In the 31st minute of the inaugural meeting between LAFC and the Colorado Rapids on Sunday, August 19th 2018, Colorado defender Kortne Ford slammed his head into the turf during a collision and remained motionless on the ground as play continued. After a stoppage, Ford was able to get to his feet and, though visibly unsteady, continue playing until substituted at halftime.
Four days later, Colorado released an injury report mentioning that Ford’s status for their next game was “Questionable-Concussion Protocol.”
American writing on concussions in sports is dominated by the American style of football; among styles that originated in England, rugby is mostly looked to as a source of ideas for greater safety (never mind its own concussion and CTE crisis, or the fact that the physics of large men colliding at high speeds does not change when they stop wearing pads) and soccer hardly features at all. Yet signs of a crisis in soccer have been there for decades: a 2014 New Yorker article features the story of Jeff Astle, who was diagnosed with CTE after his death in 2002. Long before the diagnoses began, of course, there were stories of center backs pounding aspirin to hold off the headaches before heading out and nodding away another dozen crosses.
Soccer is, compared to sports like football and rugby, well equipped to do something about head injuries: collisions like the one that injured Ford, though they can never be eliminated, are not a core part of the game in the way blocking and tackling are in American football. The chief suspect for CTE appears to be heading the ball: Astle was a center forward in the classic English mold, which is to say a player expected to get in front of the goal and knock in crosses with his forehead. Bellini, captain of Brazil’s 1958 World Cup winning team, member of the 1962 winning team, once again the captain of the 1966 team, and perhaps the most prominent player yet diagnosed with CTE, was the other side of the equation, a central defender expected to knock the ball away from forwards like Astle. A change as extreme as eliminating heading entirely (already the rule in some youth leagues) would certainly change the game, but in a game already significantly defined by what players cannot use it would be a survivable change.
But the prerequisite to action is recognition, and as Ford’s fifteen minutes of play shows soccer too often involves teams ignoring players in distress. More prominent incidents are easy to find: Hugo Lloris, goalkeeper for the World Cup holding French national team, returned to a game with his club in 2013 after being knocked out by an attacking player’s knee. The 2014 World Cup was particularly noted for players repeatedly returning to games following head injuries, culminating in German midfielder Christoph Kramer playing 14 minutes of the final after receiving a concussion (the referee, on Kramer inquiring, assured him that the game was indeed the final, and Kramer came off in the 31st minute when he was unable to continue). The 2018 World Cup did not feature quite so dramatic an incident as a player losing track of whether he was playing in the final, but it did feature Moroccan Nordin Amrabat, hospitalized due to a severe concussion suffered during a group stage match against Iran, returning to the field only five days later against Portugal.
Soccer can surely find reforms to improve the short and long term safety of the sport. Changes in heading rules (up to and including banning playing the ball with the head entirely), better enforcement of rules in situations that create dangerous collisions between players (particularly contests for high aerial balls, which often involve players jumping towards each other at high speeds with unpredictable results), giving teams better opportunities to evaluate and replace players who suffer injuries, and punishing teams who push players back to play too soon are all obvious candidates; many more worth investigating could undoubtedly be found with a little effort.
The first step is to admit that we have a problem.