Head injuries have been a big talking point in football for a long time. Prof. Dr. Tim Meyer, national team doctor and chairman of the DFB Sports Medicine commission, spoke to DFB.de in an interview to give his view on some pressing questions and current developments.
Prof. Dr. Mayer, many parents in Germany were unsure about the decision taken by the US football association to ban children under the age of 11 from heading the ball. Is it really dangerous for children of this age to head the ball?
I don’t think we need a complete ban like this nowadays. In my opinion, the studies that have been carried out in the USA don’t provide sufficient evidence to support the need for complete ban of heading the football. Therefore, you have to think about what the best strategy would be to prevent that kind of head injury. I think it would make sense for children to use lighter footballs in training in order to learn how to head the ball correctly. I think that would help them improve in the future.
Recently, the ‘NDR-Sportclub’ have been discussing the rule that exists in the English Premier League where a player must be taken off even if he only loses consciousness for a few seconds.
I don’t think this rule is really necessary. If a player in the Bundesliga loses consciousness after being involved in a head collision then he will obviously be taken off. There’s no question about it! Therefore I don’t think we need to implement new rules, every team doctor knows that a player should be taken off in this situation. Sometimes I don’t understand how the complex topic of head injuries is dealt with in football nowadays.
In your opinion, what is not being dealt with so well in discussions?
Different topics are being jumbled up in discussions: treating the injury immediately after the incident, potential long-term damage and finally, whether heading the ball can impair brain development in the long term. First of all we spoke about acute care on the pitch can made a decision on whether the player should be allowed to continue. We looked at the examples of Christoph Kramer and Álvaro Pereira. Based on the data we have available and recommendations from experts, we have to expect that players will come off after they have suffered a head concussion. Sometimes these players return to training or matches far too early after suffering this kind of injury. They are often given the go-ahead too soon.
How can we make sure that the player receives the best treatment possible?
It would really help us if a video of the incident on the pitch could become available as quickly as possible, preferably one in real time and one in slow motion. Apart from that, a lot of things have improved in recent years, such as the so-called ‘three-minute rule.’ If it’s not obvious, the team doctor has to inform the referee that it is a head injury and the game has to be stopped for a maximum of three minutes. During this time, the team doctor will make the decision about whether the injured player can continue playing. The team doctor can’t make an exact diagnosis there and then, but he can decide whether it is safe for the player to continue. The medical risks will of course be a lot higher if a player if allowed to carry on but is then involved in another head collision, in this case, the rules should probably be changed.
How are players who have incurred a head injury dealt with after they have left the pitch?
I think they are dealt with well afterwards. It is very rare that the player doesn’t go to see a neurologist afterwards in Germany. They normally have an MRI scan aswell. What we still need is another rule which decides when it is best for a player to return to training after the incident. Ideally this decision will be based on the results of neurophysiologic tests. These results will be compared to a healthy baseline level to determine whether the player is fit to return. We are considering introducing baseline testing for players who incur a head injury. Unfortunately, there are a lot of competing procedures for this treatment and there is no international standardization, which makes the process a little bit more difficult.
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Head injuries have been a big talking point in football for a long time. Prof. Dr. Tim Meyer, national team doctor and chairman of the DFB Sports Medicine commission, spoke to DFB.de in an interview to give his view on some pressing questions and current developments.
Prof. Dr. Mayer, many parents in Germany were unsure about the decision taken by the US football association to ban children under the age of 11 from heading the ball. Is it really dangerous for children of this age to head the ball?
I don’t think we need a complete ban like this nowadays. In my opinion, the studies that have been carried out in the USA don’t provide sufficient evidence to support the need for complete ban of heading the football. Therefore, you have to think about what the best strategy would be to prevent that kind of head injury. I think it would make sense for children to use lighter footballs in training in order to learn how to head the ball correctly. I think that would help them improve in the future.
Recently, the ‘NDR-Sportclub’ have been discussing the rule that exists in the English Premier League where a player must be taken off even if he only loses consciousness for a few seconds.
I don’t think this rule is really necessary. If a player in the Bundesliga loses consciousness after being involved in a head collision then he will obviously be taken off. There’s no question about it! Therefore I don’t think we need to implement new rules, every team doctor knows that a player should be taken off in this situation. Sometimes I don’t understand how the complex topic of head injuries is dealt with in football nowadays.
In your opinion, what is not being dealt with so well in discussions?
Different topics are being jumbled up in discussions: treating the injury immediately after the incident, potential long-term damage and finally, whether heading the ball can impair brain development in the long term. First of all we spoke about acute care on the pitch can made a decision on whether the player should be allowed to continue. We looked at the examples of Christoph Kramer and Álvaro Pereira. Based on the data we have available and recommendations from experts, we have to expect that players will come off after they have suffered a head concussion. Sometimes these players return to training or matches far too early after suffering this kind of injury. They are often given the go-ahead too soon.
How can we make sure that the player receives the best treatment possible?
It would really help us if a video of the incident on the pitch could become available as quickly as possible, preferably one in real time and one in slow motion. Apart from that, a lot of things have improved in recent years, such as the so-called ‘three-minute rule.’ If it’s not obvious, the team doctor has to inform the referee that it is a head injury and the game has to be stopped for a maximum of three minutes. During this time, the team doctor will make the decision about whether the injured player can continue playing. The team doctor can’t make an exact diagnosis there and then, but he can decide whether it is safe for the player to continue. The medical risks will of course be a lot higher if a player if allowed to carry on but is then involved in another head collision, in this case, the rules should probably be changed.
How are players who have incurred a head injury dealt with after they have left the pitch?
I think they are dealt with well afterwards. It is very rare that the player doesn’t go to see a neurologist afterwards in Germany. They normally have an MRI scan aswell. What we still need is another rule which decides when it is best for a player to return to training after the incident. Ideally this decision will be based on the results of neurophysiologic tests. These results will be compared to a healthy baseline level to determine whether the player is fit to return. We are considering introducing baseline testing for players who incur a head injury. Unfortunately, there are a lot of competing procedures for this treatment and there is no international standardization, which makes the process a little bit more difficult.
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You mentioned long-term damage as another topic.
Developments in professional American football are very well-known. The NFL provides financial compensation for players who have incurred head injuries during their career. Many former American Football or Ice Hockey players in the USA have become depressed or suicidal in retirement, often because of recurring head injuries during their careers. The disorder has its own name: chronic traumatic encephalopathy, shortened to CTE. However, to assess the CTE risk in a sport, we have to deal precisely sport-specific rules and reality.
What does the CTE risk look like in football?
A head injury occurs in football probably every other matchday, however the CTE risk is low. For example take forwards and defenders who are constantly challenging for the ball in aerial duels. There hasn’t been a single case of a football suffering from chronic traumatic encephalopathy in Germany which is certainly due to the much lower probably of head injuries in the sport.
What has the DFB done to reduce the probability of incurring the head injury?
In 2013, the DFB Sports Medicine decided to make head injuries a key issue for the next three years. All Bundesliga club doctors had to attend two days of specific training with the DFL. Additionally, we provided further training for team doctors of professional football clubs in Frankfurt, exclusively about head injuries and how to treat them correctly. We changed the curriculum for coach training. I have visited Hennef twice now in order to inform prospective coaches about the risks of head injuries.
And in amateur football?
We want to improve awareness of the risks of head injuries in amateur football as well. In Germany, the number of head injuries in football outnumbers those in American Football or Ice Hockey; however that is only because of the popularity of the sport. Over 80,000 play football at an amateur level every weekend. Despite this, the number of injuries per game is not as high in football as in the aforementioned high risk sports.
INFO
Since 2014, players have to be taken off in the English Premier League even if they only lose consciousness for a few seconds. The incident involving Hugo Lloris triggered this rule as he was not substituted off in Tottenham’s match against Everton FC after he lost consciousness. The most famous incident in Germany was during the World Cup final in 2014, when Christoph Kramer collided with Argentina’s Ezequiel Garay and wasn’t taken off until 15 minutes later. As a result, FIFA introduced the ‘three minute rule’ in September 2014. The team doctor now has to inform the referee that it is a head injury and the game has to be paused for three minutes. During this time, the doctor can make the decision whether the player is able to continue playing.
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