Brain injuries in soccer – Magazine ?

In both American and soccer, blows to the head (and heading the ball) can cause concussion and traumatic brain injury. It’s time to protect the players.

American football is a tough sport, with strong, burly players who leave their opponents to the ground with one blow. The practitioners of this sport, robust athletes with helmets, shoulder pads and other protection, usually get up as if nothing had happened after a collision or emerge unscathed from under a crowd of people, ready for the next play, although sometimes there are legs or Injured knees that require the player to be taken off the court. But things can be much worse if a blow to the head shakes their brain, causing a concussion that will eventually cause an initially invisible, but serious deterioration in cognitive functions. It has recently been discovered that soccer (or simply soccer), an even more popular sport, could be just as dangerous for its followers.

uncomfortable reality

Research is being conducted to improve safety in soccer and football, as well as to understand why concussion can be so damaging to the brain. In the case of the American, the evidence that it can cause shock has been accumulating for a long time, but the National Football League (NFL), the multi-billion dollar organization that controls professional American football, turned a blind eye until it was sued by 4,500 former players. In 2015, a federal court in the United States approved an agreement through which the NFL agreed to disburse $765 million to compensate former players with brain damage and to fund research into brain injuries. The NFL has changed its rules to reduce head impacts during the game.

Many observers think these measures are insufficient and question the validity of the concussion statistics presented by the NFL. As if that were not enough, this problem also affects student American football players and all amateurs in general. But the issue is already being recognized. Now soccer has to face the same unpleasant reality, a sport much more popular than the American sport, with some 250 million players of both sexes around the world and multitudes of fans.

The bad thing about using your head

It may seem exaggerated to compare football with American football in terms of its ability to cause brain damage. In the American style, the sound of hooves colliding gives an idea of ​​the large amount of force and energy that is transferred in impacts. Any blow to the head can jar the skull enough to cause shock (a word that means “violent shaking”) and traumatic brain injury (TBI), which can cause everything from loss of consciousness and mental confusion to long-term injuries.

Most worryingly, even a mild head injury that only knocks the player out of action for a few moments can cause progressive cognitive damage if it occurs repeatedly. This degenerative disorder, known as chronic traumatic encephalopathy (CTE), resembles Alzheimer’s disease, with symptoms such as depression, memory loss, and emotional instability. Like Alzheimer’s, CTE is incurable and only manifests itself after years, making diagnosis difficult. An important clue in the identification of this disease was discovering former American football players whose mental state had deteriorated, in some cases from an early age.

Soccer, unlike American football, is an elegant game in which speed, agility and skill are worth more than brute force. Players do not wear helmets or shoulder pads; They are dressed lightly and wear shin guards for protection only. Violence in the game is grounds for expulsion, which does not prevent soccer from having a high potential to cause injuries. Players move at high speed, and in their runs they can collide, stumble, and fall resoundingly while trying to grab the ball, or crash into the goal posts. At the 2014 World Cup in Brazil, there were three cases of loss of consciousness due to blows to the head, but the three players insisted on returning to the game against medical recommendations. One of them, Christoph Kramer of Germany, suffered the mental disorientation typical of a concussion and had to leave the field with assistance.

As if that were not enough, football has a feature that almost seems designed on purpose to cause brain injuries. In addition to using his feet, the player can control the ball with header shots. This subjects the head and brain to forces and torques that they cannot tolerate repeatedly. The effects of these impacts may accumulate to produce CTE, especially in young people and women, whose smaller, less resilient necks do not provide the support needed to absorb these impacts.

It is not known for sure how much damage head hits cause in soccer but, as in American soccer, some cases point to a real problem of TBI and CTE. In 2013, two well-known soccer players died: a former Brazilian champion and a 29-year-old American semi-professional player. Analysis of their brains showed that they suffered from CTE. There are previous similar cases. In 2002, Jeff Astle, an English player for the West Bromwich Albions team known for his ability in heading plays, died. He was 59 years old, but his brain was so damaged by CTE that one doctor compared it to the brain of a 90-year-old man.

FIFA, like the NFL, refuses to accept the possibility that injuries caused by football can affect the brains and lives of players. The opposition of both organizations aims to protect a very profitable business. But evidence beyond the anecdotal is needed to show that playing soccer can have serious long-term effects. We still do not have indisputable scientific and clinical evidence of the relationship between football and brain injuries. For the sake of this sport and its fans, we must understand how these injuries occur and find ways to protect players.

Acceleration

You could start by studying the biomechanics of blows to the head to understand how they can cause concussion. In 2007, Kevin Guskiewicz, a sports medicine specialist, and his colleagues at the University of North Carolina, reported pioneering results in the case of college or university football. For five seasons, the researchers studied 88 players fitted with helmets with devices to measure the acceleration produced by the typical forces of the game. The data was transmitted by radio in real time to computers located next to the field. Analysis of more than 100,000 head impacts showed that the forces are enormous, with accelerations up to 169 times that of gravity (i.e. accelerations of 169g). It is a very high value. In experiments with rocket-powered sleds to determine the acceleration limits for fighter pilots and astronauts, it is shown that above 25g there are injuries even with the body properly supported. The rotational impact data is equally worrying. A rotational impact is a skewed blow that produces a spinning effect. The maximum angular acceleration measured was almost 2,400 revolutions/s2, indicating that an American player’s head can undergo extremely large and rapid twists.

The good news is that of all these impacts, only 13 caused a concussion. But the results are disconcerting, because the severity of the shock does not correspond to the magnitude of the impact that caused it. A stronger direct or rotational blow does not necessarily produce a more severe concussion. Another study, carried out in 2009 by a different research group, confirmed that large accelerations, in this case more than 80g, do not necessarily cause shock. These results make it difficult to define the limits of tolerance to concussion, as well as to improve protective equipment.

These investigations have less time in football, where, in addition, they are more difficult to carry out because the players do not wear helmets to mount the measuring instruments. But in 2012, Erin Hanlon and Cynthia Birs, from Wayne State University in Michigan, managed to measure head accelerations for the first time in women’s soccer of 13- and 14-year-old girls. The researchers mounted wireless instruments and accelerometers on compact bandanas that did not interfere with the players’ movements. However, the study was limited to practice games because the girls were reluctant to wear the bandanas in competition.

Data was obtained for 24 players, which were stored on a computer. The match was videorecorded to be able to relate the measured accelerations to their causes: head blows and other impacts, mostly clashes and falls, in which there were no important differences in terms of the force exerted. The highest acceleration was 63g. There were elevated angular accelerations, but no concussions were diagnosed during the study. Certain players made multiple moves with their heads, but the number was not enough to evaluate their effects.