Head injuries and trauma in footballers has been an ongoing conversation between the sports and medical world in seeming perpetuity, particularly when it comes to concussions (medically referred to as mild traumatic brain injuries or mTBI for shot). And rightfully so, the brain is only the most important organ of the entire body, right?
Within the past five years there has been movement in properly recognising the dangers of concussion in football which has led to changes at identifying, treating and returning to play protocols – although the implementation and oversight of them has been inconsistent at best.
Further, there’s been recognition of how head trauma for footballers may start at a very young age due to constant heading of the ball – “micro impacts” – which could be cumulative in nature and lead to micro-changes. In accordance with that, there have been some changes to youth football in certain countries with bans or limitations on heading for youth players and slowly building up that tolerance.
For example, the United States Soccer Federation does not allow heading for any U11 player in practice or games (even when playing at a higher level) and limits heading practice for U12 and U13 players to 30 minutes each week, with no more 15-20 headers per week, per player in training. There are no heading limits for U12 and U13 during games, however.
With the increased focus on these head injuries have come further introspection and studies on how to potentially reduce that risk further.
One such study came from researchers at Purdue University in Indiana who studied three potential variables of the football itself that could be leading to increased peak impact forces of the ball with players’ heads.
The first variable was velocity and it was tested by kicking footballs of three different sizes – 4, 4.5, and 5 – against a force plate to measure the impact.
The second variable was how much the ball was inflated, measured as PSI, with balls ranging from 4 PSI to 16 PSI. The range includes both pressure levels that are below manufacturing specifications and nearly at the upper limit.
The third variable was how water-logged the ball was (water absorption). This was tested by submerging each ball into water for 90 minutes, weighing and rotating the ball at 15 minute intervals.
Velocity contributed the most to the impact generated by the ball on a player’s head, which doesn’t come as a surprise. However, there’s no reasonable way to control that in-game. Imagine telling a footballer that they couldn’t fully swing through a ball or something of that nature.
Ball pressure and water absorption also increased peak impact force. One of the researchers commented that if the pressure of the ball was too high or the ball had absorbed too much (or both) it’s like “heading a brick”. For example, after just the first 15 minutes of being submerged in water, the football had already exceeded the regulation weight. Researchers also found that some of the lower ranges within the manufacturer specifications could reduce potential head injuries by up to 20%.
In both cases, these are variables that could be controlled and implemented. Governing bodies could standardise those pressures as the correct ones the balls need to meet prior to games and footballs during rainy matches could be rotated through quicker, ideally every 15 minutes.
Head injuries and concussion issues are certainly not going away and as we study them, we not only learn just how pervasive their impacts are but potential ways to mitigate them. These two recommendations could help do just that.
Dr. Rajpal Brar, DPT, (@3cbperformance) is a physiotherapist, movement expert, fitness trainer, sports scientist and mindfulness coach. He runs the LA and online based physiotherapy and athletic performance clinic 3CB Performance, and you can subscribe to his Youtube channel (which posts analyses of Lionel Messi and more).