CTE head injuries and the Women’s World Cup

The knock-out stage of the 2023 FIFA Women’s World Cup is approaching and it’s crunch time for teams hoping to make it out of the group stage and into the last 16.

With bodies being put through the gruel of tournament football, are players risking serious long-term brain injury?

One ubiquitous aspect of football, despite the name of the game, is the header. Are players doing themselves harm by sticking their necks out to play the ball with their heads? In many contact sports, concern for players is growing in relation to risk of concussion and Chronic Traumatic Encephalopathy (CTE) – a neurodegenerative disorder with Alzheimer-like symptoms associated with environmental factors such as exposure to head knocks during team sports.

Little is known about how CTE affects female athletes.

“Female players do have a greater risk of concussion than their male counterparts, but there is no clear reason why,” Dr Alasdair Dempsey, a senior lecturer in Exercise Science in the School of Allied Health at Perth’s Murdoch University, tells Cosmos in an email.

But concern over CTE is growing because it doesn’t require concussion-level blows for sportspeople to be at risk.

“We need to change the narrative – CTE is not relating to concussion,” says neuroscientist Alan Pearce, an adjunct professor at La Trobe University in Melbourne. “It’s exposure to sub-concussive hits” that are the primary driver for CTE development according to Pearce.

“In soccer there is a huge concern because of the heading of the ball, and exposure to repetitive heading of the ball not so much in a game but in practice. Many players say they used to do 50 headers in practice two or three times a week,” Pearce notes.

“Two weeks ago, we published the first case of a professional female athlete. So, it’s very hard for us to extrapolate that and say whether women are more likely to get CTE than men,” Pearce says.

One common factor is that athletes diagnosed with CTE started playing at a young age.

“If you look at the soccer players that have been diagnosed with CTE in the United States, and in the UK, they started playing it at five or six years of age,” notes Pearce.

Headers aren’t the only way that football players are at risk of head injury.

“Most concussions occur when contact is made to the head by another player rather than when actually heading the ball itself,” says Dempsey. “Heading the ball produces accelerations between 25 and 35g which is much less than head-to-head contacts of around 50g.”

“Someone can get concussed from a 15g hit, or they can be concussed from a 100g hit [roughly equivalent to the force an 80-kilogram person not wearing a seatbelt would experience if crashing in a car travelling more than 30 kilometres an hour],” says Pearce. “Some players don’t even get concussed when they record an 80 or 90g hit.”

Pearce also says that “linear” hits aren’t as damaging as those that cause rotation of the skull.

“This could be when the player is trying to change the direction of the ball by heading the ball, but also just general contact. When you get bumped, even in soccer, you’re not expecting that. So your head tilts and twists. Multiply that by tens of thousands of knocks over a career, and you can start to see how the math starts to add up,” Pearce says.

Pearce believes that reducing exposure, particularly at a young age, would bring the risk of CTE down significantly.

“CTE is a disease of exposure. We are seeing in the data. This is because kids are starting to play sports from five or six years of age, and they don’t have the informed knowledge to make a decision on whether they play this sport or not.”

He says that sports should be modified to reduce the exposure of children to head knocks that can lead to CTE in later life.

“We don’t want parents take their kid out of footy or soccer which will happen because as parents start to get more worried about this. We’re not wanting to put kids into cotton wool. We’re just want to reduce this exposure. You don’t give kids cigarettes or alcoholic drinks because it can affect the brain. It’s all the same.”

Pearce notes international examples where modified sports are legislated to reduce risk for young people as well as older and professional athletes.

“In the UK, they’re trialling a two-year ban on headers for children 12 years and under. In Scotland, they’ve banned heading for all players the day before and the day after their match. In America, they have modified versions of American football, called ‘flag football’, up to the age of 14 years of age. What we’ve seen in the data is that it’s not actually to the detriment of their skill acquisition.”

Concern has grown among athletes over the risks. Some players at the 2023 FIFA Women’s World Cup have also begun wearing a “Q-Collar” which purport to protect the brain during head impact. But Pearce warns against the device which he refers to as “snake oil.”

“They claim to reduce the risk of concussion by occluding the blood flow to the brain. When you are concussed, blood flow to the brain drops. What they’re saying is that, if you wear this collar, it keeps the blood in the brain.” Pearce notes. “they rely on the principle of the woodpecker not getting concussed. Well, if you look at comparative anatomy, a woodpecker’s brain and skull is completely different to human evolved at completely different why for what it does.”

“It’s real pseudoscience,” Pearce comments.