Head injury watch: Gerd Müller

German football great Gerd Müller has passed away at 75. He suffered from Alzheimer's at the end of his life, and is sadly another data point in a growing body of evidence that many professional footballers sustained brain injuries through heading the ball, over the course of their careers. Of England's 1966 World Cup winning side, Ray Wilson, Martin Peters, Jack Charlton and Nobby Stiles all died with dementia, and Bobby Charlton has the condition too.

Rugby has been sending mixed messages on this front. The Lions series saw a number of incidents where players from both sides avoided red cards or citings for head contact. There was also very poor clarity over how Cowan Dickie and Biggar came to be playing so soon after head injuries.

Gerd Müller is a reminder that head injuries don't necessarily manifest themselves early but can still have a significant effect on the quaity of a person's life. We also know from cases like Alix Popham (41) that it can hit much earlier. At last count, some 175 former players have signed up to the lawsuit against World Rugby. It isn't clear whether that lawsuit has any legal merit, but all those players must have been diagnosed with some form of condistion.

The issues surrounding head trauma, whether through direct contact with the head or through body contact strong enough to cause the brain to bruise, are actually quite old.  The term 'punch drunk' was coined in the 1920s or 1930s for boxers who took too many head shots.  So in the macro sense the only thing new is the supporting science.  

As a doc at pro sport games, who treats pro athletes, a Rugby player, an army vet, and a parent, there is absolutely no one who wants this studied and precautions put in place more than I.  However, I also feel there is a group of people, certainly here in America as well as back home, who want all contact sports eliminated, as unsafe and in some cases uncivilised.  

This is a very fine line.  Are we going to eliminate Soccer, Rugby Union, Rugby League, American Football, Lacrosse, Hurling, Ice Hockey, Aussie Rules, martial arts, boxing, wrestling, and more sports?  Obviously not.  But these sports have to pull their collective heads out and look at this as a macro, as a sporting issue, not an issue unique to their tiny little fiefdoms or just their sports.  Anyone who has ever served in any country's armed forces and even more so in the field, have been subject to all kinds of trauma as well.  My point is contact is part of life and it isn't going away.

What we need is better science to measure and get a handle on people at the beginning stages to help manage them better and potentially remove them from their situation until healed.  People in responsible positions, coaches, med staff, and so on, need better training and must be empowered to take early action.  In all walks of life.  And we need to take sport and do what we can to make them safer without destroying the basic element which makes each sport special.  It is interesting that all the padding in American Football has not eliminated concussion or head trauma (or frankly body trauma in American Football players, the levels of which and damage is unbelievable).

More older players in many sports will come forward, and I hope they do.  This is the only way to drive the investigation into the science and how to make the games safer, but as I said, without destroying the basic element which makes each sport special.  

The only exception for me is MMA which I think is dangerous and harmful by design and not that long ago was illegal.  Exists to satisfy people's blood lust.  But I suppose that is a separate discussion for another day.

A couple of thoughts to add

1) MMA - yes but. I don't know if it makes a difference or not but would not be surprised if there were less 'head shots' over the course of a bout than there would be in a boxing match. (To be honest I find MMA boring)

2) A fundamental role of contact sports is to channel the aggression that is natural in young men in a controlled way. If you consider such sports evil they are still a much lesser evil than the alternative.

Contact sports channel aggression and present physical challenges in old b*stards too!  
Men and women both.

In some ways I see a difference between the sports like rugby and football, where the head injuries / CTE are a by-product of other activities and are not the intent of the sport, and combat sports like boxing and MMA, where the objective is to inflict injury that has inevitable long term consequences.

If boxing wasn't historically legal, it would certainly not be legalised now knowing what we know about the long term effects of being repeatedly hit in the head (and MMA would not have been sanctioned). It's a bit like smoking tobacco - if there wasn't a long history, it would be in the same group as cannabis etc.

Part of the issue with the NFL and injuries generally, including the abundance of head injuries, is the very nature of the padding worn - remove the body armour and especially the helmets and face protection, and you'd get lessened impacts and fewer injuries especially to the big guys on the offensive and defensive lines. I know the rules officials have become very strict on hits to the head and even moreso hits where the defender  leads with the crown of the helmet (more to do with the risk of compressional spinal injuries than concussions). However, you get two guys of 225 lbs (i.e a biggish receiver or safety) each capable of running 100m in 10.5 s, crashing into each other at speed and it will always be rather messy. Unfortunately, some fans seem to think the changes so far have made the game soft, and it's probably going to take another generation of fans before the cleaner version of the game to be widely accepted.

For soccer, it seems that the issue is more with the older generation of players (i.e. 60s / 70s and before) - as balls have got lighter (especially in the last 20 years), there should be less long term damage from heading, although it will not be eliminated and there is still the risk of injury from head to head or heat to body clashes.

Rugby is definitely going the right way in terms of attempting to referee-out dangerous head contact, but the nature of the game means that some blows to the head are still likely (e.g. from knees / legs while tackling low). The return to play protocols seem sensible in theory but I'm not convinced they are always strictly adhered to in practice. Perhaps there should be a mandatory 2 weeks off before players are even allowed to begin the protocols following a head knock?

Since Gerd Müller's death, Denis Law (81) and Terry McDermott (69) have both revealed Alzheimer's diagnoses. McDermott said in a statement “I’m not frightened of taking it on and also, as we’ve seen, there are a lot of former players in a worse state than me....The number of ex-players being diagnosed with dementia or Alzheimer’s is frightening.”

As others have said above, football and rugby are different cases. However, football is a larger part of sporting life, so any health discussion which takes in football will have more cut-through.

McDemott also brings the disease a bit closer to home, as he was still playing internationals in the early eighties.

https://www.bbc.co.uk/sport/rugby-union/58369271

Doesn't sound great.

It's the cumulative effect of sub concussive blows that I feel rugby is largely trying to bury its head in the sand over. Concussion is getting more and more focus (though still some worrying incidents such as Cowan-Dickie's obvious concussion just before the Lions tour) but the effect that lots of sub concussive blows has in causing CTE and DAI (diffuse axonal injury) has had very few mentions.

Growing research to show that DAI can occur with mild TBIs is the big worry for contact sports I think. In short a DAI happens when the axon (the part of a neuron carry electrical impulses from one neuron to another in the brain) shears due to rapid acceleration or deceleration of the brain. Growing research to show that this can happen with sub concussive impacts is a big concern for a sport such as rugby where the brain undergoes rapid acceleration and deceleration in pretty much every tackle.

https://www.telegraph.co.uk/rugby-union/2021/10/06/simon-halliday-departs-warning-world-rugby-wife-wont-let-boys/

Simon Halliday departed his role as European Professional Club Rugby chairman on Tuesday with a warning that World Rugby is sleepwalking its way towards disaster over brain injuries after revealing his own children do not play the sport due to safety concerns.

A former England centre, Halliday is one of rugby’s longest serving administrators having served on the Rugby Football Union Council as well as at club level for Harlequins, Bath and Esher. In a candid interview with Telegraph Sport, he reflects upon the bruising battles to form an eight-year agreement between European leagues and unions with a Club World Cup starting in 2024 as its centrepiece.

However that blueprint for future prosperity is overshadowed by the existential crisis that rugby faces over a concussion lawsuit involving dozens of former players. World Rugby has commissioned studies examining the effects of fewer replacements and lower tackle heights, but Halliday insists the governing body must act far more decisively.

“Change some laws fast,” Halliday said. “Get on with it. Why are you waiting? I am sick and tired of hearing platitudes. Make some decisions. You can commission as many reports as you like, but all I know is that my wife scared to let my boys play rugby and she will not be the only one. She is not a shrinking violet, she loves the game but she says ‘no way am I letting them play when you see the head shots they take.’ Participation levels everywhere are down, down, down. Make decisions and you will bring people back.”

World Rugby have recently introduced the 50-22 law and goal line drop out but their wish to limit contact training to a maximum of 15 minutes per week as advisory rather than mandatory is an example of Halliday’s point. “If they have the evidence why do not just act?” he says. “What are you waiting for?”

As a centre for Bath, Harlequins and England, Halliday missed the advent of professionalism and believes a lot of the solutions to rugby’s present problems are to be found in previous era, including fewer replacements and better tackle technique. “It is soul destroying to see those players suffering that because the game was different back in my day,” Halliday said. “The cuts, the wounds and the bruises were inflicted without cameras. There was a lot more blood and you gained a lot more scars from people who wanted to have a go at you. You took more of a kicking but we aren’t wondering about what our names are.”

Hard to disagree with a lot of that but tbh I'm a bit unsightly on if his last point is accurate. There was a general feeling in football that they had no issues around this but then suddenly a lot of cases make the news because their is more focus on finding the stories. Given the macho view that rugby players spend 80 mins pretending not to be hurt and playing on with concussions it doesn't 'feel' right to simply say it was all OK in the old days. But as I say don't know for certain.

No 7&1/2 wrote:Hard to disagree with a lot of that but tbh I'm a bit unsightly on if his last point is accurate. There was a general feeling in football that they had no issues around this but then suddenly a lot of cases make the news because their is more focus on finding the stories. Given the macho view that rugby players spend 80 mins pretending not to be hurt and playing on with concussions it doesn't 'feel' right to simply say it was all OK in the old days. But as I say don't know for certain.

Agree with that. It seemed like he was offering a number of good points, but that last line didn't read very well for me either.

There was a specific issue in football with heading what was a relatively heavy leather ball. I suspect that the current generation of football players won't suffer brain damage in significant numbers simply because the ball has changed.

Rugby the problem is potentially worse because the impacts are harder and more frequent. I also suspect that League is going to be in for some tough times for similar reasons.

I suppose that brings it back round to the commissioned studies rather than potentially rose tinted glasses. It's not exactly either or though.