To evaluate the association between post-concussive symptomatology and heading in professional soccer players, overcoming the bias of self-reported exposure, we evaluated several clinical neuropsychiatric symptoms using questionnaires after a thorough objective follow-up of players heading-exposure throughout an entire season METHODS: We collected heading data for all Israeli Premier League players for an entire season using a web-based platform for performance analysis, which enabled us to quantify the exact number of headers per player. Players filled questionnaires regarding post-concussion symptoms, depression, anxiety and sleep disorders. We tested the association between the number of headers and each outcome using a negative binomial regression corrected for the hours played.
159 players were included, of which 79 considered in the high heading exposure group (49%) defined as more than median number of headings (1.34 per game hour). Among players without any past head injury, those with higher heading exposure were less likely to suffer post-concussion symptoms compared to players with low heading exposure (RR per heading per hour=0.94, 95%CI [0.912;0.963]). Players with high heading exposure suffered less from depression symptoms (RR=0.98, 95%CI [0.961;0.997]), anxiety (RR=0.98, 95%CI [0.958;0.997]) and sleep disorders (RR=0.98, 95%CI [0.961;0.996]).
Professional soccer players with high heading rate do not display higher post-concussive symptomatology severity. Symptoms among players with low heading exposure might be explained by low resilience, possibly associated with an inferior heading technique. Alternatively, it can reflect heading avoidant behavior.

© 2020 American Academy of Neurology.