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Heading in soccer increases serum neurofilament light protein and SCAT3 symptom metrics
  1. Colin Wallace1,2,
  2. Jonathan D Smirl2,
  3. Henrik Zetterberg3,4,5,6,
  4. Kaj Blennow3,4,
  5. Kelsey Bryk7,
  6. Joel Burma2,
  7. Jill Dierijck8,
  8. Alexander David Wright9,
  9. Paul van Donkelaar2
  1. 1 Faculty of Medicine, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
  3. 3 Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
  4. 4 Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
  5. 5 Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
  6. 6 UK Dementia Research Institute at UCL, London, UK
  7. 7 College of Health Sciences, University of Delaware, Newark, Delaware, USA
  8. 8 Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
  9. 9 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Colin Wallace, ; colin.wallace{at}


Objectives To determine the effect of heading a soccer ball on serum neurofilament light (NF-L) protein, plasma tau protein and symptom metrics including total number of symptoms reported and symptom severity scores on the Standardized Concussion Assessment Tool— 3rd edition (SCAT3).

Methods Eleven male collegiate soccer players were recruited to take part in three experimental conditions including heading, sham and control conditions. Participants were required to perform 40 headers in 20 min in the heading condition, and control 40 soccer balls directed at them with their hands, chest or thigh in the sham condition. No ball contact was made during the control condition. Blood sampling and SCAT3 symptom assessments were completed prior to and 1 hour following conditions. A subset of participants returned 3 weeks following the heading condition for blood sampling.

Results NF-L was elevated at 1 hour (p=0.004) and 1 month (p=0.04) following the heading condition, and at 1 hour (p=0.02) following the control condition. Tau levels remained unchanged following all conditions. The total number of symptoms (TS) and symptom severity (SS) scores from the SCAT3 were both elevated following the heading condition (p=0.01 and p=0.03, respectively). Both TS and SS decreased following sham (p=0.04 and p=0.04) and control conditions (p=0.04 and p=0.04).

Conclusion An acute bout of soccer heading is associated with increased NF-L concentrations at 1 hour and 1 month following the session and can lead to symptoms commonly reported following sport-related concussion.

  • protein
  • soccer
  • prospective
  • football
  • head

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  • Contributors CW, JDS, KeB, JB, JD, ADW and PvD all contributed to the conception of the study and data collection. CW, HZ, KaB and PvD contributed to data analysis and interpretation, drafting and revision of the manuscript, and final approval of the version submitted for publication was approved by all authors.

  • Funding This research was funded by grants to PvD from the Canadian Institutes for Health Research (CIHR), Canada Foundation for Innovation (CFI) and Mitacs. CW was supported by the Mitacs Accelerate Programme.

  • Competing interests HZ and KaB are co-founders of Brain Biomarker Solutions in Gothenburg AB, a GU Venture-based platform company at the University of Gothenburg. HZ has served at advisory boards for Eli Lilly and Roche Diagnostics and has received travel support from Teva. KaB has served as a consultant or at advisory boards for Alzheon, BioArctic, Biogen, Eli Lilly, Fujirebio Europe, IBL International, Merck, Novartis, Pfizer and Roche Diagnostics.

  • Patient consent Obtained.

  • Ethics approval All procedures in this study were approved by the Clinical Research Ethics Board at the University of British Columbia and were conducted according to the declaration of Helsinki guidelines.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement The data will be made available upon request.