World Cup Reignites Talk of Concussion Safety

We’re going to the finals! Tuesday night, the U.S. women’s soccer team defeated top-ranked Germany to score a place in the Women’s World Cup finals. But national pride and enthusiasm aside, this summer’s tournament has reignited talk about the dangers of concussions and chronic traumatic encephalothopy (CTE) in soccer. Just 28 minutes into Tuesday night’s game, American player Morgan Brian and German player Alexandra Popp’s heads collided on a free kick near the U.S. goal. Both players spent a few minutes writhing on the ground afterwards (Popp with a noticeably bloody head wound), and after a few minutes on the sideline, both were examined by team physicians and returned to the game. FIFA was criticized for not having an independent neurologist on the sideline to evaluate the extent of the head trauma, and the incident prompted a number of articles about player safety.

FIFA, soccer’s international governing body, recently adopted new concussion safety guidelines, which allow a referee to stop the game for three minutes while the team doctor evaluates the player and determines his or her ability to continue playing. But the incident Tuesday night put an international spotlight on the need for independent doctors to perform the evaluations. Others, including former professional players and Chris Nowinski of the Sports Legacy Institute (and author of our Cerebrum article, “Hit Parade: The Future of the Sports Concussion Crisis”), are looking beyond the professional arena and advocating for a ban on heading,  for children under the age of fourteen.

The New York Times and other media outlets have published stories about former soccer players plagued by brain trauma, but research can only tell us so much after the damage has been done. Michael Lipton of Albert Einstein College of Medicine is now using MRI to study the brains of current soccer players in the hopes of better understanding the relationship between head impacts and resulting brain injury and cognitive dysfunction.

In research partially funded by the Dana Foundation, Lipton and his colleagues have found that cumulative head impacts can result in changes to brain structure and worse performance on cognitive tests (particularly memory tests). Their research also indicates that there may even be a heading threshold (more than 1,000 headers) above which the risk for brain damage increases significantly. But that’s not the end of the story, he explains in our new grantee Q&A:

[W]e observed that a subset of individuals who did very little heading, looked, on our tests, like the people who did a lot of heading. The number of people in this study was too small for us to draw strong conclusions, but this observation at least points to the possibility that a minority of people are more sensitive to repetitive head injury, and may have significant adverse effects even with modest exposures.

Dr. Lipton has helped pioneer the use of DTI to evaluate head injuries. Photo courtesy of Albert Einstein College of Medicine.

Dr. Lipton has helped pioneer the use of DTI to evaluate head injuries. Photo courtesy of Albert Einstein College of Medicine.

In a larger study that should end in 2018, Lipton and his team hope to shed light on the role of genes in predisposing players to worse effects of heading. He explains:

For example, the apolipoprotein E gene, in certain variants, is known for its association with degenerative diseases such as Alzheimer’s disease. In that light, we will explore its potential role in the evolution of brain pathology following mild trauma.

Once believed to be the “safe sport,” soccer now finds itself in the company of football and boxing in terms of concussion concern and CTE. With ongoing research by scientists such as Lipton, we can hope that new recommendations for concussion safety are on the horizon.

Read more on Lipton’s thoughts on treatments for mild traumatic brain injury (mTBI) and how it is perceived as a public health issue in our interview.

– Ann L. Whitman

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