Head injuries in football: A ticking time bomb

"I remember everything," Ryan Mason recalls. "The short corner, the cross into the box, the impact. It came from nowhere."

On January 22 last year, Mason played his final game. After a career that had seen him appear for Tottenham Hotspur and once for the England national team, his final act as a professional was a routine headed clearance for Hull City at Stamford Bridge. However, his clash of heads with Chelsea's Gary Cahill left him with a cracked skull. Despite the 26-year-old's best efforts to return to the game, he retired in February on medical advice.

Ominous statistics

Head injuries have long been dismissed as part of the rough and tumble of the game. When Christoph Kramer, the Germany international, suffered concussion in the last World Cup final, he asked the team doctor, who had rushed onto the field to treat him: "Is this the World Cup final?" The doctor assumed he was joking, but he wasn't. "I need to know," Kramer insisted.

Head injuries of this kind are surprisingly frequent, in the Bundesliga and beyond. Both the procedure for treating head injuries and attitudes towards them lags far behind other sports, such as rugby and American football. In 2017, a record 281 concussions were recorded throughout the NFL season, up 38 on 2016.

Read more: German soccer lags behind on concussion risk 

Chronic traumatic encephalopathy (CTE) is a degenerative brain disease caused by repeated concussions, and various medical studies have concluded that a direct link exists between concussions and the onset of CTE. In 2005, researchers published the first confirmed case of CTE in an NFL player (the lead author of that study, Bennet Omalu, was portrayed by Will Smith in the movie Concussion). The results of that report contained ominous statistics to suggest CTE might be frighteningly prevalent among players.

Priority treatment

In football, head injuries are rarer than the 0.41 concussions per NFL game, but the risk of serious injury is greater given that very few players wear protective headwear. It had been hoped that the headguard worn by Arsenal goalkeeper Petr Cech since his brush with death in a Premier League match in 2006, would become the norm at least in goalkeepers — but that proved a false dawn.

Mason says even the treatment he received in the immediate aftermath of the accident was not entirely satisfactory.

"I had unbelievable treatment to get me back to full health and fitness, even if I've had to leave the game," Mason told DW. "But that's the one area where I would say things need to change. The policy is that for split head injuries, where two players are on the ground, the home player will receive priority treatment. In my case, I had a much more severe injury than Gary Cahill, but I had to wait longer to get priority treatment."

24-hour lock out

While football still has a long way to go before it reaches the levels of awareness and education that have helped the NFL combat the problem, a Bundesliga team doctor told DW that the procedure for treating head injuries falls short of what is required to protect players.

"What should happen when a player gets a head injury and what actually happens, tend to be two different things," Dr. Tim Niedergassel, the team physician for Arminia Bielefeld and former physician for Hamburg, told DW. "In theory, the team doctor should be allowed on to the field as quickly as possible to perform a basic neurological check. This is the minimum mandatory check required, and that's where head injuries differ from other types of injury."

Niedergassel believes that a change of culture is required and that players should be locked out of playing for at least 24 hours after receiving a blow to the head.

"In the 2014 World Cup final, Christoph Kramer absolutely should not have been allowed to play on. This is clear. He had concussion and this is really, really serious," he said.

"And if Kramer had got a second hit to the same part of his head later in the game, then it could have become very serious indeed. He wasn't orientated at all and by playing on he was putting himself in danger of a chronic brain injury. This kind of situation should be a no-go. He simply had to be substituted because he had suffered a traumatic brain injury."

‘Change of culture'

"It's not always possible to be able to determine how intensive a concussion is at the time of the injury, so a player that sustains concussion must always be removed from the game so he can be properly examined. There should be at least a 24-hour lock out from the moment a player suffers a head injury, and this must be standard across football, and all sports.

"Lack of awareness of the dangers of head injuries is a big problem, especially in football. Players are praised when they recover from an injury and get back on the pitch, but this is the wrong attitude, and potentially very dangerous. When players are encouraged by their coaches or fans to "run on” after suffering an injury, they don't really realize how dangerous that can be. Football would do well to change that culture that still exists in the game, because they don't understand the potential danger they're putting their players in."

While Ryan Mason can at least be happy that he's made a full recovery and is forging a new career as a TV pundit, his premature retirement should serve as a warning