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 …