Concussions are putting thousands of footballers at risk each year—and many don’t have a clue
The amnesia started after Katie Rumfola’s third concussion in September 2012, when an opponent’s knee slammed into her temple. “I would wake up and I would only remember up to, like, my senior year of high school or my freshman year of college,” the former California Baptist University goalkeeper told Eight by Eight in a recent interview. Friends and family would have to prompt Rumfola’s memory throughout the day as the symptoms gradually retreated. Another concussion the next year forced her to give up football altogether.
Rumfola, now a 23-year-old assistant coach at California State University-San Bernardino, still wakes up in an amnesiac fog — one of the many post-concussion symptoms that still plague her. She is one of countless athletes who experience lasting, sometimes progressive impairment from concussions. These devastating effects have become a prominent issue in the sporting world as an increasing number of former athletes come forward with brain damage and life-changing symptoms. The discussion around concussion safety, however, has until recently been focused mostly on hard-hitting sports like American football, despite the fact that in football — and particularly in womens’ football — concussions are fairly common.
At the collegiate level in the United States, the rate of concussions suffered in men’s and women’s football are only exceeded by American football and hockey, according to research published in the Journal of Athletic Training. Women football players are especially prone to concussion. Numbers from the high school injury surveillance system High School RIO, developed at the Colorado School of Public Health, show that girls’ high school football has the third-highest rate of concussions among all popular U.S. sports, again exceeded only by American football and ice hockey.
Though concussion rates for professional football players are harder to come by, few deny the prevalence of the problem. “Football is awash with incidents in which players suffer potentially concussive blows to the head and stay on the pitch,” said FIFPro, the international football players” union, in a recent statement. As serious head injuries in the top-flight become increasingly high-profile, the issue of concussions in football has become hard to ignore, fueling a growing discussion about organizations’ responses to the epidemic.
In the 2014 World Cup final, medical personnel and coaches allowed German defensive midfielder Christoph Kramer to return to the field after suffering a serious concussion, despite the fact that he was so groggy that he didn”t know where he was. To the chagrin of concussion safety advocates, Kramer was one of three World Cup players who were allowed to continue playing after receiving head injuries.
“Because of the ridiculous lack of enforcement, and nobody wanting to take responsibility for these players, these things happen,” said Olympic gold medalist and World Cup champion goalkeeper Briana Scurry, whose own career was ended by concussions. “MMA is more humane than FIFA is right now,” she added, referring to mixed martial arts, in which referees are quick to end a fight when a fighter has been knocked out.
A FIFA spokesman declined to comment for this article because of an ongoing lawsuit, saying only, “As a general matter, player safety is a critical priority at FIFA.”
The fact that so many football players are allowed to continue playing soon after receiving a concussion is particularly disturbing. The likelihood of dangerous long-term effects is increased when someone receives a second concussion before fully healing from the first, according to the Centers for Disease Control and Prevention. There also exists the possibility, though rare, of what is called “second-impact syndrome” — rapid, catastrophic swelling of the brain that results in severe brain damage, physical disability and often death.
Some players are especially worried that FIFA isn’t serious about the higher risk of concussion that women face. Every venue at this summer’s Women’s World Cup will use artificial turf — a hard and abrasive surface that, according to some studies, increases the likelihood of injuries, including concussions. A number of top women players filed a lawsuit last October with the Human Rights Tribunal of Ontario over the decision, alleging sexual discrimination — something that FIFA has been repeatedly accused of in the past. They have since withdrawn their lawsuit.
FIFA, however, is just one of many major football organizations to face criticism over their handling of concussions. The Premier League implemented new rules last August meant to improve the league’s response to head injuries, placing the final assessment of whether a player should continue in the hands of doctors, not managers or players. While many see the rule changes as a positive step, some critics say they don’t go far enough as troubling incidents continue to occur.
In October, doctors cleared Chelsea goalkeeper Thibaut Courtois to continue playing for 13 minutes after taking a knee to the head. Then, in December, it took three calls from a doctor and intervention from players before play finally stopped and stretchers came to attend to Chelsea defender Kurt Zouma after a head-to-head collision with his own goalkeeper, Petr Cech, who himself wears protective headgear after a 2006 kick to the head left him almost dead on the field.
The Premier League did not respond to multiple requests for comment.
As criticism of football organizations’ handling of the concussion crisis continues to mount, many have begun looking for a solution. While there exists no panacea for the epidemic, concussion advocates suggest a number of different measures that vary based on the level of play.
Parents and youth players in California recently filed a lawsuit against FIFA and several U.S. youth football organizations in an attempt to improve concussion safety. Because pretty much every league in the world abides by FIFA’s “Laws of the Game,” the plaintiffs are seeking an injunction that would change these rules.
What the lawsuit is calling for, among other things, is a medical substitution that would not best online casino count against a team’s three allowed substitutions. Professional and other high-level leagues would be required to allow a temporary substitute to enter the game while doctors evaluate a player’s head injury. Because the stakes are so high in top-flight football, players currently feel pressure to continue playing despite receiving a possible concussion, and coaches are incentivized to risk player health. Rather than face the disadvantage of continuing down a player while doctors put a player through a concussion protocol, a temporary substitution would allow players the time they need to be properly examined.
While some critics have concerns about teams trying to gain an unfair advantage using a temporary substitute, it is an idea that is gaining in support. The rules of sports are constantly changed over time, proponents of the temporary substitution say. It was only in 1998, after all, that the number of substitutions was expanded to the current system of three.
At the amateur and youth levels, however, the problems are vastly different, and some would say the stakes even higher. Young brains take longer to recover from concussions, and are more susceptible to severe symptoms, according to the Sports Concussion Institute. Even more troubling, amateur coaches often don’t have medical professionals on the sideline with them, and the coaches themselves aren’t trained to deal with head injury, said Chris Nowinski, a former WWE wrestler and co-founder of the concussion safety organization Sports Legacy Institute.
It’s for these reasons that so many concussion safety advocates propose a limit on headers for youth players. The lawsuit against FIFA, for example, seeks to prevent players under the age of 14 from heading the ball altogether, and limit the number of headers players under 17 can take. “There’s no single change in any sport that would prevent so many concussions,” said Nowinski, whose athletic career was also ended by concussions. A limit on headers, he said, ensures that players entering higher levels of play have “less mileage on their brains.”
Some football traditionalists might gasp in horror at the idea of prohibiting youth headers, but some teams that applied the change have seen a positive response. “People get it and are in favor of it,” said Mark Duncan, the athletic director of The Shipley School in Bryn Mawr, Pennsylvania, which last year banned headers for middle school players. Duncan said that reactions to the ban “have been 90 to 95 percent positive.”
Regardless of rules changes, however, everyone who interviewed for this article agreed that the most important factor in the fight against concussions is education. Parents, players, coaches and even fans, they all say, need to be aware of the symptoms, long-term effects and proper treatment of concussions for there to be any real progress.
Concussions are vastly underreported in all sports, and Nowinski attributes this in large part to a lack of awareness. Most people, for example, don’t realize that the majority of concussions don’t result in a loss of consciousness. “If you talk to very young athletes, they just assume that the headaches and blackouts are normal,” Nowinski said. “As long as it doesn’t cause loss of consciousness, they just keep going and it’s never reported.”
Like many players, Alecko Eskandarian — a former MLS finals MVP forced to retire after a number of concussions — isn’t quite sure how many concussions he has had over his playing career. Before experience and time with doctors taught him to recognize concussions, Eskandarian said he simply referred to them with phrases that many athletes use like “getting my bell rung,” unaware that what he was experiencing might be a serious brain injury.
It’s for this reason that players like Scurry, the World Cup champion goalkeeper, say education is so important. No change will completely eliminate the risk of concussion in football, but as more athletes come forward and tell their stories, players, coaches and parents can learn to minimize the risk of long-term injury. And when players do get seriously injured, Scurry and others want them to know that they aren’t alone. “Part of my role,” she said, “is letting people know how horrible it was for me, a two-time Olympic gold medalist.”
“Kids really need to understand the importance of your brain functioning properly,” Eskandarian said, “because once that’s thrown off or once you’re getting a bit of brain damage, that’s a life-changer.” Because severe depression is a symptom experienced by many players who receive repeat concussions, he said being educated about concussions is crucial. “When you lose the feeling of being normal, it’s a tough thing to cope with.”
Rumfola, the former California Baptist University goalkeeper, certainly agrees. “It was really surprising how mentally tough it was,” she said. “Even through all the physical pain I had, I would almost rather have the physical than the emotional or the mental stuff…. The hardest part has been the mental part of things.”
That’s quite a statement given the physical hardship she has faced. About a week after her fourth and final concussion, Rumfola started having seizures. They have since gone away — she hasn’t had one in over a year — but their effects still linger in painful ways. Rumfola injured her neck and shoulder from twitching, causing painful nerve damage from her neck all the way down her arms.
After getting hit in the temple, sometimes it’s difficult “thinking of the right word or putting sentences together,” she said. “Or sometimes stuttering is a problem.” Headaches are an everyday occurrence, and she gets more serious migraines at least twice a week. When asked what advice she would give to other players, she said, “Really take your time and listen to your athletic trainer or your doctor” when recovering, so as to avoid life-changing symptoms like her own. “You don’t want to have these later on in life.”
Follow Dustin Christensen on Twitter at @dustyc123.