Soccer / medical

Killed by Football: "The King", Head Injuries, & FIFA's Ticking Time Bomb
During his footballing career Jeff Astle was nicknamed "the King". As West Brom's idolised number 9, the pitch was his domain, the crowd his subjects, The Hawthorns his kingdom. His style was that of the traditional centre forward, strong, pugnacious, good in the air. In 2002 Jeff died; he choked to death in front of his horrified family, robbed of his mind, he choked to death not knowing he'd ever been a footballer. Even in death there were no certainties left. He had been diagnosed as suffering from Alzheimer's Disease. But, as it turned out, Jeff didn't have Alzheimer's, he, as a port-mortem examination confirmed, had been suffering from Chronic Traumatic Encephalopathy a condition caused by repeated concussions and sub-concussions. His brain was so damaged by repeated trauma that it couldn't signal Jeff to spit out, to clear his airway, to save his life. What caused his sad end? Well, the concussive effect of repeatedly heading a ball. Jeff had been killed by football. Football is unique in being the only sport where participants deliberately engage in repeated head impacts. Yet, despite that fact, many of the preventative measures employed to date have focused solely on accidental collisions. That may be about to change as new studies into the impact of heading suggest the time has come for a complete rethink. Researchers at Albert Einstein College of Medicine have found that repeated ball heading has a greater negative effect on cognitive function than unintentional impacts. Over a 2 week period data was collected from 308 amateur football players aged from 18 to 55. As part of the study participants were charged with recording their recent footballing activity and with completing a battery of neuropsychological tests. Heading frequency was found to correlate with impaired performance on psychomotor speed and attention tasks and with deficits on working memory tasks. According to lead researcher Dr. Michael Lipton the results are concerning as "even transient reductions in neuropsychological function from heading could translate to microstructural changes in the brain that then lead to persistently impaired function." The findings are echoed by those of a Puerto Rican study which focused on a cohort of children aged 9 to 11. Prior to playing, the children took a series of cognitive tests and were equipped with a specialised headband designed to track head movements and related impacts. Much like the Einstein study reduced cognitive performance was again linked to increased heading frequency. On this occasion, however, differences between the sexes were apparent. Boys tended to display drops in the capacity to quickly interpret new information, while girls performed worse on sequential memory tasks. Meanwhile, the data collected from the headbands underlined the extreme forces involved in heading the ball. Acceleration forces of between 16 to 60 Gs were recorded. To put that into context, a force of 60 Gs would likely lead to a concussion in an adult player. What would it do to a child? Let's use the case of Morocco winger Nordin Amrabat to highlight football's seeming indifference to this ticking time bomb. During a World Cup match against Iran, Amrabat, resembling a Ko'ed heavyweight, lay prostrate on the pitch. Seconds before his head had impacted the ground violently after losing out on a 50/50 tussle with an opposing player. The Moroccan medical staff rushed to their stricken player. They duly picked Amrabat to his unsteady feet, slapped him in his groggy face, and told him to get about his business. Unsurprisingly, this slipshod treatment didn't exactly do the trick, and Amrabat was soon on his way to hospital. Amrabat, for his part, remembers none of this. "I can’t even remember the beginning of the game before the incident. From the first minute of the match until I woke up in the hospital five or six hours later“. Yet, 5 days later, and in contravention of FIFA's concussion protocol, he was back in the thick of it against Portugal. Even Morocco's team doctor, Abderrazak Hifti, admitted the decision to include Amrabat was wrong, but confided that he felt pressure from within the team to clear the player. What is the point of establishing a concussion protocol, if it isn't enforced? FIFA have to accept a degree of responsibility in Amrabat's case. He should have been automatically excluded from the Portugal match, the decision taken out of both the Moroccan FA's and the player's hands. Best practice must be universally applied with competing interests duly dismissed. Consider, Amrabat's own "enlightened" self justification for playing, to see why. “A week is the official time you should recover for to make sure that you are safe but I decided to make it shorter. I Googled the consequences that concussion can have on someone and I thought I can do it, I can play.” Did Google mention that returning to play before an initial concussion has fully resolved itself leaves a player susceptible to recurrent concussions, which can be provoked by ever decreasing levels of force? In other words, by playing Amrabat exposed himself to an increased probability of suffering a repeat concussion. Football needs to disabuse itself of the "ah sure it's just a knock" mentality and recognise the life and death implications of concussion. If Amrabat were a rugby union player suffering from concussion, he would be excluded for a minimum of 21 days. Contrast that to FIFA's suggestion (it's clearly not a rule) of 6 days and make up your own mind as to which sport takes concussion seriously. While establishing a protocol in theory marks a step forward, in reality it will represent little more than lip service if it isn't enforced and if sporting expedience continues to supersede medical recommendations of best practice. In the United States heading for all children aged 10 and under has been banned since 2016. Dr. Lipton suggests that measures should go even further with across the board restrictions placed on heading both during practice and games. "Heading is a potential cause of brain injury," he warns, "and since it's under control of the player, its consequences can be prevented." The future may even see outfield players following Petr Cech's sartorial lead. Research from the Virginia Tech Helmet Lab, suggests that certain models of "soccer helmet" can reduce the risk of concussion by more than 70%. Moreover, miniaturised electroencephalogram technology implanted in helmets could signal to the sidelines if a player has suffered a concussion and dismiss any bravura attempts at dissimulation on the player's part. Ultimately, as Dr. Lipton himself cautions "We need a much longer-term follow-up study of more soccer players to fully address this question,". What is already abundantly clear is that football will need to adapt; through strict adherence to a more rigorous concussion protocol, through the integration of modern medical technology, and perhaps through fundamental changes to laws of the game.

Yaya Toure