Measuring the impact: How FIFPRO research is examining heading and brain health

• FIFPRO research project is measuring professional footballers’ exposure to head impacts during training and matches
• Players have worn instrumented mouthguards to measure the frequency and force of headers
• Data is being collected from men’s players across several European countries, while research involving women’s players set to follow

Every time a footballer heads the ball, the action is visible. The impact on the player’s head, however, is much harder to measure.

Despite growing discussion around heading and brain health, significant gaps remain in the scientific evidence on what repeated exposure might mean for a player’s brain health over the course of their career.

A research project coordinated by FIFPRO with the Amsterdam University Medical Centers is measuring professional footballers’ exposure to head impacts during training and matches. Data has been collected in Malta, the Netherlands, Finland, England and Portugal, with research involving women players set to follow. 

“We do not have a lot of data on heading, especially,” said FIFPRO’s Director of Medical Prof Dr Vincent Gouttebarge, a former professional footballer who played 14 seasons in France and the Netherlands. 

“We have some data with regards to the frequency of heading during matches, but we have much less about the number of headers during training and almost nothing available about the forces associated with headers.”

Measuring frequency and force

Existing research provides some evidence that head injuries and impacts – encompassing both concussion and heading – could be associated with adverse long-term consequences for brain health. But the available evidence remains limited.

The FIFPRO study is examining not only how often players head the ball, but also how hard those impacts are.

Players wear special mouthguards that measure the force of impacts to the head. Researchers then use video footage from training and matches to link those measurements to individual headers.

“A long kick from a goalkeeper of 50 or 60 metres that leads to a header has a different force and a different impact compared to when you throw the ball,” said Prof Dr Gouttebarge.

Former footballer Dr Freja Lahteenmaki is involved in the research as part of her PhD. Now practising medicine in Finland, Dr Lahteenmaki studied in Copenhagen for six years while playing in the Danish top flight for clubs such as Blodklubben af 1893 and FC Nordsjaelland.

“As a former player, I have seen many of my former team-mates experience the effects of head impacts and concussions,” said Dr Lahteenmaki. “I understand first-hand how concussions can affect not only everyday life, but also performance on the pitch. That personal experience is one of the reasons why this area of research is so important to me."

Dr Lahteenmaki continued: “When we look at brain health in footballers, we look at the cumulative load on the brain – and that consists of the impact magnitude, as well as the frequency of impact.

“We know there's a lot of studies done in rugby and American football and this is important to explore more in football where we intentionally use our head.”

Research in a real football environment

Much of the data has been collected during player union training camps, including those organised for out-of-contract footballers, as well as in collaboration with clubs.

The approach allows FIFPRO to collect data from different groups of players without asking one squad to wear mouthguards throughout an entire season.

Player participation during training has been high, with around three-quarters of players having worn the mouthguards during sessions. Uptake during matches has varied, in part because mouthguards can affect how players communicate with team-mates.

“It’s not feasible to ask players to wear an instrumented mouthguard during the whole season,” said Prof Dr Gouttebarge. “In order to make a good estimation of the true exposure to headers, you either need a large sample or you need to follow players for a long time.”

Players are also asked after each session to estimate how many headers they made, giving researchers both objective measurements and players’ own perceptions of their exposure.

“When I was a player, heading wasn’t discussed”

For Prof Dr Gouttebarge, who retired from professional football in 2007, the research also illustrates how much attitudes towards brain health have changed.

“When I was a player, heading wasn’t discussed beyond the technical or tactical aspect of the header,” said Prof Dr Gouttebarge, who played for the likes of Auxerre, Volendam and Almere City. “There was nothing associated with the potential long-term health impact as there is now.”

But while awareness has increased, scientific understanding is still developing. Concussion has historically been underdiagnosed in football, while data on routine heading exposure remains limited.

That leaves an important question over the potential contribution of concussion, repeated heading, or a combination of the two to long-term brain health.

“We know from other sports that repeated concussion over a career is not beneficial,” said Prof Dr Gouttebarge. “But is it heading in football? We don't know because headers haven’t been documented and studied enough.

“It could be that both together create a challenging dynamic for long-term brain health. That’s why we need to get a better insight into that combination.”

Could research change heading guidelines?

One of the aims of the study is to provide stronger evidence on which football can base player-health decisions.

Current heading recommendations can restrict players’ exposure to higher-force headers during training. But Prof Dr Gouttebarge says more data is needed to understand and quantify what constitutes a high-force header.

“If we have more data about the force associated with heading, then potentially we can put a number to that,” he said. “That could help us have more valid, quantified guidelines for players.”

One study alone will not determine future regulations. Prof Dr Gouttebarge says FIFPRO’s findings will need to be considered alongside other high-quality research before recommendations can be made.

The project will now expand its data collection among women’s professional footballers.