Professional soccer is full of painful-looking headers. That is to say, athletes hitting the soccer ball with their head in order to pass or shoot. You may have witnessed a few of these moves at the Paris Olympics, but are they actually safe to do? Or are they just downright dangerous? Turns out, as cool as headers are to witness, they really do take a toll on players’ health (Olympians included).

No matter what team is performing the headers, they all look like they hurt . . . at least from a viewer’s perspective. While headers are a hallmark of soccer, researchers and industry officials are starting to take a closer look at how they impact players’ brain health. For example, during last year’s men’s World Cup, FIFA introduced “injury spotters” who rewatch game video in slow motion and alert team doctors to possible concussions, among other things. Still, some experts believe there isn’t enough being done to protect players from brain damage. Read on to see what we know about the health risks of headers.

Chris Nowinski, PhD, is a neuroscientist and CEO of the Concussion Legacy Foundation (CLF).
Dennis Cardone, DO, is a sports medicine specialist and codirector of the NYU Langone Concussion Center.

When discussing head injuries in sports, concussions are among the biggest concerns. Concussions are a type of traumatic brain injury caused by a blow to the head or body that causes the brain to move rapidly back and forth inside the skull, per the CDC. And according to concussion expert Chris Nowinski, PhD, it’s very possible that heading a soccer ball could cause a concussion.

“About 10 percent of concussions in soccer happen from head to ball contact on a header,” Dr. Nowinski says. Still, while headers increase the risk of a concussion, you’re more likely to get one from colliding into another player, says sports medicine specialist Dennis Cardone, DO. “Sure, when you look at the data, most concussions do occur with heading, but it’s not head-ball contact, it’s head-to-head contact,” Dr. Cardone explains.

That said, soccer players appear to be at risk of head injuries from both collisions and headers themselves — and those head injuries, whether they result in concussions or not, are serious. “The biggest danger presented by repeatedly heading the ball is the accumulation of nonconcussive impacts,” Dr. Nowinski says. “These do not cause concussion symptoms, but they are the driving force behind CTE,” he says. CTE is short for chronic traumatic encephalopathy — a brain condition linked to repeated head injuries and blows to the head which gets worse over time and can lead to dementia, per the Mayo Clinic.

“While research into heading’s link to CTE is ongoing, a 2021 UK study of nearly 8,000 former pro soccer players found that outfield players (non-goalkeepers) were four times more likely than the general population to develop dementia, another neurodegenerative disease, while goalkeepers, who rarely head the ball, did not have a higher risk of dementia,” Dr. Nowinski says. Even worse, a 2018 study from the Albert Einstein College of Medicine found that women players may be more vulnerable to injuries from heading the ball than men. The research found that “regions of damaged brain tissue were five times more extensive in female soccer players than in males.”

Concussions usually aren’t life-threatening, but the short- and long-term effects can be serious. Immediate concussion symptoms can include headaches, nausea or vomiting, balance and vision problems, feeling sluggish or groggy, confusion, concentration or memory problems, and mood changes, according to the CDC. But sometimes these symptoms stick around for weeks to months or years — called post-concussion syndrome — according to the University of Queensland Brain Institute in Australia. Even worse, just a single blow to the head can have severe consequences later in life.

“A single concussion can change the course of a person’s life,” Dr. Nowinski says. “Concussions are associated with an increased risk of developing a new mental health disorder. Mismanagement of concussions can increase the chances of longer recoveries, post-concussion syndrome, and, in rare cases, even the often deadly second-impact syndrome,” which is when someone experiences a second head injury before completely recovering from an initial head injury, per the National Library of Medicine.

Research is even stronger showing that repeated head injuries (even if they don’t cause a concussion) can cause the death of nerve cells and contribute to CTE, according to the Mayo Clinic, which can lead to lifelong problems with mental health, behavior, and memory.

In addition to the aforementioned FIFA spotters, leagues and federations are starting to do more to prevent head injury during matches and practice. The US Soccer Federation, for example, has a player health and safety program called Recognize to Recover, which aims to promote safe play and reduce injuries in soccer players of all ages. A main component of the program is focused on head injuries, including concussions. As part of its coaching guidelines to reduce head injuries, US Soccer has banned kids 10 and under from heading the ball in practice and games and advises limiting headers for kids ages 11 to 13 — but the same can’t be said for other countries.

“I’d like to see more soccer federations worldwide enact rules prohibiting headers in youth soccer, as US Soccer has for players under 11,” Dr. Nowinski says. “There is too much critical development taking place in an adolescent brain to make the practice worth the risk. I don’t think children should head soccer balls until at least age 14.”

For adult players, headers remain part of the game. To minimize potential injury while performing one, Dr. Cardone says players have to stabilize their neck and torso to reduce rotational forces (head rotation is a main cause of concussion, according to research). It’s also better to hit the ball with the front or side of the head (which is what you’ll often see done by pros) because hitting the ball from these regions is “more protective,” Dr. Cardone says; the crown of your head is the most sensitive area. That’s why football players, for example, are told not to tackle with their heads down, he says. Impact on that vulnerable area leads to “more catastrophic neck injuries as well as potential concussions,” he says.

But even intentional heading doesn’t stop head injuries from happening on the field. For Dr. Nowinski, the best way to protect players is by reducing their lifetime exposure to head impacts and severe head impacts, “thereby lowering their risk for dementia and CTE,” he says. “Limiting heading in practice is a simple place to start. It’s worth considering more rule changes about when and where heading is allowed during games, too — the hardest head impacts are on corner kicks, goal kicks, and punts. Would a ban on heading punted balls at the high school level materially change the game?”

Even if headers remain part of the game, monitoring for potential concussions — and keeping those players off the field — is an important part of protecting athletes from second-impact syndrome, which can be deadly. “This is why the Concussion Legacy Foundation advocates for concussion prevention and educates coaches, parents, and teammates to recognize potential concussion signs and make sure that player is immediately removed from the field,” Dr. Nowinski explains. “Proper concussion management in pro sports sets the example for young players that their brain health comes first and foremost.”

Lauren Mazzo was the senior fitness editor at PS. She is a certified personal trainer and fitness nutrition specialist through the American Council on Exercise. Prior to joining PS, she worked for six years as a writer and editor for Shape Magazine covering health, fitness, nutrition, mental health, sex and relationships, beauty, and astrology. She graduated from Ithaca College with a degree in Journalism and minors in Writing and Honors, with additional studies in gender, sex, and love.

Samantha Brodsky is a former assistant editor at PS. She uses her gymnast background to inform her sports and fitness coverage, powering through Peloton videos in her free time.