Concussion in football players is a significant concern due to the nature of the sport, which involves high-impact collisions, tackling, and heading the ball. While football is often viewed as less physically violent than American football, the risk of concussion remains high, and its consequences can be long-lasting. The incidence of sport-related concussion (SRC) has been increasing in different sports and its impact on long-term cognitive function is increasingly recognized.
What is SRC/ Concussion?
A concussion is a mild traumatic brain injury (TBI) that occurs when a blow or jolt to the head causes the brain to move rapidly within the skull. This can lead to a temporary loss of brain function. Concussions can affect a player’s physical, cognitive, and emotional state and may result in symptoms like headaches, dizziness, confusion, memory issues, or sensitivity to light and sound.
Repeated concussions are associated with an increased risk of several neurologic diseases and long-term cognitive deficits. To improve cognitive outcomes in athletes with SRC, standardized guidelines for the assessment and management of SRC are vital. However, current concussion management guidelines lack procedures for rehabilitating acute and long-term cognitive symptoms.
“Concussions are invisible injuries, but their impact on a player’s health and career can be devastating.”
Increased awareness for the management and rehabilitation of cognitive symptoms in SRC is needed by all clinical neurologists treating professional and amateur athletes. Cognitive training as a ‘prehabilitation’ tool can be used to alleviate the severity of cognitive symptoms and as a rehabilitative tool to improve cognitive recovery post injury.
Risk factors in football
- Heading the ball: Although heading a ball may not cause a concussion in every instance, repeated headers over time have been associated with brain injury, including concussions and chronic traumatic encephalopathy (CTE).
- Collisions and tackling: Direct impacts, like being tackled or colliding with other players, can lead to a concussion. This is especially prevalent in more physical positions, such as defenders or forwards.
- Goalkeeper risk: Goalkeepers are at an increased risk of concussion, particularly from collisions with opposing players or the goalposts, or from powerful shots to the head.
- Foul play or accidents: Intentional fouls (like elbows or head clashing) or accidental impacts (such as a knee to the head during a tackle) can result in concussions.
- Underreporting: Players, coaches, and even medical staff might downplay the symptoms, leading to concussions not being properly diagnosed or treated.
FIFPRO’s stance
FIFPRO is at the forefront of addressing the issue of concussion. SRC is a serious health concern for players, but it still lacks proper awareness in the football industry. Adequate health and safety protocols, as well as industry-tailored approach to research, are still missing. FIFPRO’s Chief Medical Officer Dr Vincent Gouttebarge states:
“It is essential to improve the recognition and management of concussion in professional football so that the players’ health can be protected on the short- and long-term.”
Diagnosis
Concussions are usually diagnosed based on symptoms, the mechanism of injury, and a neurological examination. A player who shows signs of concussion should be removed from the game immediately. Medical professionals may use the SCAT5 (Sports Concussion Assessment Tool) to assess the severity of the injury. In some cases, imaging like an MRI or CT scan may be used to rule out more severe brain injuries.
The FA has published a guide for concussion, with the strapline “If in doubt, sit them out.” Below are some questions to ask a player if concussion is suspected. An incorrect answer to these questions may suggest concussion. Video footage of the incident may also assist in identifying visible signs of whether concussion has occurred, along with the severity of the injury.
Protocols
For SRC, most sporting bodies now follow specific management guidelines published by the Concussion in Sport Group table below.
After an initial 24–48 hours of rest, a concussed player can begin a graded return to sport. The guidelines suggest a minimum of 24 hours between each stage, which in theory could result in a concussed athlete returning to play within a week. These guidelines reduce the immediate likelihood of sustaining an additional concussion, which is vital, given that further concussion during this acute phase can exacerbate the neuropathophysiological cascade.
“If in doubt, sit them out.”
Prevention strategies
Preventing concussions is challenging, but there are several strategies to reduce the risk:
- Proper technique: Players should be taught proper techniques for heading the ball, tackling, and protecting themselves during physical encounters. Teaching safe playing habits from an early age is critical.
- Protective equipment: While helmets and other protective gear are common in American football, in football, the focus has been more on minimizing impacts rather than using head protection. Some research suggests that ‘headgear’ could potentially reduce the risk of injury, but it’s not universally recommended at all levels.
- Rule changes: Many professional leagues have implemented rules to minimize risky behaviour, such as restricting heading in youth football or limiting the number of headers allowed in practice. Other regulations, like automatic substitutions or removal from play following suspected concussions, are becoming more common.
- Education and awareness: Educating players, coaches, and parents about the signs and symptoms of concussion can lead to better reporting and treatment. More awareness around the importance of rest and recovery is critical to prevent long-term issues.
- Concussion baseline testing: Some teams conduct baseline testing of athletes’ cognitive function before the season starts. This provides a reference point to assess how a player’s brain function has changed post-concussion.
Nutrition for brain health in Contact Sports
Nutrition plays a crucial role in supporting recovery after a concussion, especially for football players. Concussion can cause inflammation in the brain and impact cognitive function, so a nutrient-dense eating method can help repair brain tissue, reduce inflammation, and support overall recovery. A well-balanced diet focusing on anti-inflammatory foods, antioxidants, brain-boosting nutrients, and proper hydration can significantly aid in concussion recovery. Additionally, working with a Nutritionist overseen by Medical Doctors, is essential to tailor a nutrition plan to the individual’s needs and ensure optimal recovery.
“A well-balanced diet can aid brain recovery after a concussion.”
10 key nutritional factors and foods which may be beneficial for SRC
Omega-3 fatty acids
- Why: Omega-3s (particularly DHA and EPA) are essential for brain health. They have anti-inflammatory properties and can help repair brain cells.
- Sources: Fatty fish (like salmon, mackerel, sardines), walnuts, flaxseeds, chia seeds, and algae-based supplements.
Antioxidants
- Why: Antioxidants protect the brain from oxidative stress and inflammation, which can be heightened after a concussion.
- Sources: Vitamin C: Oranges, strawberries, bell peppers, and broccoli. Vitamin E: Almonds, sunflower seeds, spinach, and avocados. Polyphenols: Dark chocolate, berries (blueberries, strawberries), green tea.
Protein
- Why: Protein helps with tissue repair, including brain tissue. It also helps maintain muscle mass, which is important for athletes during recovery.
- Sources: Lean meats (chicken, turkey), fish, eggs.
Magnesium
- Why: Magnesium is involved in nerve function and may help reduce brain inflammation.
- Sources: Dark leafy greens (spinach, kale), almonds, pumpkin seeds, black beans, and avocados.
Vitamin D
- Why: Vitamin D plays a role in neuroprotection and may help reduce brain inflammation after a concussion.
- Sources: Fatty fish, plant-based milk, and exposure to sunlight.
B vitamins
- Why: B vitamins, especially B6, B12, and folate, support brain function and may help with cognitive recovery.
- Sources: Eggs, poultry, whole grains, beans, and leafy greens.
Hydration
- Why: Staying hydrated is essential for maintaining cognitive function and reducing symptoms like headaches, which are common after a concussion.
- Hydration Tips: Drink plenty of water, and consider coconut water for electrolytes. Avoid sugary drinks or excessive caffeine.
Curcumin (Turmeric)
- Why: Curcumin has potent anti-inflammatory and antioxidant properties, which can help with brain healing.
- Sources: Add turmeric to meals or consider turmeric supplements (with black pepper for better absorption).
Zinc
- Why: Zinc is important for neuroprotection and can aid in the healing process of the brain.
- Sources: Shellfish (especially oysters), pumpkin seeds, cashews, chickpeas, and beans.
What would a Recovery Meal Plan for a Football Player Post-Concussion look like?
Player story: Gustav Sandberg Magnusson
Gustav Sandberg Magnusson is a former Swedish footballer who played for IF Brommapojkarna for most of his career. In the 2024 season, he suffered five concussions, forcing him into early retirement. The former defensive midfielder now works as a director at his former club.
What happened?
- During the 2024 season, he suffered five concussions over a relatively short period.
- After the fifth concussion, medical advice and his own assessment led him to retire from playing.
- The last concussion was caused by what appeared to be a fairly light head impact, but it had large consequences. He reportedly had each concussion closer together in time; the recovery windows shortened, symptoms intensified, and the impact of even minor knocks worsened over time.
- Memory loss: He lost memory of the incidents in several of the concussions. In at least two or three, he could only piece together what happened by watching video.
- Symptom severity: The last concussion left him much worse than previous ones- in a darkened room, unable to do basic daily things, indicating more than just pain but neurological impact.
- Psychological / behavioural changes: He notes that even in everyday life (e.g. playing with children), he now reacts differently being more cautious about head impacts.
Gustav reflects on his concussions a year on from his retirement, relaying his story for FIFPRO:
“I suffered five concussions in my final season as a player. It turned out to be an unacceptable amount in such a short timeframe and I had to retire from playing. I’ve asked myself so many times if there’s something I could have done differently, if there was a way these injuries could have been avoided. I don’t think I have an answer.
I’ve always had a rough playing style. I go for everything 100 percent and I guess that makes me more susceptible to a concussion than others. But five? You’d be unlucky to tally that amount in a season even in rugby or American football…
When I suffered my last concussion, I knew something wasn’t right. I didn’t feel good. All I could do was lie in a darkened room. I couldn’t even go to the playground with my kids.
In football, 33 is quite old. But as a person and a father, I had so much time ahead of me and I wanted to feel fit and healthy for as much of it as possible. When three doctors advised me to stop playing, it was tough to hear. But they were telling me something I already knew: it was time to hang up the boots. In the end, it was a relief not to have to make that decision on my own.
I still have a scar from last season’s first concussion. It was a bad one. I don’t have any memory of the incident, and it was only when I looked back at the video that I saw what had happened and it was a hard knock.
The rehab served as a ladder to recovery. First, you have to lie in a dark room until you have no symptoms. Then you can go for a walk, then you can practice with the ball and so on. You can only move forward when you are completely ready. Then, you suddenly find yourself on the pitch again.
The recovery time was different with each concussion. After the second one I was back playing after a week. The only problem was that a third concussion followed just three games in.
They were now coming much closer together than before. By the fourth concussion I was scared. Like with the first three, I had no memory of the event and had to watch it back to see what had happened.
While I was aware of the risks of concussions, at the time I didn’t understand just how much worse it could be the more you suffered them. It’s not as though I didn’t have them before when I was younger; I likely suffered a handful up until that point.
There is always going to be some element of danger when playing elite sports. Your whole body is open to injury and there’s no way to totally eliminate that.
I think the concept of a 10-minute concussion review is a great step to take, as it gives doctors the time they need to assess the situation and not take any risks. In my case, the doctors forced me off the pitch each time, and I’m grateful that the power lay with them – it was the right decision.
It should never be up to the player or coaches because you can’t be truly objective in that situation. Players want to win games and you’ll do anything to do that, even if it means continuing when you shouldn’t. It’s also difficult for players to make a sound judgement on how serious the injury is at that point in time.
Physically, I’m fine now. I got out at the right time, but my experiences have left an impact on me. It’s the little things, such as my seven-year-old climbing on my back which makes me immediately move my head out of the way, like I’m subconsciously avoiding any possible chance of it happening again.
All I can say is that you’ve got a long life to live after football, so make sure you leave the game with every capacity to make the most of it.”
“All I can say is that you’ve got a long life to live after football, so make sure you leave the game with every capacity to make the most of it.”
Takeaways
Concussion in football players is a serious issue and requires careful management to ensure proper recovery and minimize long-term consequences. Prevention, early diagnosis, and proper treatment are key to protecting players from the effects of brain injuries. With more attention being paid to concussion protocols and player safety, there is hope these injuries can be better managed moving forward.
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