On September 29, Robin Le Normand, the center back for Atlético de Madrid and the Spanish national team, had to leave the field in the final minutes of the Madrid derby played at the Cívitas Metropolitano stadium after suffering a severe blow to the head when colliding with Real Madrid midfielder Aurélien Tchoaumeni. Result: a head injury with a subdural hematoma that will prevent him from returning to the playing fields until the hematoma is reabsorbed. It was a game changer. A chance blow to the head that, however, according to a study published in the prestigious scientific journal Lancet Neurologyand presented this morning at the Hospital Clínic of Barcelona, is increasingly common.
“I have been watching football for 50 years and my impression was that in recent decades football had become more competitive, more physical, more aggressive; and that more and more blows to the head were seen that require medical assistance,” says Dr. Alex Iranzo, neurologist and head of the Sleep Unit at the Hospital Clínic. To corroborate their hypothesis, the authors of the study, led by Iranzo, set out to analyze World Cup matches from different decades. They chose West Germany in 1974, Italy in 1990, Germany in 2006 and Qatar in 2022, the last football World Cup held to date. From each of these tournaments, Irina Martín, a medical student at the University of Barcelona, watched 30 matches chosen at random and took note of each hit to the head with the ball and each blow received by a soccer player’s head, since whether it was colliding with another player, against a post or against the grass.
The results corroborate Iranzo’s hypothesis. In the 1974 World Cup, around 1,800 headers on the ball were recorded, compared to 2,600 in the 1990 tournament, 2,700 in 2006 or 2,500 in 2022. However, the most significant data in the study is the number of hits received by the players. footballers in the head, who went from 17 in 1974 – barely one for every two games – to 22 in Italy 1990, 46 in Germany 2006 and 50 in Qatar 2022 – more than 1.5 per game -. Of all these head collisions recorded, 33% required medical assistance and only in five did the blow force the footballer to leave the field. All five, curiously, in the last two World Cups analyzed, 2006 and 2022.
The collection of this data is more important than it may seem at first glance. “We have measured this because repetitive low-intensity blows (headbutts) and collisions to the head are associated in the long term with a greater risk of developing neurodegenerative diseases such as Alzheimer’s and Parkinson’s,” says Alex Iranzo.
The relationship between blows to the head and dementia is much more studied in sports where physical contact is much greater, such as American football, ice hockey or rugby. In fact, according to data from FIFPRO, the entity that brings together football players’ unions around the world, it is estimated that for every case of concussion in football there are 150 cases in American football or ice hockey, and 300 in rugby. In football, however, alarm bells began to ring after the death in 2002 at the age of 59 of the British goalscorer Jeff Astle, recognized for his power in the aerial game. And they skyrocketed when England’s 1966 World Cup heroes began to succumb to neurodegenerative diseases. Of the 11 who started on the Wembley pitch in the final against Germany, five have died with dementia (Ray Wilson, Martin Pieters, Nobby Stiles, Jack Charlton and Bobby Charlton).
Since then, retired footballers such as Alan Shearer and Gary Lineker have expressed their concern about this and have even promoted football matches without headers. More recently, former Real Madrid center back Raphael Varane explained in an interview published in the French sports newspaper L’Equipewho recommended to his seven-year-old son “not to headbutt in training and matches.” That same recommendation was officially taken by the American Soccer Federation in 2015, when it prohibited head-butting in training for children under 10 years of age. It was later followed by other football federations such as the English, Scottish and Northern Ireland, which prohibit hitting or heading children under 12 years of age.
These prohibitions are supported by the latest scientific evidence. According to a study carried out in Scotland in 2019 with the support of the English federation and the players’ union, footballers would be 3.5 times more likely to develop neurodegenerative diseases in the future than the general population. Another more recent study, carried out in Sweden, indicated that elite footballers are 1.5 times more likely than the rest of the population to develop dementia or Alzheimer’s. From the Hospital Clínic itself, Dr. Alex Iranzo led another investigation that concluded that being a professional soccer player increases the risk of suffering from REM sleep disorder, a disorder considered an early symptom of Parkinson’s.
“The most important thing is not to be alarmist. The vast majority of soccer players will never develop dementia or Parkinson’s, but they are more predisposed than the population that does not hit their head daily. These blows leave small marks on the brain that after 30 or 40 years, in people with a predisposition, can be the drop that causes these diseases to appear,” he explains. The researcher is aware that eliminating the header in soccer is a chimera: “Imagine, we would have been left without Puyol’s goal against Germany in the 2010 World Cup or without Merino’s goal in the last Euro Cup!”; but he defends the need to educate footballers and coaches on the importance of “not risking one’s own head or that of others”; and encourages football federations and competitions to adopt preventive strategies such as educational programs, fair play regulations, automatic red cards for intentional hits to the head, reducing the number of matches played per footballer each season or the use of protective equipment.
The Federation and the AFE, hand in hand
Claudio Vázquez Colomo, head of Medical Services of the Royal Spanish Football Federation (RFEF), explains to Morning Express that this type of research “is important” because it allows us to continue advancing and generating knowledge about the fact that being a footballer can be considered a risk factor for developing neurodegenerative diseases. “It is true that a few decades ago the type of game was different and so was the ball, but regardless of that it seems that the risk is there, since everything indicates that constant hits increase the risk of these diseases. Furthermore, in the study carried out in Sweden it was found that goalkeepers were not affected, which further reinforces the idea that field players are more exposed to these diseases,” he points out.
Although he considers that there is still some way to go, the doctor believes that considerable progress has been made in raising awareness among coaches and footballers about the importance of taking care of these blows to the head. “Within the world of football, doctors have been fighting for years to achieve greater social and sporting awareness of the importance of traumatic brain injury. Until very recently, a player who suffered a severe blow to the head was almost put on the field on the fly without being examined. Now we have achieved that in the event of what is called a concussion, a referee can stop the game for three minutes so that the footballer can be examined and if there is any sign of alarm he can be replaced,” explains Vázquez. In this sense, the team’s doctor recalls that on July 1, a protocol in the trial phase created by the International Football Association Board (IFAB) came into force that, in those competitions that adopt it, will allow players to be replaced. have suffered a concussion without said change counting in the calculation of the five substitutions allowed in the main international competitions. The objective, the doctor points out, is to avoid what is known as second impact syndrome. And, as the expert points out, if a footballer suffers a second concussion in the same match or during the weeks it takes to recover from the first, the consequences “could be very serious.”
Eugenio Martínez de las Heras knows about these advances Geniewho after debuting with Real Madrid in the 1984-1985 season developed a 17-year career for 2nd and 2nd B teams (today the First Federation). Throughout that career as a central defender he suffered two concussions. The first wearing the Madrid Castilla shirt, in the 2nd Division. “I got a gash in my temple and I didn’t really know where it was.” The second as a Burgos footballer in the 1987-1988 season, in a duel against Hércules: “They hit me on the back of the head and I continued playing dazed, as if I were in a movie.”
Today, still linked to football and as head of the Health Department of the Spanish Football Players Association (AFE), he recognizes that a situation like this would be unviable. The AFE itself and La Liga presented a protocol on concussions at the beginning of the 2023-2024 season. The campaign also includes an awareness section for footballers, in which, through an informative video, they inform about the symptoms of a traumatic brain injury and the importance of leaving the field of play if they suffer one.
“It is an issue that worries us, as this campaign shows, but we are also quite concerned about giving an alarmist vision,” says Geni. The former soccer player is skeptical about the impact that heading the ball can have on a possible future development of dementia, especially now that “the material of the ball is increasingly lighter and less heavy.” “It is true that today’s balls are not as heavy,” admits Dr. Alex Iranzo; which, however, clarifies that this lightness does not necessarily reduce the risk, since in return it increases the speed of the ball: “Today, if you are hit in the head by a ball or you take a corner, since the speed of the ball is greater, The deceleration is also greater and the brain bounces against the skull several times.”
Geni, finally, also shows his discrepancies with the results of the study, especially with regard to the numbers of headers given to the ball. “I experienced soccer in the 80s and 90s, the mud fields, the Mikasa ball that swelled with water and weighed two kilos, which led to a more direct game and more aerial play. Today there is a more combination game, with shorter center forwards, wingers with changed legs, and that means that there are many fewer headers in a match than there were decades ago and many fewer divided balls, which is where most of the matches occur. the blows,” he argues. Geni, however, does claim the need to raise awareness among footballers about the risks of concussions. “It is an important part of the protocol, because with the adrenaline of the games, sometimes you get hit in the head and all you want is to go out and play again. The danger is there and that is why it is important to understand when to leave the field,” he concludes.