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Female soccer players at greater risk of TBI for 'heading' soccer balls than male players, says study

Press releases may be edited for formatting or style | August 01, 2018 MRI
OAK BROOK, Ill. - Researchers have found that women who play soccer may be more at risk than their male counterparts. According to a new study published in the journal Radiology, female soccer players exhibit more extensive changes to brain tissue after repetitive 'heading' of the soccer ball.

Soccer is the most popular competitive sport in the world, and female participation in the sport is on the rise. The Fédération Internationale de Football Association (FIFA) 2014 Women's Football Survey reported more than 30 million female soccer players worldwide.

Heading, in which players field the soccer ball with their heads, is a key component of the game. Heading-related impacts have been associated with abnormalities in the brain's white matter that are similar to those seen in patients with traumatic brain injury. Cumulative heading over a one-year period has been associated with cognitive dysfunction and microstructural changes to the brain's white matter.
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Long-term consequences of repeated exposure to heading is an area of concern because repetitive head injury in athletes has been associated with cognitive decline and behavioral changes.

"In general, men do a lot more heading than women, but we wanted to specifically examine if men and women fare similarly or differently with a similar amount of exposure to repeated impacts to the head," said the study's lead author, Michael L. Lipton, M.D., Ph.D., professor of radiology at the Gruss Magnetic Resonance Research Center at the Albert Einstein College of Medicine and medical director of MRI at Montefiore Medical Center in New York City.

Dr. Lipton and colleagues used diffusion tensor imaging (DTI), an advanced MRI technique, to assess microscopic changes in the brain's white matter in 98 amateur soccer players--49 men and 49 women--with an average age of 25.8 years. All participants had many years of soccer and heading exposure, including 12 months of frequent heading exposure leading up to the study (median headers: 487 per year for the men and 469 per year for the women). Participants had no significant differences in demographic factors.

DTI produces a measurement, called fractional anisotropy (FA), which characterizes the movement of water molecules in the brain. In healthy white matter, the direction of water movement is fairly uniform and measures high in FA. When water movement is more random, FA values decrease.

"A decline in FA is an indicator of changes in the white matter microstructure that may be indicative of inflammation or loss of neurons, for example," Dr. Lipton said.

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