Hitting a Nerve

The soccer punch


Soccer is the most popular sport on Earth.

A recent JAMA Neurology article noted the incidence of neurodegenerative disease in retired professional soccer players. It found that, not surprisingly, the frequency of such was higher than in the general population, highest amongst defenders and lowest in goalkeepers (presumably because the latter can use their hands).

Dr. Allan M. Block, a neurologist is Scottsdale, Ariz.

Dr. Allan M. Block

The point here shouldn’t surprise anyone: Repeatedly hitting your head on solid objects is a bad idea.

Somewhere, a long time ago, early vertebrates developed a bony case to protect their centralized nervous system. Its success is shown by the fact that skulls and spinal cords among vertebrates have more similarities than differences: They work. It’s true that some ungulates use their heads to fight, but their skulls are adapted for such, being thicker and having horns and antlers to lessen the impacts.

But humans? Nope. The skull can support up to nine tons of (slowly-applied) weight (don’t try this at home) but repeated impacts aren’t good for its contents.

There is no degree of external protection that will prevent this, either. We talk about helmets, but the reality is that, while they definitely reduce exterior injuries, they do very little to prevent the effects of rapid acceleration/deceleration on the brain inside. This is what results in concussions, coup & contra-coup injuries, and the shearing effects of diffuse axonal injury.

I’m not saying we should ban soccer, or football, or any of the other activities that clearly have a high risk of repeated head trauma. They’re ingrained into the cultures of our societies.

At this point it’s pretty much impossible for participants and their family members to not be aware of the risks posed by these sports. The popular press has covered it in great detail.

At some point there’s only so much you can warn people about. Like tobacco smoking or riding without a helmet, you accept the risks, fully aware of the serious potential consequences. For those who wish to participate, it’s their decision.

But it’s also time to stop blinding ourselves to the simple facts. Repeated head injuries can have serious repercussions. Minimizing them, pointing out their delayed onset, and turning a blind eye won’t change that.

If we’re going to continue enjoying contact sports, we have to accept that someone is going to pay the price for it, even if they’ve been forewarned. And no amount of protective gear, at today’s technology, is going to change that.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

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