Heading and unintentional head impacts have opposing associations with Patient Reported Outcomes in amateur soccer players

Liane E. Hunter, Chloe Ifrah, Molly E. Zimmerman, Mimi Kim, Richard B. Lipton, Walter F. Stewart, Michael L. Lipton

Research output: Contribution to journalArticle

4 Scopus citations


The effects of soccer-related head impacts, beyond overt concussions, on Patient Reported Outcomes (PROs) have not been explored to date. Generalized estimating equations were employed to determine the association between soccer-related head impacts (headers in the prior 2 weeks, unintentional head impacts in the prior 2 weeks, headers in the prior 12 months and lifetime concussions) on PROs including depression, anxiety, sleep disturbance and sleep impairment. Compared to players with no unintentional head impacts in the prior 2 weeks, players with one unintentional exposure reported more symptoms of anxiety (p = 0.002) and players with 2+ exposures reported more symptoms of depression (p = 0.006) and anxiety (p < 0.001). In contrast, players in the 3rd Quartile of 12 mo. headers reported less anxiety (p = 0.001), sleep disturbance (p = 0.002) and sleep impairment (p < 0.001) compared to those in the 1st quartile. Unintentional head impacts are associated with worse PROs while more headers are paradoxically associated with better PROs.

Original languageEnglish (US)
Pages (from-to)390-400
Number of pages11
JournalResearch in Sports Medicine
Issue number4
StatePublished - Oct 2 2018



  • Patient Reported Outcomes
  • soccer
  • traumatic brain injuries

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

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