The shifting media discourse surrounding head injuries in association football

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.

Full text

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.
References
Amako, U. (2018). Loris Karius: Danny Mills oers shock Liverpool transfer theory af-
ter concussion reveal. Daily Express. https://www.express.co.uk/sport/football/970513/
Loris-Karius-Danny-Mills-Liverpool-transfer-concussion-Champions-League-nal/amp.
Anderson, E., & Kian, E. M. (2012). Examining media contestation of masculinity and head
trauma in the National Football League. Men and masculinities, 15(2), 152-173.
Anderson, E., & White, A. J. (2018). Sport, theory and social problems: A critical introduc-
tion (2nd ed.). Routledge.
BBC. (2019). Dementia in football: Ex-players three and a half times more likely to die of
condition. BBC Sport.https://www.bbc.co.uk/sport/football/50124102.
BBC. (2020a). Nobby Stiles: World Cup winner and former Man Utd midelder dies aged
78. BBC Sport.https://www.bbc.co.uk/sport/football/36963874
BBC. (2020b). Sir Bobby Charlton: England World Cup winner diagnosed with dementia.
BBC Sport. https://www.bbc.co.uk/sport/football/54770216.
BBC. (2020c). Raul Jimenez: Wolves striker has surgery on fractured skull after David Luiz
head clash. BBC Sport.https://www.bbc.co.uk/sport/football/55125293.
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.
5
©2021 by the authors — Open Access — Distributed under CC BY 4.0

Cassilo, D., & Sanderson, J. (2018). “I don’t think it’s worth the risk”: Media framing of
the Chris Borland retirement in digital and print media. Communication & Sport, 6(1),
86–110.
Di Virgilio, T. G., Hunter, A., Wilson, L., Stewart, W., Goodall, S., Howatson, G., Donald-
son, D. I., & Ietswaart, M. (2016). Evidence for acute electrophysiological and cognitive
changes following routine soccer heading. EBioMedicine, 13, 66–71.
Dunn, A. (2020). Sir Bobby Charlton’s dementia diagnosis rearms need to establish link
with football. The Daily Mirror. https://www.mirror.co.uk/sport/football/news/sir-bobby-
charlton-dementia-diagnosis-22942784.
Dunn, M. (2020). There’s nothing macho about head injuries. The Express. https://www.express.co.uk/
sport/football/1366851/Terry-Butcher-warns-David-Luiz-modern-stars-concussions-latest-
news-Premier-League/amp.
Gadd, M. (2020). Terry Butcher donates iconic memories to Sir Bobby Robson auction and
will coach amateur side at St George’s Park event. The Daily Mail.https://www.dailymail.co.uk/
sport/sportsnews/article-3329422/Terry-Butcher-donates-iconic-memories-Sir-Bobby-Robson-
auction-coach-amateur-St-George-s-Park-event.html
Hill, S., Magrath, R., & White, A. (2020). “Part and parcel of the game?” Physical edu-
cation teachers, head trauma, and the Rugby Football Union’s “Headcase” programme.
Managing Sport and Leisure, 1-15.
Hughes, R., & Coakley, J. (1991). Positive deviance among athletes: The implications of
overconformity to the sport ethic. Sociology of Sport Journal, 8(4), 307–325.
Hurst, H. T., Hancock, S., Hardwicke, J., & Anderson, E. (2020). Does participation in
Downhill mountain biking aect measures of executive function? Journal of Science and
Cycling.
Ingle, S. (2020). Football needs to catch up and get its house in order over concussion. The
Guardian. https://www.theguardian.com/sport/blog/2020/nov/30/football-concussion-raul-
jimenez-david-luiz?CMP=Share_iOSApp_Other
Jackson, J. (2020a). Nobby Stiles, 1966 World Cup winner with England, dies aged 78. The
Guardian. https://www.theguardian.com/football/2020/oct/30/nobby-stiles-world-cup-winner-
with-england-1966-manchester-united-dies.
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.
6
©2021 by the authors — Open Access — Distributed under CC BY 4.0

Jackson, J. (2020b). England legend Sir Bobby Charlton is diagnosed with dementia The
Guardian. https://www.theguardian.com/football/2020/nov/01/sir-bobby-charlton-diagnosed-
with-dementia-wife-lady-norma-conrms
Keegan, M. (2020). Enough is ENOUGH: Sportsmail launches campaign to tackle football’s
dementia scandal with a call for immediate action amid a growing number of former play-
ers aected by brain disease. The Daily Mail. https://www.dailymail.co.uk/sport/football/
article-8955591/Enough-Sportsmail-launches-campaign-tackle-dementia.html
Levitch, C. F., Zimmerman, M. E., Lubin, N., Kim, N., Lipton, R. B., Stewart,W. F., Kim, M.
& Lipton, M. L. (2018). Recent and long-term soccer heading exposure is dierentially
associated with neuropsychological function in amateur players. Journal of the Interna-
tional Neuropsychological Society, 24(2), 147–155.
MacInnes, P. (2020). Children under age of 12 should not head footballs in training, say
FAs. The Guardian. https://www.theguardian.com/football/2020/feb/24/children-under-
age-of-12-banned-from-heading-footballs-in-training
Mackay, D. F., Russell, E. R., Stewart, K., MacLean, J. A., Pell, J. P., & Stewart, W. (2019).
Neurodegenerative Disease Mortality among Former Professional Soccer Players. New
England Journal of Medicine, 381(19), 1801-1808. doi:10.1056/NEJMoa1908483
Maher, M. E., Hutchison, M., Cusimano, M., Comper, P., & Schweizer, T. A. (2014). Con-
cussions and heading in soccer: A review of the evidence of incidence, mechanisms,
biomarkers and neurocognitive outcomes. Brain Injury, 28(3), 271–285.
McNamee, M. J., Partridge, B., & Anderson, L. (2015). Concussion in sport: Conceptual
and ethical issues. Kinesiology Review, 4(2), 190–202.
PA Sta. (2020). Headway leads renewed calls for concussion substitutes after David Luiz
plays on. FourFourTwo.https://www.fourfourtwo.com/news/headway-leads-renewed-calls-
for-concussion-substitutes-after-david-luiz-plays-on-1606727483000
Parry, K. D., Anderson, E., Hurst, H. (2020). Football and dementia: heading must be
banned until the age of 18. The Conversation. https://theconversation.com/football-and-
dementia-heading-must-be-banned-until-the-age-of-18-150575.
Rathborn, J. (2020). Raul Jimenez injury: Wolves conrm striker suered fractured skull
after clash of heads with David Luiz. The Independent. https://www.independent.co.uk/
sport/football/premier-league/wolves/raul-jimenez-injury-hospital-arsenal-luiz-b1763786.html
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.
7
©2021 by the authors — Open Access — Distributed under CC BY 4.0

Roderick, M. (2006). Adding insult to injury: Workplace injury in English professional
football. Sociology of Health & Illness, 28(1), 76–97.
Russell, E. R., McCabe, T., Mackay D. F.,Stewart, K., MacLean, J. A., Pell, J. P. & Stewart,
W. (2020). Mental health and suicide in former professional soccer players. Journal of
Neurology, Neurosurgery & Psychiatry, 91,1256-1260.
Ruston, S. W., Kamrath, J. K., Zanin, A. C., Posteher, K., & Corman, S. R. (2019). Perfor-
mance versus safety: Understanding the logics of cultural narratives inuencing concus-
sion reporting behaviors. Communication & Sport, 7, 529–548.
Sanderson, J., Weathers, M., Snedaker, K., & Gramlich, K. (2017). “I was able to still do
my job on the eld and keep playing”: An investigation of female and male athletes’
experiences with (not) reporting concussions. Communication & Sport, 5(3), 267–287.
Spiers, T. (2020). Raul Jimenez and the recovery process from a serious head injury. The Ath-
letic.https://theathletic.co.uk/2229222/2020/11/30/raul-jimenez-wolves-fractured-skull/.
White, A. J., Parry, K. D., Humphries, C., Phelan, S., Batten, J., & Magrath, R. (2020). Duty
of Karius: Media Framing of Concussion Following the 2018 UEFA Champions League
Final. Communication & Sport, doi:10.1177/2167479520948048.
Wilson, J. (2020). Sir Bobby Charlton diagnosed with dementia. The Telegraph. https://
www.telegraph.co.uk/football/2020/11/01/sir-bobby-charlton-diagnosed-dementia/.
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.
8
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