Enhancing Brain Health in Athletes: Understanding Head Impacts and Interventions

As concern grows over head impacts in sports, particularly soccer, understanding the brain health implications in athletes has never been more critical.

The mechanism initiating changes in cortical folding (gyrification) may be associated with downstream neurological effects. Frequent heading in soccer is associated with measurable brain changes in observational cohorts of amateur players. These studies highlight structural alterations that could be relevant to neurological function, signaling a potential risk that warrants monitoring—particularly in cohorts with higher heading exposure.

Disruption in neural pathways can be associated with difficulties in cognition and movement precision—functions that are crucial in sport. While formal guidelines focus primarily on concussion management (for example, positions from national public health agencies, neurology societies, and the Concussion in Sport Group), routine monitoring for subtle cognitive or motor changes from repetitive head impacts remains an area of ongoing research. Research in young athletes showing early neurodegenerative signals has been interpreted by some as hypothesizing links to processes implicated in chronic traumatic encephalopathy (CTE); however, CTE remains a postmortem diagnosis, and causality or temporal sequencing in living athletes has not been established.

These evolving insights are reshaping how clinicians and coaches design training to mitigate neurological risks while supporting performance. Exercise interventions such as aerobic, resistance, and high-intensity interval training (HIIT) are being utilized to enhance neuroplasticity (for example, increases in brain-derived neurotrophic factor and changes in functional connectivity) and cognitive reserve. Preclinical work—including reports of HIIT-associated increases in BDNF in animal models—and some human exercise studies suggest that HIIT can elevate neurotrophic markers; however, evidence specific to athletes with repetitive head-impact exposure remains limited.

These exercise interventions are promising adjuncts in athletic and rehabilitation care, with targeted training adaptations that may support cognitive reserve over time, though adoption and evidence strength vary across settings. New insights into exercise neuroscience now allow more tailored approaches matching athletes' needs—for example, graded exertion protocols with symptom-limited thresholds, cognitive load titration in return-to-learn or return-to-play plans, and vestibular/oculomotor-directed therapy—though personalization strategies continue to be studied.

Practical monitoring strategies can help teams translate uncertainty into action. Baseline and periodic assessments of cognition, balance, and visual–vestibular function provide reference points to detect change over a season. Incorporating informant input from coaches or parents, as appropriate, can surface subtle shifts in reaction time, decision-making, or coordination that may not appear on brief screenings.

Exposure tracking adds needed context. Simple logs of heading frequency and technique during training and matches, combined with session RPE (rating of perceived exertion) and sleep quality notes, can help correlate symptom fluctuations with periods of higher impact exposure. Where available, validated head-impact sensors may offer additional data, but they should complement—not replace—clinical observation and athlete report.

Shared decision-making and counseling remain central. Athletes and families benefit from balanced discussions that acknowledge both the uncertainties in current evidence and the potential for cumulative effects. Counseling can include technique refinement to reduce unnecessary headers in practice, emphasizing protective rules adherence, and clarifying return-to-play steps when symptoms emerge.

Implementation barriers are real. Resource constraints, limited access to multidisciplinary care, competing performance pressures, and variable familiarity with neurocognitive tools can slow adoption. Teams can start with low-cost steps—standardized symptom check-ins, brief cognitive tasks, and consistent documentation—while building toward more comprehensive protocols as capacity grows.

Research gaps define the road ahead. Priority areas include longitudinal studies linking exposure metrics with multi-modal biomarkers, trials evaluating tailored exercise programs for head-impact populations, and pragmatic studies of monitoring workflows that fit real-world sport settings. As evidence accumulates, recommendations will evolve; for now, careful monitoring and individualized load management offer a prudent path.

Key Takeaways:

• Track heading exposure over time and contextual factors (e.g., practice vs. match, technique) to inform training and risk discussions.
• Monitor cognition and motor function longitudinally using brief, repeatable screens and collateral observations; escalate evaluation if changes emerge.
• Use individualized exercise programming as an adjunct—not a substitute—for clinical care, and set expectations about variable evidence and adoption.
• Discuss uncertainties and research gaps openly with athletes and families, incorporating shared decision-making into participation and return-to-play choices.