Does heading a football lead to brain trauma? New Swedish study suggests it could

As football codes across the world increasingly deal with legal actions from players for concussion and head injuries, a study from Europe says elite footballers are 1.5 times more likely to develop a neurodegenerative disease, particularly Alzheimer’s and dementia.

A large study investigated head injuries among more than 6,000 Swedish footballers who played in the top-flight Allsvenskan between 1924 and 2019, comparing them to a non-athletic control group.

The risk of developing neurodegenerative illness was found to be significantly higher among the footballers: nine percent of those assessed had some form of disease, compared to six percent in the general population.

One exception was found: goalkeepers were not prone to any considerable increase in risk, suggesting the act of ‘heading’ exposing outfield players to repeated trauma throughout their careers may lead to neurodegenerative issues.

“Goalkeepers don’t have the same increased risk of neurodegenerative disease as outfield players,” says researcher Peter Ueda, a clinical epidemiologist at Sweden’s Karolinska Institute.

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“Goalkeepers rarely head the ball, unlike outfield players, but are exposed to similar environments and lifestyles during their football careers and perhaps also after retirement. It has been hypothesised that repetitive mild head trauma sustained through heading the ball is the reason football players are at increased risk.

“It could be that the difference in neurodegenerative disease risk between these two types of players supports this theory.”

Alzheimer’s risk higher, but not for some other disorders

While pro footballers are 1.5 times more likely to develop risk of all-cause neurodegenerative disease, a more detailed breakdown shows the occurrence of motor neuron diseases were not substantially different to the wider population, and Parkinson’s was found to occur less frequently.

Their findings add more weight to other recent studies into brain diseases in professional athletes.

In 2021, a study by Scottish neuroscientists looking into the impact of field position on neurodegeneration drew similar conclusions: professional footballers were at 3.5 times greater risk of neurodegenerative disease than the general population, but with no significant increase among goalkeepers. In an earlier study, that same group found an increased risk of mortality from neurodegenerative disorder than control groups.

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Last year, they found risk of brain disorders in rugby union players was double that of non-players.

Despite the difference in risk, that two studies have demonstrated heightened danger of brain disease among top level footballers indicates there’s an issue, at least historically, in the way football impacts player health, says Ueda.

“While the risk increase in our study is slightly smaller than in the previous study from Scotland, it confirms that elite footballers have a greater risk of neurogenerative disease later in life”, Ueda says.

“As there are growing calls from within the sport for greater measures to protect brain health, our study adds to the limited evidence-base and can be used to guide decisions on how to manage these risks.”

The researchers note that as neurodegenerative illness tends to develop in later life, most players detected with disease played top-level football in the mid-20^th century. Whether these findings could apply to younger, and female groups (only male players were studied) is unclear.