Addressing head injury risk in youth football: are heading guidelines the answer?

BACKGROUND: Recent findings of neurodegenerative pathology in former professional football players have once again called into question the role that "heading", a fundamental aspect of the game, plays in the onset of neurological disease. By introducing guidelines aimed at limiting heading among youth players, the United Kingdom recently joined the United States as the only two nations yet to implement heading regulation in response to growing concerns surrounding football's head injury burden. PURPOSE: Evaluating the efficacy of risk mitigation strategies requires the continual reviewal of available evidence, however, youth heading guidelines have yet to undergo such an empirical evaluation. This review aims to address this absence by first discussing the literature informing heading-related health risk, followed by an assessment of the decision to limit youth heading in response to this research. MAIN FINDINGS: The risk of injury due to heading remains highly uncertain, especially as it pertains to youth players for whom epidemiological data is severely lacking. However, consideration of policy making under conditions of scientific uncertainty, as well as intrinsic risk factors of acute head injury in children and adolescents, currently warrants a precautionary approach to youth heading regulation. CONCLUSIONS: Further research must be pursued to ensure that future risk management strategies remain grounded in evidence and enhance the safety of football for vulnerable individuals. While our understanding of the neurological outcomes of heading remains limited, the adoption of heading guidelines reflects an appropriate response to uncertain risk.