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The shifting media discourse surrounding head injuries in association football

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Abstract

Until recently, there has been a lack of significance placed on concussion in association football, particularly in mainstream media coverage. Contemporary incidents and research show that traumatic brain injuries, which may result in neurodegenerative disease, are common in football, but remain poorly understood. However, following the deaths of several heroised FIFA World Cup-winning footballers, as well as a serious head injury to two players in 2020, a noticeable shift in media attitudes towards concussion and head injuries in sport has been detected.
ACADEMIA Letters
The shifting media discourse surrounding head injuries in
association football
Keith D. Parry
Adam J. White
Eric Anderson
John Batten
Until recently, there has been a lack of signicance placed on concussion in association foot-
ball, particularly in mainstream media coverage. Contemporary incidents and research show
that traumatic brain injuries, which may result in neurodegenerative disease, are common in
football, but remain poorly understood. However, following the deaths of several heroised
FIFA World Cup winning footballers, as well as a serious head injury to two players in 2020,
a noticeable shift in media attitudes towards concussion and head injuries in sport has been
detected.
Introduction
In recent years, there has been increasing academic attention focussed on sporting injuries,
particularly within the eld of the sociology of sport. Much of this focus has been on the
impact of concussion on the health and welfare of athletes, with this attention largely driven by
cultural conversations inspired by high-prole lms such as the Will Smith movie Concussion,
or documentaries such as Killer Inside, about NFL player Aaron Hernandez (Parry et al.,
2020). Initially, concussion was a term that was used loosely in mainstream media coverage,
with its signicance downplayed. However, there has since been a move to refer to concussion
Academia Letters, April 2021
Corresponding Author: Keith D. Parry, kdparry@bournemouth.ac.uk
Citation: Parry, K.D., White, A.J., Anderson, E., Batten, J. (2021). The shifting media discourse surrounding
head injuries in association football. Academia Letters, Article 488. https://doi.org/10.20935/AL488.
1
©2021 by the authors — Open Access — Distributed under CC BY 4.0
as a traumatic brain injury, alongside recognition that it may be a potential risk factor of
Chronic Traumatic Encephalopathy (CTE). As such, concussion has come to be been seen as
one of sport’s greatest challenges (Anderson & White, 2018).
This paper discusses the media discourses associated with head injuries and concussion
in association football (soccer), presenting preliminary observations of a shift in attitudes
towards the seriousness of the topic, which reects a move that occurred a few years earlier
in American football (Anderson & Kian 2012). Taking an analysis of 2018 media framing of
concussion in football as a starting point, initial comparisons from media coverage of head
injuries and repeated head impacts are presented.
Head injuries in sport
The link between traumatic brain injury and neurological decits has been studied for some
time. For example, punch drunk syndrome – later described as pugilistic dementia and most
recently identied as CTE – was rst identied in the early 20th century amongst boxers (Rus-
sell et al. 2020). However, until recently, the primary focus of concern for concussion has
been on American football. Nevertheless, consideration is now occurring in sports such as
downhill mountain biking (Hurst et al., 2020), rugby (Hill, Magrath & White, 2020), as well
as association football (Roderick, 2006). Here, concussion often results from unintentional
head impacts (e.g., head-to-head collisions), but a growing number of studies show that detri-
mental sub-concussive impacts may result from heading the ball (Di Virgilio et al., 2016;
Levitch et al., 2018; Maher et al., 2014). Specically, Di Virgilio et al. (2016) found that 20
consecutive head impacts from heading a standard football (weighing 400 grammes) resulted
in immediate and measurable alterations in brain function. Furthermore, a large-scale study of
former professional football players in Scotland found that, mortality from neurodegenerative
disease was higher and dementia-related medications were prescribed more frequently in the
former professional football players (Mackay et al., 2019).
This latter study, funded by the Football Association and Professional Footballers’ As-
sociation, received much media attention and was viewed as vindication by the families of
a number of deceased former footballers who had argued that heading footballs during their
playing career had led to the onset of dementia (BBC, 2019). Shortly afterwards, in 2020, a
major shift occurred when the football associations of Scotland, England and Northern Ireland
banned heading of the ball during training sessions for children until the age of 12 (MacInnes,
2020), following a move seen in America ve years earlier.
Historically though, there has been a lack of signicance placed on concussion in foot-
ball in media coverage. White et al. (2020), in a study of media reports of a head injury
Academia Letters, April 2021
Corresponding Author: Keith D. Parry, kdparry@bournemouth.ac.uk
Citation: Parry, K.D., White, A.J., Anderson, E., Batten, J. (2021). The shifting media discourse surrounding
head injuries in association football. Academia Letters, Article 488. https://doi.org/10.20935/AL488.
2
©2021 by the authors — Open Access — Distributed under CC BY 4.0
sustained by Loris Karius, found that it was common for media reports to deect attention
away from head injuries and to display a general lack of understanding of concussion causes
and symptoms. In addition, former players and those involved in the sport were often used
as ‘ocial sources’ that downplayed concussion. For example, one ex-player was quoted as
saying, “so many players have bumped heads. Could you go back retrospectively and go he
was bit dazed?” (Mills cited in Amako, 2018).
Explanations for this disregard include that such injuries are contrary to the popular, hege-
monic masculinity narratives surrounding sport (Cassilo & Sanderson, 2018) and that the me-
dia, as a stakeholder, wishes to protect the reputation of sport (White et al., 2020). However,
recent incidents show that common traumatic brain injuries, which may result in neurodegen-
erative disease, and are now known to be common in modern football, are receiving greater
media attention. Indeed, following the death of several heroised FIFA World Cup winning
footballers in 2020, a noticeable shift in media attitudes towards concussion and head injuries
in sport can be identied.
A turning point in football
In late 2020, three notable incidents served as the impetus for a shift in attitudes towards
media coverage of head injuries within football. First, Norbert ‘Nobby’ Stiles, a member of
England’s 1966 FIFA World Cup winning team, passed away. Reports of his death made
reference to the fact that he had been diagnosed with dementia and linked the cause of this
disease to repeated heading of the ball in his career (BBC, 2020a; Jackson, 2020a).
Second, it was announced on 1st November that Sir Bobby Charlton, another World Cup
winning hero, had been diagnosed with dementia. His brother, who played in the same win-
ning team, had died earlier in the year after a battle with dementia. Charlton’s diagnosis meant
that ve of the eleven starting players in the 1966 nal had been diagnosed with neurological
diseases. Media reports have linked all of these cases to the repeated heading of footballs
during their playing careers (BBC, 2020b; Dunn, A., 2020; Jackson, 2020b; Wilson, 2020)
and a number have referenced Mackay et al.’s (2019) study into Scottish footballers (BBC,
2020b; Jackson, 2020b).
Thus, it appears that the loss of football (and cultural) heroes, as a result of their sporting
eorts, has inuenced the reporting on head injuries in football and also sparked further debate
into the eect of repeated heading of the ball on brain health (Parry, Anderson & Hurst, 2020).
Initial observations suggest that, in all instances, traumatic brain injuries were a signif-
icant element of media reporting and the information presented on concussion and head in-
juries was more accurate than found by White et al. (2020). Signicantly, the Daily Mail, a
Academia Letters, April 2021
Corresponding Author: Keith D. Parry, kdparry@bournemouth.ac.uk
Citation: Parry, K.D., White, A.J., Anderson, E., Batten, J. (2021). The shifting media discourse surrounding
head injuries in association football. Academia Letters, Article 488. https://doi.org/10.20935/AL488.
3
©2021 by the authors — Open Access — Distributed under CC BY 4.0
British tabloid newspaper launched a campaign, Enough is Enough, to draw attention to the
link between football and dementia (Keegan, 2020). Here, former footballers, family mem-
bers of players who died from dementia, as well as The Alzheimer’s Society, called for a
radical intervention into heading the ball in the sport. This campaign produced a 7-point
charter calling for research into the link between football and dementia, limiting heading in
training, alongside the recognition of dementia as an industrial disease in football. It drew
supportive comments from a variety of current and former players and the current manager
(Gareth Southgate) of the England men’s national team (Keegan, 2020).
Third, a clash of heads that resulted in serious head injuries to two players in an English
Premier League match between Arsenal Football Club and Wolverhampton Wanderers Foot-
ball Club was widely discussed in the media (BBC, 2020c; Rathborn, 2020; Spiers, 2020).
While one of the players (Raul Jimenez) was stretchered from the eld of play with a frac-
tured skull, the other, David Luiz, initially remained on the pitch despite sustaining a serious
cut to the head (bleeding through the bandages applied to cover the injury) before being re-
moved some time later – a move that drew widespread criticism and resulted in calls for the
introduction of concussion substitutions (Ingle, 2020; PA Sta, 2020).
The response to Luiz’s injury was of particular signicance as players have previously
been praised for remaining on the pitch following head injuries, including (in)famous cases
where they have been bleeding extensively (Gadd, 2015). Athletes that sacrice their bodies,
often in ways that may be seen as deviant in broader society but are considered normative in
sport (Anderson & White, 2018; Hughes & Coakley, 1991), have been heroised previously,
and it has been found that both players and pitch-side doctors are complicit in the lack of
concussion management within elite sport (Ruston et al., 2019).
The symptoms of concussion are “vague and heterogeneous” (McNamee et al., 2015, p.
193) and so diagnoses and prognoses are complicated and contested, allowing players to stay
in the game following head injuries. Often, footballers may be pressured through a culture of
risk to continue, regardless of the severity of their injuries and physical condition (Sanderson
et al., 2017). Roderick (2006, pp. 18–19) notes: “athletes learn to disregard the risk of
physical harm to normalize pain and injury as part of their sporting experience”. However,
in this most recent incident, the widespread media criticism of Luiz remaining on the pitch
indicates both reporting and cultural shifts. Indeed, one former footballer, who had similarly
played on while blood stained and bandaged, Terry Butcher, was critical of Luiz. Reecting
on his own decision to remain on the pitch, Butcher claimed that he now considered himself
to be a “bloody fool” and far from heroic (cited in Dunn, 2020). The picture of Butcher, with
his national shirt stained with blood, has been an iconic image of English masculinity and
bravery (Gadd, 2015), so it is signicant for him to claim that playing on following a head
Academia Letters, April 2021
Corresponding Author: Keith D. Parry, kdparry@bournemouth.ac.uk
Citation: Parry, K.D., White, A.J., Anderson, E., Batten, J. (2021). The shifting media discourse surrounding
head injuries in association football. Academia Letters, Article 488. https://doi.org/10.20935/AL488.
4
©2021 by the authors — Open Access — Distributed under CC BY 4.0
injury is foolish.
Conclusion
In the two years between the 2018 Karius injury and the series of culturally signicant events
and incidents in 2020, there appears to have been a shift in media reporting on concussion
and head injuries in football. Rather than downplaying the signicance of head injuries and
concussion, media reports now highlight the signicance of these injuries and aim to educate
readers on this issue. The criticism of David Luiz remaining on the pitch, following what
was a signicant clash of heads, is further evidence for a move away from heroising athletes
for sacricing their bodies in the pursuit of victory. Although further in-depth investigations
of media coverage in football are needed to conrm these observations, it seems that the
signicance of head injuries and the potential dangers from heading footballs is now a feature
of reporting.
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Purpose This article provides an analysis of British physical education (PE) teachers’ knowledge of and attitudes toward concussion in rugby. Methods Semi-structured interviews were conducted with 15 qualified PE teachers responsible for rugby delivery in their respective schools (and who also hold a minimum of a Level 2 Rugby Football Union (RFU) accredited coaching award, and have completed the organization’s concussion awareness training initiative, “Headcase”). Findings Due to the absence of appropriate training – both in coaching qualifications and broader teacher training – these teachers lack understanding of signs, symptoms, and aftercare of suspected concussion. Findings also indicate that “Headcase” may be problematic in providing adequate education to ensure PE teachers are adequately prepared should serious injury arise. Implications Given the findings of this research, we recommend: (1) “Headcase” be delivered by a qualified practitioner or form a central part of existing coaching qualifications; (2) Mandatory tackle training to be provided to PE teachers; (3) Mandatory injury logs to be kept by every school in order to better understand the frequency of injury in PE.
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Introduction There is growing recognition of an association between contact sports participation and increased risk of neurodegenerative disease, including Alzheimer’s disease and chronic traumatic encephalopathy. In addition to cognitive impairment, a range of mental health disorders and suicidality are proposed as diagnostic features of traumatic encephalopathy syndrome, the putative clinical syndrome associated with chronic traumatic encephalopathy. However, to date, epidemiological data on contact sport participation and mental health outcomes are limited. Methods For a cohort of former professional soccer players (n=7676) with known high neurodegenerative mortality and their matched general population controls (n=23 028), data on mental health outcomes were obtained by individual-level record linkage to national electronic records of hospital admissions and death certification. Results Compared with matched population controls, former professional soccer players showed lower risk of hospital admission for anxiety and stress related disorders, depression, drug use disorders, alcohol use disorders and bipolar and affective mood disorders. Among soccer players, there was no significant difference in risk of hospitalisation for mental health disorders between outfield players and goalkeepers. There was no significant difference in rate of death by suicide between soccer players and controls. Conclusions Among a population of former professional soccer players with known high neurodegenerative disease mortality, hospital admissions for common mental health disorders were lower than population controls, with no difference in suicide. Our data provide support for the reappraisal of currently proposed diagnostic clinical criteria for traumatic encephalopathy syndrome, in particular the inclusion of mental health outcomes.
Article
Background: Neurodegenerative disorders have been reported in elite athletes who participated in contact sports. The incidence of neurodegenerative disease among former professional soccer players has not been well characterized. Methods: We conducted a retrospective cohort study to compare mortality from neurodegenerative disease among 7676 former professional soccer players (identified from databases of Scottish players) with that among 23,028 controls from the general population who were matched to the players on the basis of sex, age, and degree of social deprivation. Causes of death were determined from death certificates. Data on medications dispensed for the treatment of dementia in the two cohorts were also compared. Prescription information was obtained from the national Prescribing Information System. Results: Over a median of 18 years, 1180 former soccer players (15.4%) and 3807 controls (16.5%) died. All-cause mortality was lower among former players than among controls up to the age of 70 years and was higher thereafter. Mortality from ischemic heart disease was lower among former players than among controls (hazard ratio, 0.80; 95% confidence interval [CI], 0.66 to 0.97; P = 0.02), as was mortality from lung cancer (hazard ratio, 0.53; 95% CI, 0.40 to 0.70; P<0.001). Mortality with neurodegenerative disease listed as the primary cause was 1.7% among former soccer players and 0.5% among controls (subhazard ratio [the hazard ratio adjusted for competing risks of death from ischemic heart disease and death from any cancer], 3.45; 95% CI, 2.11 to 5.62; P<0.001). Among former players, mortality with neurodegenerative disease listed as the primary or a contributory cause on the death certificate varied according to disease subtype and was highest among those with Alzheimer's disease (hazard ratio [former players vs. controls], 5.07; 95% CI, 2.92 to 8.82; P<0.001) and lowest among those with Parkinson's disease (hazard ratio, 2.15; 95% CI, 1.17 to 3.96; P = 0.01). Dementia-related medications were prescribed more frequently to former players than to controls (odds ratio, 4.90; 95% CI, 3.81 to 6.31; P<0.001). Mortality with neurodegenerative disease listed as the primary or a contributory cause did not differ significantly between goalkeepers and outfield players (hazard ratio, 0.73; 95% CI, 0.43 to 1.24; P = 0.24), but dementia-related medications were prescribed less frequently to goalkeepers (odds ratio, 0.41; 95% CI, 0.19 to 0.89; P = 0.02). Conclusions: In this retrospective epidemiologic analysis, mortality from neurodegenerative disease was higher and mortality from other common diseases lower among former Scottish professional soccer players than among matched controls. Dementia-related medications were prescribed more frequently to former players than to controls. These observations need to be confirmed in prospective matched-cohort studies. (Funded by the Football Association and Professional Footballers' Association.).
Article
Athlete safety and concussion injury have garnered considerable attention recently, and appropriate evaluation of athletes following head impacts depends, in part, on athletes’ self-reporting of the symptoms. The National Collegiate Athletic Association has focused primarily on concussion injury education to encourage self-reporting; however, such efforts have not been especially effective and many potential injuries continue to go unreported. This research investigates cultural narratives, derived from sports media and popular culture, and how their narrative logics contribute to the context in which student-athletes make head injury reporting decisions and how these narratives offer templates for understanding potential consequences. We argue that performance-oriented narratives are more prevalent and showcase pathways to more immediate satisfaction of desires or goals. Ultimately, we argue that not only does analysis of prevailing cultural narratives illuminate the context in which athletes make reporting decisions but also that such understanding could inform narrative-based interventions in order to emphasize and model recommended behaviors, such as injury reporting, and values, such as long-term brain health and player wellness.
Article
Objectives: The present study examined the relative contribution of recent or long-term heading to neuropsychological function in amateur adult soccer players. Participants and methods: Soccer players completed a baseline questionnaire (HeadCount-12m) to ascertain heading during the prior 12 months (long-term heading, LTH) and an online questionnaire (HeadCount-2w) every 3 months to ascertain heading during the prior 2 weeks (recent heading, RH). Cogstate, a battery of six neuropsychological tests, was administered to assess neuropsychological function. Generalized estimating equations were used to test if LTH or RH was associated with neuropsychological function while accounting for the role of recognized concussion. Results: A total of 311 soccer players completed 630 HeadCount-2w. Participants had an average age of 26 years. Participants headed the ball a median of 611 times/year (mean=1,384.03) and 9.50 times/2 weeks (mean=34.17). High levels of RH were significantly associated with reduced performance on a task of psychomotor speed (p=.02), while high levels of LTH were significantly associated with poorer performance on tasks of verbal learning (p=.03) and verbal memory (p=.04). Significantly better attention (p=.02) was detectable at moderately high levels of RH, but not at the highest level of RH. One hundred and seven (34.4%) participants reported a lifetime history of concussion, but this was not related to neuropsychological function and did not modify the association of RH or LTH with neuropsychological function. Conclusion: High levels of both RH and LTH were associated with poorer neuropsychological function, but on different domains. The clinical manifestations following repetitive exposure to heading could change with chronicity of exposure. (JINS, 2017, 23, 1-9).