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Play Soccer, But Protect Your Head
Study finds elite soccer players report more depression, anxiety and difficulty thinking
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Key takeaways
- Retired elite soccer players reported more anxiety, depression and thinking difficulties than a control group in a new study.
- Brain scans showed structural differences and reduced gray matter in some former players.
- While the research suggests the players’ brains show early signs of change, it cannot conclusively link that change to future brain disease.
Among elite soccer players, repetitive head impacts — specifically heading the ball – may be a warning that brain disease could occur later in life, according to a new study.
Until now, scant research has examined the effects of repetitive brain impacts on midlife soccer players, says clinical researcher Caleigh Grace Lynch, lead author of the study at Imperial College London and the UK Dementia Research Institute Centre for Care Research & Technology. The study examined 142 former professional soccer players — 126 men and 16 women — ages 30 to 60.
The research is unique in that it looks at individuals “much earlier than most studies,” says Lynch. Examining players at midlife — and following up in the long term — provides an opportunity to study possible connections to later brain disease, she says.
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The study, which was presented at the recent Alzheimer’s Association International Conference in London, did not attempt to diagnose Alzheimer’s or other brain disorders in the participants. Rather, it identified self-reported symptoms in the retired players that were not apparent among members of a control group with no history of head injuries or neurological problems, she says.
Compared with the healthy control group, players experienced higher levels of depression, anxiety, and difficulty with decision-making skills and thinking. MRI scans also identified differences in brain structure between some former players and members of the comparison group.
This suggests effects on brain health “before clinically apparent neurodegenerative disease would typically emerge,” Lynch says.
“We are going to be tracking this same group over several years,” Lynch adds. “We hope to identify which changes remain stable, which progress, and which early markers may predict future cognitive decline or neurodegenerative disease. Ultimately, this approach aims to better understand how these conditions develop during life, when interventions may be most effective.”
Early brain impacts
Although the scientists did not find significant differences using standard cognitive testing, the players described higher feelings of depression and anxiety, and a worsening ability to plan, focus on and solve problems and manage daily tasks, compared with the control group, according to the study.
Thirty-one percent of the former players scored in the range indicating clinically significant depression symptoms, compared with 9 percent of controls, while 42 percent scored in the range indicating clinically significant anxiety symptoms, compared with 25 percent of controls.
Also, brain imaging of 124 former players revealed lower gray matter volume in several brain regions, including frontal, cingulate and thalamic areas that play important roles in memory, attention, decision-making and emotional regulation, compared with the controls. At the group level, there was evidence of reduced brain volume in the players, compared with controls.
Additional research presented at the conference examined soccer players five to 10 years post-collegiate play and found early accumulation of the tau protein, one of the characteristics of Alzheimer’s disease, “with poorer episodic memory observed with higher tau.” Another study that analyzed the brains of 69 deceased former soccer players found evidence of chronic traumatic encephalopathy (CTE) in 17 of them — nearly 25 percent — with higher odds of CTE occurring among those in the group who had played the longest number of years.
Amateur players, too
Other research suggests even amateur players may be at risk. A study recently published in JAMA Neurology and presented at the conference analyzed the blood of a group of amateur soccer players and found elevations of neural blood biomarkers soon after heading, but not before.
Thomas W. Kaminski, director of the Athletic Training Research Laboratory at the University of Delaware, says the studies advance knowledge about the effects of repetitive head impacts in sports. However, he says, it’s probably premature to conclude such symptoms are predictive of future Alzheimer’s or other brain diseases.
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“In the soccer world, unlike the American football world where the connection between repetitive head impacts and CTE (Chronic Traumatic Encephalopathy) is very advanced, I think it is too early to make any definitive connection,” says Kaminski, who was not involved in the studies.
However, “generally speaking, the further you advance in the sport of soccer from youth, high school, travel, collegiate, professional and national team participating, and you head the ball a great deal…the chances of developing downstream detrimental cognitive decline — dementia, CTE, etc. — are possible,” he adds.
Soccer has long been popular in the United States among youth and adults, especially with this year’s World Cup taking place in several U.S. cities. Adult soccer leagues flourish here, with more than 225,000 players and 400 organized leagues, according to the United States Adult Soccer Association. Even more adults play in less-formal leagues.
Safer play
The recent research may raise questions for adult players as to their own possible risks, and whether they should consider quitting the sport. Kaminski recommends wearing protective equipment — mouthguards and headgear, like a soft flexible headband designed to absorb impact — and suggests they be cautious about heading.
“My advice to seniors, me included, who participate in organized soccer activities would be to shy away from performing intentional or purposeful headers in both practices and games,” he says.
“Unintentional impacts are probably “very low risk,” he adds, but players should avoid intentional headers “by playing balls to the feet or chest area of the body,” he says.
But he urges older adults not to stop playing. “The benefits of the physical activity associated with playing soccer past the age of 50 are huge,” he adds. “Exercise is medicine. Movement is vital.”
Tracy Espiritu McKay, a psychiatrist at NYU Langone Health, who also was not involved in the study, acknowledged that the effects from earlier play “can absolutely play a role in how we function as we age, but stressed that “athletes shouldn’t dwell on how they played the game in the past,” she says.
They should, however, change how they choose to continue playing “by avoiding heading to the greatest extent possible,” calling it “the single, most impactful precaution that players can do."
She also urged athletes to keep on playing and to follow brain-heathy behaviors, such as following the Mediterranean diet, getting adequate sleep, correcting hearing loss and staying social.
The key takeaways were created with the assistance of generative AI. An AARP editor reviewed and refined the content for accuracy and clarity.
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