In the opening round of this year’s World Cup, a Moroccan midfielder named Nordin Amrabat collapsed to the grass after knocking heads at full speed with an opposing player from Iran. He lay on the ground for more than a minute before being helped to the side and examined by a member of Morocco’s medical staff, whose idiosyncratic concussion protocol involved slapping him repeatedly in the face.
Among the World Cup’s three-billion-plus audience who watched this display in dismay was Vincent Gouttebarge, a former teammate of Amrabat’s from the Dutch league and chief medical officer for the international football players’ union, FIFPro.
“I was very disappointed to see that,” says Gouttebarge. “The actions of the medical staff sent a bad message to a public that needs to be educated about concussion management. I had a kind of deja vu from four years ago in Brazil. Nothing has changed.”
At the 2014 World Cup in Rio de Janeiro, a concussed and visibly disoriented player for Germany named Cristoph Kramer continued playing after a violent collision, even though the impact left him unsure where he was. “Is this the final?” he asked the referee. The Kramer episode sparked a debate within football about FIFA and concussion protocols, and the association subsequently reformed its recommended guidelines.
In a statement to Rolling Stone, a FIFA spokesperson said that for the ongoing 2018 World Cup, “all team doctors took part in a workshop where they were provided with detailed information and guidelines concerning the proper handling of potential concussion incidents during the competition.” But events in Sochi are reminders that these rules are mere suggestions, and why many observers feel that FIFA is not especially concerned with education or enforcement. The spectacle of the Moroccan staff trying to slap an obviously concussed player awake was followed by Amrabat’s return for the second round match against Portgual – just five days after leaving a hospital with no memory of anything of the previous six hours – wearing a medically pointless leather helmet.” “I was sure 2014 would be a turning point, but FIFA still doesn’t care,” says Taylor Twellman, the all-time leading scorer in U.S. pro soccer and an ESPN analyst. After Twellman’s career was cut short by concussions, he started a foundation to advocate for reforms aimed at reducing head injuries in the sport.
“It’s going to take a very serious injury, someone dying on the field, for them to get serious about a real concussion policy,” he says. “I gave up trying to talk to FIFA years ago. They aren’t interested in dialogue. If FIFA won’t listen on concussions, they certainly won’t listen on long-term issues like CTE.”
Indeed on the issue of CTE, or Chronic Traumatic Encephalopathy, an impact trauma-linked brain disease, FIFA has been largely silent. FIFA’s website contains just one mention of degenerative brain disease: a chirpy 2012 write-up of a project to help Alzheimer’s patients “reconnect… for a while at least, to a lost personal history” by showing them “photos and memorabilia from patients’ favourite clubs.”
In the coming months and years, FIFA brass can expect more people trying to show them photos of ruined brains from the growing scientific literature linking impact sports – including American football, boxing, hockey and rugby – to heightened risk of degenerative brain disease later in life, in particular CTE. According to research conducted at the Mayo Clinic, nearly a third of impact-sport athletes have traces of CTE when they die, compared to 12 percent of the general population over the age of 60.
The literature on head trauma has only recently begun to target soccer players. In 2015, researchers at Purdue University found that the impact of heading a goal kick was equal to getting tackled in American football, or taking a clean jab in the boxing ring. Last year, researchers at University College London published the first ever soccer-specific CTE study in the journal Acta Neuropathologica. The brains of six professional soccer players all showed signs of Alzheimer’s, while four of the six revealed the distinctive protein buildup characteristic of CTE.
“This is the first time CTE has been confirmed in a group of retired footballers [soccer players],” said lead author Helen Ling in an interview posted by the university. “Our findings suggest a potential link between playing football and the development of degenerative brain pathologies in later life.”
Though Ling conceded the sample size was small, and that the findings are far from conclusive, she released the paper with a public call for FIFA to support more and larger studies. FIFA was fast to reject the idea. The day after the publication of her study, a FIFA spokesman called the study “inconclusive” and flatly told Agence France-Presse, “Football does not belong to the high-risk sports for brain and head injuries…. To our very best knowledge, there is currently no true evidence of the negative effect of heading or other sub-concussive blows.”
That sentiment was repeated in an email to Rolling Stone. “FIFA takes its responsibility with regards to the issue of head and brain injuries very seriously,” the FIFA spokesperson said. “To our very best knowledge, there is currently no true evidence of the negative effect of heading or other sub-concussive blows. Results from studies on active and former professional football players in relation to brain function are inconclusive.”
If this sounds familiar, it’s because the NFL held the same line for years until science, public and player pressure and one very large class-action lawsuit made the position untenable. Only in March of 2016 did an NFL medical official publically concede a link between playing football and heightened risk of developing CTE.
FIFA has been more focused on the money to be made in the globalization and promotion of football. Its reserve bank account has more than quintupled since 2004, while the World Cup has grown in value to more than $2 billion, making it the most lucrative sporting event in the world.
This growth has closely tracked to the rise of public and player concern over head injuries and brain disease. In 2002, a high-profile inquest and coroner’s report linked the death at age 59 of legendary English forwardJeff Astle to heading soccer balls. Astle, a star of England’s victorious 1966 World Cup team, was famous for scoring more goals with his head than with his feet. Following his death, his daughter Dawn started a head-injury advocacy foundation in his name. Like Twellman and others, she has run up against a wall of silence from FIFA.
“I don’t need FIFA to tell me anything about CTE,” says Dawn Astle. “Her Majesty’s coroner ruled that my dad’s death was an industrial disease, resulting from the repeated heading of footballs. It’s right there on his death certificate.”
She continues, “I wouldn’t trust FIFA to walk my dog. It’s a corrupt organization. There has to be an independent authority or regulator at the global level. You can’t have football looking into football.”
Astle isn’t alone in her belief that FIFA will require the pressure of an independent authority. Among those advocating such a regulator is Chris Eaton, FIFA’s former chief of security, and the primary force behind the explosive 2011 operation that uncovered widespread corruption and match fixing in the sport.
“As with any industry dominated by business motivation, international football must be held accountable by an external regulator,” says Eaton. “It’s sad that FIFA is so focused on the business of expansion at the expense of the health, safety and security of its vulnerable participants.”
FIFA, like the NFL, is beginning to see the first voluntary early retirements by active players worried about their brains. In September of last year, Irish forward Kevin Doyle retired on medical advice after reporting constant headaches, which he blames on decades of heading the ball. Leading soccer publications and websites, meanwhile, have become forums for public anger and debates over dramatic rule changes. Peter Staunton, the chief correspondent for Goal.com, a popular online soccer magazine, called for the banning of heading following the publication of the CTE study in Acta Neuropathologica.
“A ban on heading would bring the simultaneous benefits of reducing the number of repeated sub-concussive blows to the head and minimizing the risk of potentially deadly brain trauma injuries,” wrote Staunton. “Whatever football looks like after a ban can be sorted out down the line but the alarming thing at the moment is that it appears action will only be taken when something catastrophic happens. What’s it going to take? Coma? Permanent vegetative state? Brain death? If we can ban tackles from behind to save players’ legs, can’t we ban what are effectively tackles in the air to save their brains? Maybe we’ll look back in 50 years and wonder how the hell we ever let this continue so long.”
Some national football associations, often after much prodding by player unions, have begun considering reforms and calling for more brain research. The Dutch and English football associations recently initiated studies on the long-term consequences of heading the ball. If the results send them to the rulebook to make changes, they might learn something from the experience of professional rugby.
“International rugby is state of the art when it comes to designing policies to address and reduce total brain trauma – the sub-concussive and concussive hits that put you at greater risk for CTE,” says Dr. Robert Cantu, co-founder and medical director of the Concussion Legacy Foundation. “FIFA, on the other hand, reminds me of where the NFL was a decade ago.”
Vincent Gouttebarge, the medical officer for FIFPro, the players union, is cautiously hopeful that 2018 will be the year FIFA finally begins to take action. FIFPro recently signed a six-year agreement with FIFA that includes meetings to discuss an agreed slate of issues, including health and safety. The first meeting will take place later this year, and Gouttebarge plans to push for a new level of dialogue.
“In an ideal world, you would see all three stakeholders – FIFA, the clubs and players – collaborating to protect the health of players in the short and long-term,” he says. “A huge number of former players struggle with mental and physical health issues. In the past, FIFA has been reluctant to collaborate with us, but if the research [on CTE] becomes conclusive, our duty is to the players, not the owners.”
Dawn Astle, meanwhile, is girding for what she expects to be ongoing fierce resistance on the part of football’s famously corrupt ruling body.
“Players are dying and FIFA doesn’t give a damn,” she says. “Their attempt to protect its multi-billion pound business borders on criminal bloody negligence. They don’t want anybody to think that football [soccer] is a killer. But it is.”