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Dr Richard Weiler, Department of Medicine and Sports Science, West Ham United Football Club, London, E6 5NX, UK; rweiler{at}

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Background to heading risk

Football (soccer) heading is an integral game-related skill which affects performance.1 The sport is under increasing pressure to minimise head to ball contact due to reported concerns of developing long-term neurodegenerative diseases (ND).2 The English Football Association (FA) recently responded with guidance limiting headers in training.3 However, current research presents no high-quality evidence directly linking heading exposure to ND, despite widespread media reports to the contrary.2 Mackay et al 4 found mortality from various NDs listed on retrospective death certificates (participants born before 1 January 1977) was 1.7% among former Scottish soccer players and 0.5% among controls, but heading exposure was not measured. The Scottish National Record Statistics (SNRS) confirm dementia deaths alone were much higher, representing 11.1% of all Scottish deaths in 2019 (pre-COVID-19).5 Even accounting for diagnostic improvements spanning the data period of the Mackay et al 4 cohort, the massive differences between mortality rates in Mackay et al 4 (all ND‘s) versus the SNRS (dementia alone) highlight considerable methodological challenges. Therefore, conclusions around the risks of heading based on Scottish football players or the general population are not currently possible or evidence-based. Calls to limit or even ban heading completely based on public health ‘precautionary principles’ are also not scientifically supported, may be politically …

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  • Contributors Conceptualised by AC, JE, DB, RW and RC. 2021/2022 season long heading audit performed by JE and AC. First draft manuscript drafted by JE, with support from DB and RW. All authors provided feedback on consequent drafts until agreement was reached on the published version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.