Heading soccer balls poses a much greater threat to women's brains than men's, new research suggests.
Damage to white matter
The study included 49 female and 49 male amateur soccer players, aged 18 to 50. They reported a similar number of headings over the previous year (an average of 487 headings for the men and 469 for the women).
Brain scans revealed that regions of damaged white matter in the brain were five times more extensive in the women than in the men.
"Researchers and clinicians have long noticed that women fare worse following head injury than men, but some have said that's only because women are more willing to report symptoms," said study leader Dr Michael Lipton.
"Based on our study, which measured objective changes in brain tissue rather than self-reported symptoms, women do seem more likely than men to suffer brain trauma from heading soccer balls," Lipton said.
The findings suggest that gender-specific guidelines for soccer heading may be required, the study authors said.
Lipton is a professor of radiology and of psychiatry and behavioural sciences at Albert Einstein College of Medicine, and medical director of MRI services at Montefiore Medical Center in New York City.
About 30 million women and girls play soccer worldwide, according to the International Federation of Association Football.
Identifying risk factors
It's not clear why women might be more sensitive to head injury than men, but differences in neck strength, sex hormones or genetics might be factors, the researchers suggested.
The brain changes among the women in the study didn't produce any noticeable symptoms, such as declines in thinking ability, but are still cause for concern, the researchers said.
"In various brain injuries, including chronic traumatic encephalopathy (CTE) [a degenerative brain disease found in athletes, military veterans, and others with a history of repetitive brain trauma], subclinical pathology develops before we can detect brain damage that affects function," Lipton explained.
"So before serious dysfunction occurs, it's wise to identify risk factors for cumulative brain injury – such as heading if you're female – so that people can act to prevent further damage and maximize recovery," he said.
The study, published online in the journal Radiology, raises the question of whether soccer players should stop heading altogether.
"We have carried out several studies showing that most players seem to tolerate some level of heading," Lipton said in a journal news release.
"Rather than ban heading altogether – which probably isn't realistic – we'd like to get a better handle on how many headers will get players into trouble," he said. "What is important about this study is that men and women may need to be looked at differently."
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