How World Cup players can (and can’t) prevent head injuries

The 2023 FIFA Women’s World Cup has reached the pointy end. Tonight, Australia’s Matildas will play England in the second semi-final to see who will face off in Sunday’s final against Spain, who saw off Sweden last night.

In their quest to win the coveted trophy, football players are wearing their hearts on their sleeves and putting their bodies on the line.

One risk which is gaining media attention is the football players’ heightened chance of concussion and CTE (Chronic Traumatic Encephalopathy) – a neurodegenerative disorder with Alzheimer-like symptoms – coming from headers or unintentional head knocks in training or during games.

Growing evidence links football players —who engage in headers or have experienced head knocks — with CTE later in life. Papers have been published this year in the Lancet and Journal of the American Medical Association pointing to this connection.

“As the public became aware of CTE, it created this danger that everybody’s now thinking, ‘this might be dangerous for us,’” Dr James Smoliga, a medical researcher at Tufts University in Massachusetts, tells Cosmos. “Everybody wants a way to fix the problem.”

But Smoliga warns of “snake oil” and “pseudoscience” which preys on these genuine concerns. In particular, Smoliga is concerned about a product known as “Q-Collar”.

“The device is claimed to mimic the mechanism that woodpeckers use to protect their brains from damage,” Smoliga says. But he says the scientific literature does not support this claim.

The device has even made an appearance at the World Cup with players such as Canada’s Quinn and Costa Rican midfielder Rocky Rodriguez donning the gadget during group-stage games.

In its statement authorising the Q-Collar for market, the US FDA writes: “Data do not demonstrate that the device can prevent concussion or serious head injury.”

The Q-Collar, Smoliga explains, is a device worn around the neck to apply light pressure to the jugular veins. Its creators claim that, by increasing blood in the brain, the wearer is protected from brain injury.

“It was originally designed specifically to prevent concussions, but was not effective in doing so, so the researchers and company switched their claims from ‘concussion prevention’ and ‘anti-concussion’ to the less clearly defined claim of ‘brain protection,’” Smoliga notes.

Smoliga says the US FDA authorised the device for market based on “flawed” research. He emphasises that the fact the product has made it to market “should not be mistaken as evidence of effectiveness.”

“In their statement, the FDA even makes it clear that the clinical trials they performed did not use clinically validated measures of brain injury and that their intended outcomes did not match what they actually reported,” Smoliga explains.

Smoliga notes other “harebrained solutions” to CTE and concussion including a “chocolate milk” and “fish oil” which purported to protect the brain but have shown no benefit.

“I believe there are no examples of effective concussion mitigation technology,” Smoliga comments.

In fact, he believes that, by giving athletes a false sense of security, they become even more at risk as they place their bodies in even more precarious situations under the unfounded belief that they are being protected.

Smoliga and others experts suggest that the real solutions may be in training and behaviour.

He and Dr Alan Pearce are working on a paper on whether neck strengthening can aid in mitigating concussions, though the results are inconclusive at this stage.

Others are calling for even more radical changes, such as adjusting rules. For example, some have suggested removing headers from games altogether, or at least banning them for young players under 18.

University of Sydney physiotherapy lecturer Dr Kerry Peek argues that education is the key, not a ban on headers.

“There is no evidence that heading the ball is safe for children under the age of 10. But the reality is we can virtually eliminate heading from children’s football by changing the way kids are taught to play the game,” Peek says.

Peek, with colleagues from Football Australia’s Expert Working Group on Heading and Concussion, as well as the Chair of UEFA’s Medical Committee, recently published recommendations along these lines in the journal Sports Medicine.

“Playing smaller-sided games and smaller goals, encouraging kids to keep possession, to play out from the goalkeeper, to play short corners and throw ins to the feet – all of these strategies keep the ball on the ground rather than in the air,” Peek comments. “And the beauty of this approach is it’s going to develop better foot-based skills or ‘ball mastery’ which makes for more skilful athletes and overall, a better game.”

Peek says this would avoid complexities around the enforcement of bans or weekly limits on headers, as proposed in other parts of the world.

With Olyroos physiotherapist Dr Matt Whalan of the University of Wollongong and University of Technology Sydney exercise scientist Professor Rob Duffield, Peek is working to develop HeaderPrep – a framework for players, trainers and coaches to condition and prepare players for headers.

“No young player should be thinking about heading a ball – even specifically designed balls for heading – until they have developed basic skills in ball tracking and body positioning,” Peek says.

“Heading is a key part of the senior game with the likes of Sam Kerr, Tim Cahill and a raft of defenders who display the importance of the technique and its impact on match days,” Ferguson comments. “As a key technique within the game, it is our responsibility to help our coaches and players learn how to safely prepare for heading the ball and to introduce the skill development appropriately to best prepare them for matches.”

That’s the aim. Now let’s see if the Matildas can head into that World Cup final.