‘Never ever did I think heading footballs could be dangerous for me.’ The words of the Premier League’s all-time top goal-scorer Alan Shearer. Having watched the BBC documentary, he presented Dementia, Football and Me a couple of years ago, it is unsurprising to hear concern in his voice when 46 of his record 260 premier league goals were scored using his head. It is worrying that he undertook a professional career spanning over two decades without knowing the importance of protecting your head when competing and this gap in knowledge is seen elsewhere.
In the 2007 League Cup final, commentator Tony Gubba immediately described John Terry as ‘brave’, when his head connected with Abou Diaby’s boot, reinforcing this dangerous behaviour. These two examples demonstrate a lack of knowledge among players and spectators of how head injury can impact our daily lives and the attitudes we hold towards these injuries.
I specialise in how a concussion can negatively impact our mental health, the way our brains function and our overall quality of life, long after the event. I have been interested in this area for the last few years and my current PhD project is investigating this. Having spoken with many athletes when conducting research, and just in general life, there seem to be common misconceptions that have emerged that could lead to risky attitudes and behaviour. As well as this, I am conscious that as researchers, we have a duty to make information much more accessible to build sportspeople’s knowledge of the most prevalent head injury in sport, and to debunk some of the myths that surround it.
What is a concussion? This isn’t something that gets asked a lot and many people seem to have their own interpretation. If you were to ask someone to describe concussion, the vast majority would start off by saying something to do with a bump to the head, whether that was playing a sport, a car crash, or elsewhere. While a concussion is considered a head injury, as most occur due to a direct blow to the head, concussions can actually be caused by a blow elsewhere on the body, if the force of the impact is transmitted to the head. One way to think about it is this: If you were to squeeze a bottle full of water with the lid on, it wouldn’t take much before the water was pressing against the lid, even though you haven’t physically touched the lid. This is the same in that if you take a blow to the body, for example, the force from that impact can travel up towards your head, without any contact to your head itself. Although it is much less likely, ceasing participation is advised if you begin to feel any symptoms of concussion (blurred vision, balance problems, nausea, etc.) when competing.
If you are unfortunate enough to have taken a blow to the head, you might expect a loss of consciousness, and one of the biggest dangers here is that when people don’t lose consciousness, they presume they aren’t concussed. Concussion does not always result in a loss of consciousness for the recipient, in fact, it is very rare and only 10% of cases actually do. This is an important misconception to address for anyone participating in contact sports because those that presume they aren’t concussed due to maintaining consciousness, may actually be placing themselves at even more risk. Despite no loss of consciousness, there could still be an onset of symptoms mentioned above that can leave you exposed to other injuries, including another bump to the head.
In a bid to combat the rising prevalence of concussion in sport, protective equipment was adopted in numerous sports, to ensure the safety of competitors and to keep them injury-free. Again, unsurprisingly, many presume that headgear protects from a concussion, but there is actually very little evidence of this. A concussion occurs when a sudden movement causes the brain to move within the skull, usually due to a blow to the head (but not always) and when the brain moves around, it collides with the inside of the skull. Wearing protective equipment like headguards or helmets only increases this hard surface in which your brain connects with and therefore provides very little protection. If anything, it is suggested that wearing helmets can lead to complacency in competitors that may feel more protected than they are and are perhaps more likely to ignore correct techniques that they have been trained. This could explain the high number of concussion cases in NFL players and negative consequences with mood and behaviour in former American football players.
With the negative effects of concussion becoming clearer, some athletes are concerned that having sustained one leaves them exposed to another. This is perfectly understandable, but the good news is that there is no clear evidence to suggest that, if properly recovered, you are not at any increased risk due to the first concussion. The key here is that you allow yourself time to recover. In around four in five cases, post-concussion symptoms (headache, vomiting, fatigue, etc.) resolve within a week or two, with the average being 10 days. It is for this reason that most sports teams will insist on a two-week recovery period following a suspected concussion.
However, recovery does not just mean abstaining from competing in your sport. For the best recovery, you should do very little for the first week following the collision and then begin to incorporate daily walking into your routine. Going back to John Terry in the League Cup final, it later emerged upon finding out that his team Chelsea had gone on to win the match, he discharged himself from the hospital and returned to celebrate with his teammates. When former teammate Frank Lampard revealed this on ITV’s Play to the Whistle, laughter ensued from all panellists and audience members, further highlighting the collective, unhealthy attitudes that we have towards head injuries in sport. So, while a concussion itself does not leave you any more exposed to another one, maybe it is much more to do with our attitudes and behaviours towards them that can predict subsequent concussions.
This is why research is so important. Research provides us with a better understanding than we did before, and my research could help inform sportspeople’s decisions when competing and being able to make an informed decision is all I seek to offer. I am an avid supporter of many contact sports whereby concussion is common. My aim is not to tear up the rulebooks, contribute to ‘OTT’ health and safety and wrapping athletes up in cotton wool. My aim is to simply inform. In the same way that people are aware of the negative consequences of smoking, drinking alcohol, and eating fatty foods, yet still choose to do it, people should also be aware of what is at the end of the tunnel if they are constantly putting their head on the line.
It is unfair for sportspeople to consistently abuse their brains, without knowing that is what they are doing. As Alan Shearer said: ‘I expected dodgy knees – but not the chance of brain damage.’
Daniel Walker is a PhD researcher and a graduate teaching assistant at Edge Hill University.