It's a scene that’s familiar to football fans around the world.
A striker like Bayern Munich’s Leroy Sane sends a powerful shot straight into a defender’s head, knocking him out.
The TV commentator praises the defender’s courage. Another jokes that he’s probably “lost a few brain cells”.
Common incidents like these highlight that while attitudes to head injuries may be changing, there’s still work to be done.
Football’s ruling body, Fifa, appears keen to take action.
At the last Club World Cup in Qatar (2019), a new rule was introduced to allow teams to substitute an extra player where a concussion had occurred or was suspected.
“It’s a sensible procedure,” says neurologist Dr Nina Feddermann-Demont from the Swiss Concussion Center in Zurich, Switzerland.
“A permanent substitution is the safest solution for the affected player because diagnosis on the sidelines is so difficult.”
This is because concussion is a dynamic injury and symptoms often only appear after a time delay.
International research suggests that concussions occur in more than one in 20 football matches around the world.
“However, there are significantly fewer concussions in football than in other contact sports such as American football, rugby or ice hockey,” she says.
She had taken part in the Fifa discussions that decided on trying out one or two additional substitutions for head injuries.
Along with the new measures for the Club World Cup, the English Premier League has introduced two additional substitutions for cases of possible concussion on a trial basis.
Dr Ingo Helmich, a neuroscientist from the Cologne Sports University in Germany, believes that head injury assessments should be done by neutral doctors.
“They can decide independently of the team, coach and score, whether a player should be examined more closely and substituted after a possible concussion,” he says.
This model was introduced in the American National Football League in 2013, for example.
Dr Feddermann-Demont, on the other hand, advocates improving the training of team doctors for the examination of head trauma and leaving the decision on substitution to them.
”The problem with independent doctors is that they don’t know the player’s history, and possibly pre-existing symptoms like headaches,” she says.
On top of that, there is a multitude of languages in professional football, she adds.
“The starting point here in football is different from, for example, sports like rugby or American football, which are popular in the Anglo-Saxon world.”
In England in particular, there’s been a debate about the possible long-term consequences of playing football.
Last year (2020), Lady Norma Ball made public that her husband, Sir Bobby Charlton, has dementia.
He’s the fifth member of England’s 1966 World Cup winning team to develop the condition.
A 2019 study by Glasgow University in Scotland found that ex-football professionals have an increased risk of dying from dementia or Parkinson’s disease.
Even though no direct link between the diseases and the technique of heading could be proven, the associations of England, Scotland and Northern Ireland decided to ban coaches training children under the age of 11 to head the ball.
That move has been criticised by Tim Meyer, head of the German Football Association’s Medical Commission.
He points to the fact that no causal link had been established, and warned against an ”over-interpretation” of the study.
He describes the ban on headers for children as “not sensible”.
And Dr Feddermann-Demont refers to a study that found that 82% of concussions in children are caused by contact with a player, rather than a ball.
“In about two-thirds of concussions, the player was hit in the back of the head.
“Banning headers would therefore not necessarily reduce the incidence of concussions,” she says. – By Florian Luetticke/dpa