In the fast pace of a soccer game (correctly known as football), a header can be a well-timed and effective move. A quick jump, a sharp motion, and the ball sails toward the goal. But for some players, these moments might carry hidden risks—ones that don’t show up like a bruise or a twisted ankle.
A new study from Columbia University and Albert Einstein College of Medicine, published today in JAMA Network Open, has uncovered signs of subtle but significant brain damage in soccer players who frequently head the ball—even in the absence of diagnosed concussions.
The findings may offer the clearest link yet between repetitive head impacts and memory loss, revealing the brain’s vulnerability in a region once difficult to examine.
Uncovering Where the Brain Feels the Hit
Dr. Michael Lipton has spent more than a decade studying what happens to the brain during soccer play. But until now, the tools available have fallen short of identifying where, and how, the damage begins.
“What’s important about our study is that it shows, really for the first time, that exposure to repeated head impacts causes specific changes in the brain that, in turn, impair cognitive functmion,” said Lipton, professor of radiology and biomedical engineering at Columbia University Vagelos College of Physicians and Surgeons.
Lipton’s team focused on the orbitofrontal cortex, a region just behind the forehead that sits atop the eye sockets. This area is responsible for executive functions like planning, judgment, and learning strategies. Using an advanced form of diffusion MRI, researchers were able to peer into the delicate interface between the brain’s gray and white matter, a site previously hidden from standard scans.
The technique, developed by graduate student Joan Y. Song, measures how sharply brain tissue transitions from gray matter (home to neuron cell bodies) to the white matter tracts that connect different parts of the brain.
“In healthy individuals, there’s a sharp transition between these tissues,” said Song. “Here we studied if an attenuation of this transition may occur with minor impacts caused by heading”.
Invisible Injuries, Measurable Effects
To explore these changes, the team recruited 352 amateur soccer players from the New York City area—men and women aged 18 to 55 who had played for at least five years. All had taken to the pitch in the past six months. Researchers estimated heading frequency with a validated self-report tool called HeadCount, which tallies a player’s annual headers.
The players also took part in cognitive tests, including one deceptively simple task: repeating back words from a grocery list, known as the International Shopping List (ISL) immediate recall.
Those who reported more than 1,000 headers per year—roughly three per day—showed two worrying trends.
First, their MRI scans revealed a blurring of the transition between gray and white matter in the orbitofrontal cortex. This blurring is thought to result from shear forces during head impacts, when the denser white matter and lighter gray matter move at different rates.
Second, these same players scored lower on memory and learning tasks than their low-heading counterparts.
Importantly, the researchers found that the structural brain changes themselves explained the dip in memory scores. The fuzzier the boundary in the orbitofrontal region, the worse the memory performance. “It’s very strong evidence that these microstructural changes are likely to be a cause of cognitive deficits,” Lipton said.
Why This Matters—Even for Weekend Warriors
Soccer is the world’s most popular sport. For most fans, it’s not physical tackling that defines the game, but skill. Yet this study joins a growing body of research suggesting that even routine, subconcussive impacts can accumulate over time, especially in sports like soccer, where heading the ball is an essential skill.
Lipton’s lab previously found that amateur soccer players showed changes to white matter even without any diagnosed concussions. But this new study pushes further: it links those changes to specific cognitive consequences, and pinpoints the orbitofrontal region as a key site of vulnerability.
It also raises uncomfortable comparisons with more violent sports like boxing or American football.
Biomechanical models of soccer heading show that the front of the brain experiences the greatest strain during impact. That matches the injury pattern seen in this study. During a header, the brain can strike the skull’s rough inner surface at the orbitofrontal cortex—a kind of contrecoup injury, though without the drama of a concussion.
The findings become more striking because they required no history of concussion. The injuries are subtle, and likely go unnoticed day to day.
Are These the First Steps Toward CTE?
Contact sports raise concern about chronic traumatic encephalopathy (CTE), a degenerative brain disease caused by repeated head trauma.
While this study does not diagnose CTE, Lipton acknowledges the similarities. “The location of the abnormality we report is remarkably similar to CTE pathology,” he noted in the press release. “Though we don’t yet know if they are linked to CTE or if any of these currently healthy athletes will develop CTE.”
His team is now conducting follow-up research to investigate that possibility, while also examining whether cardiovascular fitness can protect the brain from such impacts.
The study could reshape how coaches teach and players practice the game. In the U.S., children under age 11 are already barred from heading the ball in games. But among teens and adults, the practice is still widely accepted.
Lipton hopes that objective imaging tools like the one developed here can guide better safety protocols, and perhaps help identify players at risk before damage accumulates.
The imaging method could also open doors to treatments or interventions. By understanding exactly where the brain is most vulnerable, scientists might one day develop ways to strengthen or protect those regions—or even reverse the changes.
“Identifying such a causal link would point more specifically to the mechanism driving adverse cognitive effects of RHI,” the authors wrote in their study.
A Sharper Picture of Risk
Until now, many studies have struggled to show a direct link between heading and cognitive decline. Part of the challenge has been imaging the outer folds of the brain. The gray-white matter interface, has been notoriously difficult to measure with standard MRI.
This study breaks that barrier.
By using an approach that tracks the sharpness of microstructural transitions in the orbitofrontal cortex, Lipton and his colleagues have brought the invisible into view. Their work offers a method for tracking and understanding the problem.
As research continues, the question will no longer be whether heading the ball changes the brain. The real question is how much is too much—and what steps we’re willing to take.
