Research · Player Safety

Heading the Ball: What the Research Actually Says About Concussion Risk in Youth Football

By Muhammad Dzulhisham · MSc Sports Coaching, NSCA-CSCS

For most of football's history, heading was treated as a technical skill like any other — something to be coached, drilled, and mastered as early as possible. That assumption has come under sustained pressure over the past decade, as long-term cohort studies of former professional players began surfacing a pattern that was hard to ignore: elevated rates of dementia and other neurodegenerative disease in men who spent their careers heading a leather (and later, synthetic) ball thousands of times.

The response from the sport's governing bodies has been uneven and, in places, contradictory. England banned heading in youth training in 2020, then spent two seasons trialling its removal from matches before committing to a multi-year phase-out. The United States moved faster, banning heading outright for its youngest age groups back in 2015 — but only after a lawsuit forced its hand. Germany deliberately avoided a ban altogether. This article sets out what the underlying research shows, and what each of these associations actually changed.

What decades of tracking former players revealed

The single most influential piece of evidence is the FIELD study (Football's InfluencE on Lifelong health and Dementia risk), run out of the University of Glasgow and funded by the Football Association and the Professional Footballers' Association. Published in The New England Journal of Medicine in 2019, it compared cause-of-death data for 7,676 former Scottish male professional footballers, born between 1900 and 1976, against more than 23,000 matched individuals from the general population.^1,2

The topline finding: former professional footballers had an approximately 3.5-times higher rate of death from neurodegenerative disease than the matched comparison group. Broken down by condition, the excess risk was roughly 5-fold for Alzheimer's disease, around 4-fold for motor neurone disease, and about 2-fold for Parkinson's disease. Notably, the same cohort had lower mortality from heart disease and some cancers — consistent with the general fitness benefits of a career in professional sport — and the neurodegenerative-disease gap only opened up after age 70, suggesting a long latency between exposure and disease onset.²

A follow-up analysis of the same dataset, published by the Glasgow team in 2021, added a detail that has shaped almost every policy discussion since: the risk was not evenly distributed by position. Outfield players carried roughly four times the expected risk, with defenders — who head the ball most often, both in open play and from set pieces — facing around a 5-fold increase. Goalkeepers, who almost never head the ball, showed no significantly elevated risk at all compared with the general population.³

Former professional footballers were found to have an almost three-and-a-half-times higher rate of death from neurodegenerative disease than people of the same age in the general population — with the risk highest among defenders and no increase at all for goalkeepers.

The FIELD study is an association, not a controlled experiment, and it cannot on its own prove that heading — rather than head-to-head collisions, playing surfaces of earlier decades, or other career exposures — is the specific cause. But the positional gradient, with the players who head the ball most bearing the highest risk and the players who essentially never head it bearing none, is the strongest circumstantial evidence yet that repetitive heading is a meaningful contributor.

Individual case studies add a human dimension to the statistics. In 2014, Boston University's CTE Center confirmed that Patrick Grange — a former college and semi-professional player in the United States who had headed the ball since the age of three — had chronic traumatic encephalopathy (CTE) at autopsy, making him the first American soccer player known to receive that diagnosis. Grange was diagnosed with ALS (Lou Gehrig's disease) at 28 and died 17 months later; neuropathologist Dr. Ann McKee described his condition as "CTE-induced ALS." His case does not establish causation on its own, but it was an early, widely reported signal that CTE — a disease previously associated almost exclusively with American football and boxing — was not confined to those sports.⁴

What happens inside a young brain in the minutes after heading

Separately from the long-term mortality data, a smaller but important body of research has looked at what heading does to brain function in the short term — the "subconcussive impact" question, distinct from diagnosed concussion.

A 2016 University of Stirling study, published in EBioMedicine, had 19 amateur players head a ball fired from a machine 20 times, at a speed simulating a corner kick. Using transcranial magnetic stimulation to measure brain function before and after, the researchers — Magdalena Ietswaart, Angus Hunter, Lindsay Wilson, and Tom Di Virgilio — found measurably increased inhibition in the brain, alongside a 41–67% drop in memory test performance immediately after the heading session. The effects had normalised within 24 hours.⁵ The changes were transient, but the study was among the first to show that routine heading — with no blow severe enough to be diagnosed as a concussion — produces detectable, if temporary, changes in brain function.

The dose-response problem

A larger 2019 study from Albert Einstein College of Medicine, led by Michael Lipton, looked at whether cumulative heading exposure mattered over time rather than acutely. Researchers compared 246 amateur adult soccer players against 72 athletes in non-contact sports and 110 non-athlete controls, using diffusion tensor imaging and cognitive testing. Players with low-to-moderate heading exposure showed the kind of white-matter and cognitive profile typically associated with athletic training — generally similar to or better than non-athletes. But players with the highest heading exposure lost that advantage entirely, showing no better white-matter integrity or cognitive performance than sedentary non-athletes, and performing worse than their lower-exposure teammates on attention, processing speed, and verbal and working memory.⁶

Taken together with the FIELD study's positional gradient, this is the evidence base that has driven policy change: heading appears to carry a real, dose-related risk to brain health, distinct from clinically diagnosed concussion, and the risk compounds over a playing career that, for many players, starts in childhood.

How England moved from guidance to a phased ban

The Football Association has taken the most closely documented path of any national association, moving in three distinct stages over four years.

In February 2020, shortly after the FIELD study's publication, the FA issued new training guidance removing heading entirely from training sessions up to and including the Under-11 age group, with a graduated reintroduction of limited heading practice from Under-12 upward.⁷ That guidance covered training only — heading remained legal and unrestricted in matches at every age.

In July 2022, the FA secured approval from the International Football Association Board (IFAB) — the body that governs the Laws of the Game — to trial removing deliberate heading from matches at Under-12 level and below, starting with the 2022–23 season.^8,11 Under the trial law, an intentional header by a young player was not penalised as foul play but resulted in an indirect free kick to the opposing side, in the same way an accidental handball infringement is treated. The two-season trial ultimately involved roughly 16,000 youth teams and 107,000 players across English grassroots football.⁹

In May 2024, the FA announced the trial's outcome: deliberate heading would be phased out of grassroots matches permanently, on a rolling three-season timetable — Under-7 to Under-9 from the 2024–25 season, extending to include Under-10 in 2025–26, and Under-11 in 2026–27. Heading returns at Under-12, timed to align with most children's move into secondary school football.⁹

The FA's current training guidance, published through England Football, sets specific limits by age band:

• Under-7 to Under-11: no heading introduced in training at all.
• Under-12 to Under-13: heading technique may be introduced, capped at one session per week, using lighter balls and a maximum of five headers per player, from short, unopposed distances.
• Under-14 to Under-16: up to ten headers per player per session, once a week, from varying distances.
• Under-18 and adult: up to ten headers per session, once a week, with coaches advised to account for the added load of long-distance and contested headers.¹⁰

Scotland's ban and Germany's alternative approach

Scotland moved in lockstep with England's initial guidance and, in some respects, went further first. In February 2020, the Scottish FA banned heading from training sessions for children aged 6 to 11 with immediate effect, becoming the first European football association to impose any restriction on heading. Between ages 12 and 15, heading was designated a "low coaching priority," with hard caps — no more than five headers per training session at age 13, rising to ten per session at 14 and 15.¹²

Germany's football federation, the DFB, took a structurally different route and deliberately avoided an outright ban. Instead, the DFB redesigned its youngest competitive formats — smaller pitches, dribble-ins replacing throw-ins and goal-kicks, and small-sided "funino"-style games — so that the ball is rarely airborne and heading opportunities are minimised by the shape of the game itself, rather than prohibited by rule. The DFB's stated reasoning was that a blanket ban risks pushing heading practice into unsupervised settings — kickabouts with friends, or informal play — where children are more likely to use poor technique with no coaching correction, potentially increasing rather than reducing risk.¹⁵

UEFA, for its part, issued non-mandatory heading guidelines to its member associations in 2020, informed by an eight-country study of heading incidence in youth matches. That study found that most players under 12 rarely head the ball at all in match play — typically zero or one header per game — with exposure lowest at Under-10 and highest among Under-16 boys. UEFA's guidance focuses on practical measures: age-appropriate ball size and weight, neck-strengthening exercises, and training coaches to recognise concussion symptoms, positioning these as a floor for national associations to build on rather than a uniform rulebook.¹³

What US Soccer did after a lawsuit forced its hand

The United States moved earlier than any European federation, but not by choice. In August 2014, a class-action lawsuit — Mehr v. FIFA — was filed in the US District Court for the Northern District of California on behalf of youth players and their parents, seeking rule changes (not damages) around concussion protocols and heading limits for children.¹⁶ The case was resolved through a settlement that produced the US Soccer Federation's Concussion Initiative, implemented in January 2016.

The resulting rules, still in force today, are more granular than a simple age cut-off. Players in the Under-11 age group and younger — roughly ages 10 and under — are barred from heading the ball in both practice and games. Players aged 11 to 13 face no restriction on heading during matches, but their training is capped: no more than roughly 30 minutes of heading practice per week, and no more than 15 to 20 headers per player, per week. The rules are mandatory across all national US Soccer youth teams and academies, including Major League Soccer youth academies.¹⁶

Where Singapore fits in

The Football Association of Singapore (FAS) has not issued an explicit heading ban, but its youth development structure achieves a similar effect through design rather than prohibition. The FAS Cubs Grassroots programme uses small-sided formats — 3v3 and 5v5 — on small pitches with no throw-ins, meaning the ball is rarely, if ever, airborne long enough to produce a heading situation for the youngest age groups. Under the FAS Youth Development Plan, children do not move into full 11-a-side football until age 13, and modified rules along the way — short goalkeeper distribution instead of long kicks, kick-ins rather than throw-ins for players up to age 9 — are aimed at developing passing and dribbling rather than aerial play. For concussion management specifically, FAS-affiliated medical staff use the SCAT3 assessment tool, the protocol recommended by FIFA, to guide return-to-play decisions after a head injury.¹⁷

This mirrors the German approach more than the English or Scottish one: rather than legislating heading out of the game, the format of youth football itself is built to make heading rare at the ages where the developing brain is thought to be most vulnerable.

What the evidence does — and doesn't — settle

None of this research proves that a child who heads a ball at age nine will develop dementia decades later. The FIELD study tracked players from a different football era, using heavier, water-absorbent balls and playing far more minutes across far longer careers than most youth players ever will. The subconcussive-impact studies from Stirling and Einstein involved adult amateur players, not children, and measured short-term or accumulated effects in populations who had already been heading for years. Long-running cohorts like the University of East Anglia's SCORES study — which is following a group of professional and amateur ex-players for the rest of their lives — exist precisely because the field still lacks the kind of prospective, decades-long data on today's children that would settle the question definitively.¹⁸

What the evidence does establish, consistently across multiple independent research groups and multiple countries, is a plausible mechanism (measurable, if transient, changes in brain function after routine heading), a dose-response pattern (higher cumulative exposure associated with worse long-term outcomes), and a positional gradient (players who head most, defenders, carry the highest risk; players who barely head at all, goalkeepers, carry none). That combination — not a single definitive study — is what has been sufficient to move national federations from treating heading as a neutral technical skill to treating it as a coached, monitored, and in some cases restricted exposure, particularly before the teenage years when the research suggests both the brain is still developing and the cumulative dose has the most runway to compound.