Brain trauma in soccer

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Brain traumas (see also traumatic brain injuries ) in soccer are injuries to the brain that occur in connection with active soccer games. They represent 4% to 22% of all injuries in football and can occur without a wound , abrasion or swelling on the head.

Emergence

Football is a contact sport, and participation in this sport sometimes carries considerable health risks , both through player-player contact and through frequent header games. Football- related head injuries include concussions or bruises and in most cases result directly from a blow or blow to the head (contact forces). However, strong acceleration or deceleration of other parts of the body, in which the inertial forces are transferred to the brain, can cause damage to the brain. As a result of concussions, which can be seen as minor brain injuries, serious damage such as chronic traumatic encephalopathies (CTE) can also occur.

Intensive sporting activity in soccer can also lead to cognitive impairment. In professional Dutch football players, poorer cognitive performance was found during neuropsychological tests than in the control group. There was a correlation between the number of headers and the poorer performance in the test. Strikers and defenders were also more affected than midfielders.

In 1989 the brains of 33 former football players of the Norwegian national team were examined using computed tomography . Cerebral atrophy was found in a third of the players , which it was suspected to have resulted from repeated minor head injuries, primarily through the header game. Two years later, in extensive psychological tests, 30 (81%) of 37 former Norwegian international players showed mild to severe deficits in attention, concentration, memory and judgment, which, according to the authors, were likely to have arisen cumulatively from repeated brain trauma after headballs.

In 2013, a magnetic resonance imaging study was published in which, in 39 amateur soccer players with a median age of 31, microstructural changes in the white matter of the brain and cognitive changes were associated with the frequency of headers. All players had been active since childhood and had played 885–1550 headers per year. Players with more than 1,800 header kicks performed worse in memory tests. The studies, carried out at the Gruss Magnetic Resonance Research Center (MRRC) of the Albert Einstein College of Medicine in New York, showed significantly lower water movements in three areas of the brain. The examinations were carried out with the help of diffusion -weighted magnetic resonance tomography (DW-MRI or DTI for Diffusion Tensor Imaging), an imaging method with which the diffusion movement of water molecules in body tissue is measured and spatially resolved. DW-MRI is primarily used for brain exams. The diffusion behavior in the tissue of the central nervous system is characteristically changed in some diseases, and the directional dependence of the diffusion allows conclusions to be drawn about the course of large nerve fiber bundles (tractography), for example in the white matter of the cerebral cortex.

A study published in 2017 on 222 amateur football players (175 men, 47 women) who recorded the frequency of their headers over a two-week period and also noted any concussion symptoms, as it were, showed that frequent headball games lead to concussion-like problems. On average, each player had 44 and each player 27 header contacts. Each participant headed an average of 5.3 times per game. The players in the top quarter, i.e. those with the most header contacts, were three times more likely to report concussion-like symptoms such as pain, dizziness, and lightheadedness than the players in the bottom quarter.

Amyotrophic lateral sclerosis (ALS)

The motor neuron disease amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's syndrome, occurs more frequently among football professionals. At the University of Turin , the medical records of 7,325 former football players in the first and second Italian leagues from 1970 to 2001 were evaluated. ALS was found in eight soccer players. Since the ALS prevalence is usually 1.24 in 7,325, this resulted in a 6-fold increased risk for the footballer cohort. The longer the players played the sport and if they were active after 1980, the higher the risk. Basketball players and cyclists whose cohort sizes were 1,973 and 1,701, respectively, did not develop ALS. An increase in ALS diseases has also been observed among football professionals in the British Premier League and US football players. Why ALS accumulates among football professionals remains a mystery; In addition to the damage caused by too many headers, the long-term effects of doping are also under discussion.

cases

The Polish national player and Bundesliga professional Krzysztof Nowak from VfL Wolfsburg fell ill with ALS in 2001 and was dependent on a wheelchair within a very short time. As a result, Nowak had to end his football career at the age of 25 and died in 2005 at the age of 29. Some scientists believe that the many headballs while playing are the cause of ALS, while others believe that the extremities are trauma. Other victims are the Italian players Armando Segato, Guido Vincenzi, Albano Canazza, Gianluca Signorini, Lauro Minghelli and Stefano Borgonovo .

Chronic Traumatic Encephalopathy (CTE)

CTE is a special form of encephalopathy and is also called dementia pugilistica , punch-drunk syndrome, boxer syndrome or boxer encephalopathy in medical nomenclature . It is a neural dysfunction that occurs in people when they are exposed to frequent blows or bumps on the head. In football, for example, this is the case with headers and collisions with other players as well as when hitting the ground. The number of frequent headbuttings and thus the CTE risk is naturally particularly high in collision sports such as American football , boxing , wrestling and rugby , but repeated internal head injuries are also observed in other sports, namely soccer, ice hockey, lacrosse, skiing, karate, horse riding and skydiving. Of the cases of CTE that had been neuropathologically confirmed by 2009 , 46 (90%) occurred in professional athletes.

cases

The 29-year-old football semi-professional Patrick Grange, who died of amyotrophic lateral sclerosis in April 2012, was diagnosed with post mortem CTE level 2 in February 2014 (the highest level is 4). Grange had been a header specialist. He is the first soccer player to be diagnosed with CTE.

When Jeff Astle , a former center forward in English professional clubs West Bromwich Albion , who in 361 games recorded 174 Torerfolge 1964-1973 and 2002, died at the age of 59 years, was first Alzheimer's disease diagnosed. Later, however, an examination by the Glasgow neuropathologist Dr Willie Stewart found that Astle had CTE. His brain showed exceptionally severe pathological changes, Stewart noted: "In terms of head injuries and dementia, in boxers and others that I have seen, it was amongst the worst." "It was quite a remarkably scarred brain." According to Stewart, Astle's case is not unique in football. The Football Association (FA), the leading English football association , carried out a ten-year long-term study on the health risks of headers after Astle's death, but was unable to present any results after these ten years. In protest, West Brom supporters raise awareness in the ninth minute (Astle's shirt number) of a game.

Hilderaldo Bellini , a Brazilian national soccer player who captained the Seleção to the World Cup title in 1958 , died in 2014. Bellini's family made the brain of the deceased available for medical Alzheimer's research. During the examinations by the neuropathologist Dr Lea T. Grinberg it turned out that Bellini suffered from CTE and not from Alzheimer's disease , as initially assumed. Bellini's brain showed symptoms of level 4, the highest level.

In the Premier League , new rules for dealing with head injuries were introduced at the beginning of the 2014/15 season. These are: "A player suffering a head injury must now leave the pitch. Team managers or coaching staff will no longer decide if a player continues to play and the final decision will be with the club doctor. Home teams in the Premier League must now have a third "tunnel" doctor on match days to support the work of the doctors for both sides. The "tunnel" doctor will serve as an extra pair of eyes to spot potential concussions and watch TV replays to see the severity of incidents. The FA, in conjunction with the Football League, PFA Professional Footballers' Association and LMA (League Manager Association), is to launch a campaign aimed at making players and managers at all levels aware of the dangers of head injuries. The Premier League is to employ its own doctor to conduct research and liaise with all 20 club doctors in the league on key medical matters. All Premier League players are to undergo baseline neurological assessments as part of their annual medical check-up to help docto rs measure their recovery time if they suffer a concussion. "

Concussions

The US Centers for Disease Control and Prevention (CDC) estimated in 2010 that between 1.6 and 3.8 million concussions occur annually during exercise and other recreational activities. In soccer, concussions account for 2–3% of all injuries. The rate is as high as in American football (as of 1997). In soccer, a player typically has up to twelve head contact with the ball, which can reach a speed of 100 km / h.

After a concussion, the risk of a further one is increased because less acceleration energy is needed to cause additional damage. A second small trauma can have fatal consequences, which are called Second Impact Syndrome (SIS) in English. Longer recovery times without exercise are therefore absolutely appropriate.

Even in professional football players whose careers had not been diagnosed with a concussion, joint investigations between Ludwig Maximilians University and Harvard Medical School in 2012 using diffusion-weighted magnetic resonance imaging revealed differences in the integrity of the white matter in the orbitofrontal cerebral cortex and in the corpus callosum . Swimmers who were also free from concussions served as a comparison group. The differences are explained by the greater number of 'subconcussive' head butts in football, i.e. head butts that do not yet trigger a concussion. Because of the small cohort sizes (12 soccer players, 11 swimmers), the study should be interpreted with appropriate caution.

In college (NCAA Division I) football playing girls seem to be more prone to internal head injuries than boys, because they are exposed due to their weaker neck muscles larger spins. The concussion rates among girls and women playing soccer in North America are twice that of boys and men; across America the numbers are in the tens of thousands annually. In the United States, the American Youth Soccer Organization (AYSO) raised concerned voices in 2014 that boiled down to banning children from playing soccer with headers. In 2015, the United States Soccer Federation (USSF), the official soccer federation of the USA, decided to ban all or part of the game of headers in US youth soccer. Parents had previously filed a class action lawsuit against the world football association FIFA and the US football associations. Heading the ball is prohibited for children under the age of 11, and headers are severely restricted for children between the ages of 11 and 13.

In November 2011 the '4. International Consensus Conference on Concussion in Sports' took place. FIFA was a co-organizer and host. At this conference, representatives of the International Olympic Committee , the National Football League , the National Hockey League , World Rugby , the International Ice Hockey Federation , the Fédération Équestre Internationale and the Australian Football League came together to share their experiences and new ideas on prevention, Recognition and to exchange treatment methods. The aim was to find a common approach to dealing with a problem that can have very serious consequences for both professional and amateur athletes. Toronto neurosurgeon Karen Johnston said at the conference:

“Science helps us to understand more and more that the brain is disturbed in the event of a concussion, and that there are undoubtedly functional problems with brain activity. Very often we see athletes who, in addition to their head injuries, are subject to mood swings and have problems returning to their familiar work and sports world. "

According to FIFA, there are two situations in football in which the team doctor may enter the field of play without being asked, i.e. without a signal from the referee. On the one hand, there is a suspicion of sudden cardiac arrest and, on the other hand, there is a suspicion of a head injury, for example a concussion. When it comes to the medical diagnosis, the doctor alone decides; the trainer has nothing to say here.

cases

The former Swiss national soccer player and central defender Dominique Herr had to end his career two years after participating in the World Cup in 1994 . The reason was concussions, of which he had suffered a total of seven. “That added up and it took less and less,” says Mr. It was not customary to take a break back then, and he sometimes trained with a headache.

In 2006 Chelsea goalkeeper Petr Čech suffered a fractured skull in the game against Reading . Since then he has been wearing a helmet and is considered the voice of those who fear serious head injuries in football. After Čech's accident, the emergency plan in the Premier League was adjusted.

In November 2013, the goalkeeper has been in a match of the English Premier League Hugo Lloris of Tottenham Hotspur against Everton by the opposing striker Romelu Lukaku hit so hard on the head that he briefly unconscious was. His team doctor recommended a move, but Portuguese coach André Villas-Boas resisted. After the game he said: “Hugo has a strong character and is a great personality. So we decided to leave him on the field. "

In February 2014, goalkeeper Roman Bürki was hit in the head by Grasshoppers Zurich in a game in St. Gallen after a kick by his opponent Kristian Nushi. For about 15 minutes, Bürki lay motionless on the lawn with a concussion, as a stretcher was missing that was suitable for transporting the goalkeeper.

The concussion of the German national soccer player Christoph Kramer in the 2014 World Cup final between Germany and Argentina attracted special attention in front of a broad audience . Kramer's head collided with the shoulder of his opponent Ezequiel Garay in the 17th minute . Kramer was initially unconscious after the knockout check and continued to play from the 20th minute. Previously, due to a memory gap, Kramer had asked which game was currently. Referee Nicola Rizzoli urged Kramer to be substituted, which was only completed in the 31st minute. To this day, Kramer cannot remember the scene or the fact that he continued to play for more than 10 minutes. A US MP then turned to FIFA and wrote: "FIFA's handling of traumatic head injuries is unacceptable."

During the 2014 World Cup, the players' union FIFPro demanded that FIFA guarantee the safety of the players. The occasion was Uruguayan Álvaro Pereira , who was unconscious on the pitch after a collision against England. The team doctor indicated that he needed to be replaced. Instead, Pereira played again until the end of the game shortly afterwards, after urging it with great gestures. A very similar case involved the Argentine Javier Mascherano , who suffered a head-to-head collision with Georginio Wijnaldum in the semi-final against the Netherlands . Mascherano continued playing two and a half minutes after the collision and also played again four days later in the final against Germany.

Flooring

Concussions can arise not only through player-player contact, but also as a result of the head coming into contact with the floor of the playing field if it does not cushion the impact well. Studies in several sports at American high schools found that it causes 15.5% of all concussions. Artificial turf has fallen into disrepute because of its low impact reduction, but scientific research has produced mixed results in this regard.

Trivia

The long, thin processes (axons) of the nerve cells are particularly prone to injury when stretched and can become porous. If there are gaps in orientation or memory, the frontal lobe is particularly affected.

The 192-time American ex-national soccer player and world champion Brandi Chastain (* 1968) made her brain available to research for posthumous CTE analyzes in 2016. Before that, Chastain had advocated a ban on headers in youth soccer.

See also

literature

Web links

Individual evidence

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