Alex Greenwood wanted to keep playing, of course. Finally, at the beginning of April in the Wembley Stadium, it was all about the title played for the first time in the “Women’s Finalissima”: European champions England played against South American champions Brazil. In the 73rd minute, defending star Greenwood hit his head hard on the pitch after a duel with Brazilian Geyse, had to be treated for a few minutes – and continued playing. In the penalty shoot-out that had to decide, Greenwood scored and in the end celebrated the title with the “Lionesses”.
A day later she left the national team, officially because of knee problems, unofficially because she was to be rested after the incident. Experts sharply criticized Greenwood for continuing to play despite suspected concussion. If the world football association FIFA has its way, such an incident will not be repeated at the forthcoming World Cup in Australia and New Zealand (July 20 to August 20).
Positive experiences in Qatar
FIFA is using so-called “concussion spotters” for the first time at a women’s World Cup. These “concussion detectives” follow the World Cup games on screen and also have the option of watching certain scenes again in slow motion. If the sports physicians commissioned by FIFA think that a player may have sustained a serious head injury, they sound the alarm and inform the team doctors of the teams involved. The premiere of these “detectives” at the men’s World Cup in Qatar at the end of 2022 was a success “because FIFA received positive feedback from the participating member associations,” the world association replied to a request from DW. “In general, FIFA has made the issue of brain injuries in football one of the main goals of their medical department.”
In Qatar, too, there was a case like that of Alex Greenwood: In Iran’s first World Cup match against England (2:6), goalkeeper Alireza Beiranvand initially continued playing, although he bled from his nose after a violent collision with a teammate and lasted for minutes had been treated. A little later, Beiranvand was substituted and taken to the hospital. According to reports, FIFA’s “concussion spotter” intervened. In the days after the game, according to media reports, the world governing body urged the Iranian team to comply with FIFA’s treatment protocol for head injuries in the future. After that, Beiranvand should have been sent off immediately.
Warning of long-term consequences
“Concussion detectives” are not FIFA’s idea. In fact, the world association is actually rather late in using them compared to other contact sports. As early as the 2012 season, the American football league NFL began having all games monitored by independent sports physicians with a view to possible head injuries. They have been allowed to interrupt games since 2015, and since 2016 there have even been two experts per game. On average, the “detectives” report two suspected cases of head or neck injuries per game.
For many years, scientists have been warning not only of the immediate but also of the long-term consequences of severe head injuries in sport: for example, a higher risk in old age for neurodegenerative diseases such as CTE (Chronic Traumatic Encephalopathy, also known as Boxer’s Syndrome), Alzheimer’s or other dementia diseases.
Inequality in sports medicine care
Female athletes have so far been neglected in the scientific studies, around 80 percent of the participants were men. There are indications in several studies that women – for various reasons – contract concussions more often than men in sport. And that they take longer to recover from head injuries. For this reason, scientists are discussing whether it makes sense to introduce their own treatment protocols for female athletes.
Ohio State University’s Jaclyn Caccese, who has long researched head injuries in sports, doesn’t see it as a top priority. “Instead of focusing on concussion protocols that are tailored to women, we should first strive to ensure that women have equal access to sports medicine care,” the US researcher told DW. “Inequalities in the [sportmedizinischen – Anm. d. Red.] care can result in reduced concussion awareness, delayed game exclusion, delayed diagnosis, delayed initiation of treatment and ultimately delayed recovery.”
More security, regardless of gender
Tracey Covassin, also an expert on sports head injuries, takes a similar view. It must be ensured “that a certified sports physician is present at all sports, not just at football games,” the professor at Michigan State University told DW. “Women’s sport must be taken seriously and the presence of a sports medicine doctor is the first step in ensuring that any suspected concussion is evaluated and treated by a healthcare provider.” All concussions, Covassin said, “should be treated on an individual basis, regardless of gender.”
Both scientists think FIFA’s decision to use “concussion detectives” at the World Cup in Australia and New Zealand makes sense. “I think anything that makes men’s sports safer needs to be introduced into women’s sports and that’s a good start,” said Covassin. “If the ‘detective’ can help ensure that just one athlete with a concussion does not return to the field, then we’ve already done something for the safety of the athletes.”
More conservative approach in women
FIFA sees no need to treat women footballers differently from footballers when it comes to concussion. The FIFA treatment protocol includes a program designed to ensure that players do not return to the pitch too early after head injuries, the world governing body said. “This concept is more based on [längeren] phases than days, so it is applicable to both women and those under the age of 18.” Only when the player has completed each of these phases of gently returning to football without symptoms of illness should the player be allowed to return to competition “A more conservative approach needs to be taken with younger players and those with certain risk factors, such as a history of repeated concussions or women,” FIFA told DW.
Incidentally, without the ailing Alex Greenwood, the European champions from England lost 2-0 to World Cup hosts Australia after 30 games without defeat. The 29-year-old, known for her calm and prudent defensive work, was sorely missed. But the break after the severe head impact was necessary – for Greenwood’s lasting health, which is more important than any short-term success.