Why Collision and Concussion Are Sports’ Twin Dangers

(Bloomberg) -- Danger signs are racking up in the world of sports about the long-term consequences of head injuries. From concussions to the routine heading of soccer balls, there’s mounting evidence that professional and amateur players risk paying a serious price later in life. Rugby player Steve Thompson, a World Cup winner for England in 2003, was recently diagnosed in his 40s with early onset dementia. It’s a growing concern not just for players, parents and high schools, but also for the leagues and ruling bodies that are facing law suits.

1. What’s the biggest medical time bomb?

Chronic Traumatic Encephalopathy. It’s a degenerative brain disease notably found in autopsies of people with a history of repetitive head injuries. That includes concussions and repeated smaller impacts that don’t immediately appear dangerous, as well as collisions between players that can cause a head to oscillate at rates quick enough to harm the brain. CTE, which is linked to dementia, has symptoms including memory loss, depression, problems with impulse control and suicidal tendencies. It’s a major issue for military veterans; dozens of U.S. soldiers suffered traumatic brain injuries from an Iranian missile strike in Baghdad in January 2020. There’s even evidence Alexander the Great was a victim.

2. Is the link with sports accepted?

While the notion of a causal link between CTE and contact sports was dismissed for years, scientists no longer dispute it. Studies show there are hundreds of former football players in the U.S. whose brains show signs of CTE. There’s been a rash of suicides among players, including Junior Seau in 2012 and Dave Duerson, who in 2011 shot himself in the chest at age 50 and requested in a suicide note that his brain be examined. More than 200 NFL players get concussed every season.

3. What about the risk of dementia?

A U.K. study in 2019 found that former professional soccer players were more than three times likely to die of dementia than the general population. At least five of England’s 1966 World Cup-winning team, including Bobby Charlton, were diagnosed with the condition. A 2017 documentary and separate studies by the University of Glasgow and Liverpool Hope University emphasized how thumping the ball with the head is a huge risk. As far back as 2002, a coroner in Britain ruled that ex-England soccer international Jeff Astle died at age 59 from dementia brought on by repeatedly heading the ball.

4. What does this mean for sports participation?

It’s falling in some contact sports. In the U.S., participation in core tackle football fell 21% to 2.7 million in the five years to 2019, according to the Sports & Fitness Industry Association. In rugby-obsessed New Zealand, the share of 13- to 18-year-olds with a “meaningful engagement” in the sport fell 12% from 2015 to 2019. For rugby league, which has a reputation for being even tougher, the decline was sharper. Children aged 11 and under in England, Scotland and Northern Ireland are no longer taught to head the ball in soccer.

5. Who else is at risk?

A 2017 study of college sports by the American Academy of Orthopaedic Surgeons found female athletes more likely to suffer concussions than males. Women’s soccer had the highest rate of concussions, followed by men’s football and women’s basketball. Ice hockey also has a high incidence, along with -- unsurprisingly -- boxing. Even surfing has a problem, as does cricket, where the ball can be projected toward a batsman’s head at speeds in excess of 90 miles per hour. Australia’s Phil Hughes died in 2014 after being struck on the neck. Will Pucovski put his international career on hold in his early 20s after suffering multiple concussions while batting.

6. What’s the NFL doing?

All 50 U.S. states passed laws in the past decade addressing head injuries in youth sports. The national leagues for football, hockey, basketball and baseball have shored up their policies. The NFL ordered teams to limit contact training, banned helmet-to-helmet hits and put up $3 million to see if anyone can come up with a better helmet. But lawsuits abound, and the legal issues are growing in complexity: Two retired players recently filed actions asking that the league stop using data they say discriminates against Black players who make dementia-related claims.

7. What about other administrators?

Soccer’s FIFA has come in for strong criticism, and some protocols remain unclear. In the English Premier League in November, Arsenal’s David Luiz was allowed to stay on the field with blood seeping through a head bandage after a collision that left an opponent with a fractured skull. From 2021, a team will be able to introduce a permanent replacement if a player suffers a head injury, even if it’s used up all its substitutions. Rugby union chiefs cite rule changes to stop dangerous tackles and make scrums safer among the array of safeguards that are now in place. Clubs in a French lower league are trialling lowering the maximum height of the tackle to the waist from the shoulders; tackles cause 76% of all rugby concussions. Still, a pre-action letter of claim has been filed on behalf of World Cup winner Thompson and dozens of other rugby players over the impact of head injuries.

8. Should they go further?

With legal bills from concussion claims mounting, schools shunning contact sports and youth participation under pressure, an existential question arises: Is it possible to play with zero (or greatly reduced) contact? For the top professional leagues (the NFL is a $16 billion enterprise, by far the richest and most popular league in the U.S.), television coverage continues to focus on the day’s biggest hits. A 2017 survey of fans found half thought the NFL hadn’t done enough to address brain injuries, but there was no evidence they stopped watching as a result. Many view brutality as an acceptable part of the package, just as some younger players view head injuries as an acceptable risk.

The Reference Shelf

• Steve Thompson in the Guardian: “I can’t remember winning the World Cup.”
• World Rugby’s reaction to the possibility of legal action.
• A research paper on CTE in the military.
• University research on heading a soccer ball.
• A Bloomberg News story on the need for better helmets in the NFL.
• A Bloomberg Law story on the increase in concussion lawsuits.

©2020 Bloomberg L.P.