It was deep in the brain, visible under the microscope as reddish-brown specks. Damage in the vessels of the brain. It was clear to the researchers at Amsterdam UMC: the brain of this deceased footballer was sick. Neurologist Jort Vijverberg, who discovered the traces under the microscope, also knew immediately: this could have consequences for football in the Netherlands.
Last week it was announced that Wout Holverda, former football player of Sparta, was found to have a brain disease that is related to the many heads during his football career. Holverda passed away last December. His family had given permission to have his brain examined after his death. During his lifetime there was already a suspicion that Holverda, who was seriously demented, had suffered from his football career. That turned out to be true.
CTE, a serious brain disease, was found in his brain. It is the first time such a discovery has been made in a Dutch athlete. In addition, it is one of the first times worldwide that the disease has been diagnosed in a former football player. The clinical picture that the pathologist, the neurologist and their teams have found specifically points to damage from repeated blows to the head: headers. The damage was enormous. Holverda started to suffer from dementia at the age of 55 and was soon unable to live independently. He, like his family, suffered severely.
The discovery proves that headers can be a hazard. It also poses many questions to the football world. When exactly does a header cause damage? Will everyone be harmed? Can that be done within one season, or only over an entire career? Are (extra) safety measures necessary?
american football
The question is how the football world will respond to these issues. The first case of CTE had already been discovered in American football, ice hockey, horse racing and rugby. They all had to relate to this new reality: their sport could pose a danger to the brain.
There is a lot of evidence for brain damage, especially in American football. Boston University has a special CTE center where post-mortem research has been conducted on top athletes for years. More than 600 players from the top football league, the NFL, were found to have suffered from CTE. It was also found in large numbers of ice hockey players, jockeys, rugby players and boxers. They sustain damage from hard tackles, falls or blows to the head.
In all these sports, the discovery of CTE has led to changes and preventive safety measures. For example, every football game in the NFL is monitored by independent neurologists. They have the power to remove players from the field if they suspect brain damage. With ice hockey and horse racing came better helmets and stricter rules.
But that was not easy. It often took a long time for sports associations to decide to make their sport safer. Movies have been made in the United States and books have been written about the NFL’s battle against scientists who pointed to the dangers of the sport.
Also read: this international research by NRC watching sports associations look away from brain injury
Denial and opposition: that was always the first reaction of unions. They often seemed to want to protect their sport and not the athletes. The NFL even filed hard lawsuits against former athletes so they wouldn’t have to pay damages. In the end it did.
In NRC A year and a half ago, three scientists told how they were opposed by unions when they wanted to research brain injuries in sports. This ensured that they could hardly receive research funding. Neuropsychologist Erik Matser, who wrote in his 2000 thesis that collisions and headers in football can affect the brain, said that the FIFA World Football Association had thwarted his research.
He couldn’t get any more funding for his research, so that went awry and he chose a different career path. According to Matser, if UEFA and FIFA had been open to additional investigation, there would have been clarity about the potential danger of headers for a long time. “I’m calm down”, said Matser at the time.
In 2017, UEFA called on scientists to submit a research proposal. The European federation wanted to know how often headers were taken in youth football and whether headers cause damage to the (children’s) brain. Various universities sent in research proposals – including several Dutch researchers.
UEFA ignored brain injury
UEFA also commissioned the study from the university research groups of the chair and vice-chair of its own medical committee. They released their report in 2020. In it they advised to let children head less. The report did not show whether headers cause brain damage.
That was no coincidence. UEFA had informed concerned scientists that the research question on the harmfulness of headlines had been dropped, according to a letter that NRC saw. Football also shows restraint when it comes to research into brain injuries, just like other sports associations have done before.
Worrying findings from research have been made since then, albeit not through (financing from) the football associations. A Scottish study of 7,500 people showed that football players are 3.5 times more likely to develop dementia than the average population. Among defenders, the chance was even five times greater, the University of Glasgow discovered. In 2016, the Dutch scientist Magdalena Somethingwaart published a study at the Scottish University of Stirling that showed that players had a temporarily disrupted brain function and a reduced memory immediately after heading twenty balls.
Deceased soccer players
Yet research into the brains of deceased football players is the most important. That’s the only type of research that irrefutably shows that footballers have been injured. And that research is very scarce. Only a few cases have been described in the scientific literature worldwide. It shows how special the research at former Spartan Wout Holverda is.
The public debate about the danger of football has really only been conducted in England. At the beginning of this century, brain damage was discovered in the deceased football player Jeff Astle. At the time, the disease was not yet known as CTE, but Astle also had – like Holverda – severe dementia. After the investigation into Astle’s brain, a long battle for recognition began for his family. Time and again they pointed out the danger of brain damage, including from headers.
A catalyst was needed to get the problem on the national map. That came in 2020: five players from the national team that won the 1966 World Cup were found to suffer from dementia. Their families joined Jeff Astle’s family. Famous former players such as David Beckham, Wayne Rooney and Frank Lampard took part. A parliamentary commission of inquiry into brain injuries in sport came to a firm conclusion last year: sports associations had massively endangered the safety of their athletes by ignoring brain damage. There is now a limit on headers in England (a maximum of ten per training week).
Repeated claps
In the Netherlands, more attention has gradually been paid to the issue. The KNVB has an outpatient clinic where concussions are treated. Football players can get these if, for example, they collide hard with an opponent. The association pays less attention to the possible harmfulness of headers: it often involves repeated blows to the head below the level of a concussion – the injury that made Wout Holverda ill.
Also read: this interview with KNVB national doctor Edwin Goedhart from 2020 about brain damage in football
The KNVB changes little in that area. There is no limit on headers in the Netherlands, although the KNVB does say: do not train too much on them. If a child gets a headache, it has been too much. The football association considers it important that children learn to head technically well, so that they can head well at a later age – when the balls hit harder. Then the damage would be limited. There is no consensus in science about whether the balls used to cause more damage. On the one hand, the balls are lighter these days, on the other hand, the game speed has gone up.
The fact that the KNVB has not yet opted for a head ban – unlike the United Kingdom – can be explained by the fact that many questions are still open. The fact is that science could have been further if the football world had been more open to advance research. Moreover, the KNVB determined its position before Wout Holverda’s brain was examined under the microscope. Now the reality is different. The risk has been proven.