Introduction: Football is one of the few sports whereby the head is purposefully used as a key requirement of the game, with the skill of heading taught from a young playing age. There is current scientific and public concern over the uncertainty of short-, medium- and long-term consequences of heading on brain health. Hence, a precautionary approach to mitigate any possible risks is desirable whilst the evidence remains equivocal. One such approach is being proactive about developing and implementing strategies and guidelines that help reduce the burden (volume and intensity) of heading in young and beginner players, which requires integration of a multitude of topics to inform such strategies.
Objective: This narrative review explores the current evidence underpinning strategies that could be incorporated into future heading guidelines to reduce heading burden in players across all levels of football.
Methods: A four-step search strategy was utilised to identify all data-based papers related to heading in football. Eligibility criteria for inclusion: 1) original data; 2) study population included football players, 3) outcome measures included one or more of the following: number of headers, measurement of head acceleration during heading, or head injury incidence; and 4) published in English or an English translation available.
Results: In total, 62 papers were included. Evidence suggests that future heading guidelines should consider the following: 1) Developing a heading coaching framework which emphasises the technical proficiency of heading, 2) greater emphasis on small-sided games, particularly in young players, to limit the total number of headers per week. This is particularly focused on training for players who complete higher numbers of headers in games, whilst also reducing headers from goal kicks and punts. 3) Neuromuscular neck exercises integrated into general injury reduction exercise programs (such as FIFA 11+), 4) enforcement of rules related to deliberate head contact and 5) using lower-pressure match balls.
Conclusion: To mitigate the potential risk of heading on long term brain health, scientific evidence suggests that there are a number of pragmatic strategies that can be incorporated into future heading guidelines. It is also recommended that an implementation and evaluation plan which is co-designed by health professionals, researchers, coaches, players and other important stakeholders is developed in tandem to optimise the potential adherence to, and benefits from, any future heading guidelines.
Impact/Application to the field: This review is the first to outline the current evidence and make recommendations for the inclusion of different strategies into future heading guidelines to reduce heading burden in football players. These results can assist football governing bodies worldwide when drafting and standardising heading guidelines to protect the long-term brain health of current and future generations of players.
Conflict of Interest: The author team would like to declare affiliations with Football Australia.