Luuk de Jong (PSV), Jurriën Timber (Ajax), Gernot Trauner (Feyenoord), Jordy Clasie (AZ), Bas Dost (FC Utrecht), Mats Seuntjens (Fortuna Sittard), Mike te Wierik (FC Groningen) and many colleagues. They are subjected to a brain test at the beginning of the season. Exercises that measure stimulus processing and test memory. How quickly does a player react when he has to touch certain colors on a board? Can they say a row of words they read in the same order afterwards?
The tests can be seen as an extra to the battery of tests that football players are subjected to, especially at the start of the season. They are already measured, weighed, fat percentages checked, tendons and muscles, the heart. And now their brains too.
The idea is that a player is tested in a healthy condition, giving the medical staff a sort of personal ‘zero line’. If that same player crashes hard during a match or practice and may have suffered a concussion, the tests are repeated. If the player scores (much) less well, then the brain has not recovered sufficiently and the medical staff will advise rest.
It is a protocol that has been used for some time in rugby and American football, for example, but which has now also gained a foothold in the Eredivisie. Several clubs have included the brain tests in the medical mill for the first time this season.
This sometimes also happened in response to a letter that KNVB national doctor Edwin Goedhart sent this summer. In that letter, the KNVB confirms, the clubs from the Eredivisie and the Kitchen Champion Division pointed out the risks of a concussion and made them aware of a neuropsychological test that they can perform.
Soon there will be a separate information session of the KNVB on the subject with clubs from the Women’s Eredivisie.
According to the KNVB, clubs that have played European matches (Ajax, PSV, Feyenoord, AZ and FC Twente) are obliged to do a neurological ‘baseline test’. Clubs such as FC Utrecht, Vitesse, FC Groningen and Fortuna Sittard are now also working with it. There is no complete overview of which clubs carry out the tests – clubs themselves are responsible for it – but it is clear that brain testing has become established in Dutch professional football.
Also read: a reconstruction of research into the brain of former Spartan Wout Holverda
Wout Holverda
It is also clear that the tests are important. The discussion about brain injuries in football has become heated in recent years. Last March it was announced that a brain disease (CTE) had been found in the brain of the deceased former football player Wout Holverda, which according to his doctors is related to his career as a football player.
There is a good chance that concussions and headers played a role in the development of the disease, which led to severe dementia in Holverda at a young age. Holverda died in December last year, after which his family gave permission for a post-mortem examination. He became one of the first football players in the world who can be determined with certainty that brain damage was caused by his football career.
The syndrome – chronic traumatic encephalopathy – has previously been found in hundreds of former American football players, who received severe blows to the head during their professional careers. In many sports, it has been recognized for years that poorly treated head trauma can lead to serious brain damage.
In football, there is still scientific debate about whether blows to the head, such as headers, can directly lead to brain injury. Some countries, such as the United Kingdom, choose to limit headers as a precaution. The Netherlands does not do that, because of the lack of clarity about the effect of different types of headers.
By contrast, everyone agrees that concussions, such as after a head-to-head collision, can have serious consequences if not treated properly. Beau Rijks, ex-player of Excelsior, told a few months ago in NRC that she had to rehabilitate for more than two years after a concussion – partly because doctors at clubs where she played did not know how to deal with head trauma.
Jeroen Dieteren, head of medical staff at Fortuna Sittard, is pleased that the KNVB is urging clubs to follow concussion protocols properly. Previously, his club mainly tested players after a major collision, or when a concussion was suspected. That was difficult, because it was not clear how a player normally reacted. Dieteren: “It helps if you see the differences between the normal situation and the situation after a head trauma. Also to show to the players. Sometimes they feel like they can get back to work, but now we can show that they need a little more time to recover.”
Temporary bills
Last summer, the football rules authority, the International Football Association Board (IFAB), decided to extend a trial allowing for an extra substitution if a player may have a concussion. The trial was announced in 2020 and is now running in 144 competitions (different levels) – including in the Netherlands. Still, the IFAB is not happy with the results. Speaking at the general meeting this summer, President Lukas Brud said clubs are not following IFAB protocols well. “If you can make a substitution and you don’t use it, that’s not right. We’ve seen situations where there’s not just a suspicion of a concussion, but where it’s obvious. Then you have to take a player off the field,” Brud told the English newspaper The Guardian.
Also read: the story of Beau Rijkswho was rehabilitating for two years after a concussion
During the cup final between PSV and Ajax, last April, midfielder Joey Veerman landed hard on the ground after a duel. He continued to play, but afterwards said on television that he did not remember much of the game. “After about thirty minutes I sort of recovered,” said Veerman, who then had to ask opponent Daley Blind who had made the 1-0. Veerman “of course” did not want to be replaced, he said. PSV would later state that all necessary tests on the field (and in the week after) have been carried out, although one of the questions in the standard test (the SCAT-5) is: “Who scored the last goal in this match?”
Situations such as the one with Joey Veerman – it is more common for players to continue with clear symptoms of a concussion – led advocacy groups to advocate a temporary exchange possibility. A player may then, for example, be replaced by another player for fifteen minutes, after which it can be replaced again. The advantage would be that doctors have more time to do a good health check, instead of having to perform it quickly (on average three minutes) along the field, while the team plays football with one player less. The disadvantage may be that clubs would apply the substitution for tactical reasons.
Playing with a concussion can lead to death
Letter Headway
Headway, an influential British advocacy group that fights for safe sport, wrote this summer a letter – signed by many leading brain scientists – in which she advocates temporary substitutions in football. In the letter, the scientists criticized the rapid diagnoses in the field. “This one […] endanger the lives of football players. Continuing to play with a concussion can lead to sudden death, and in some cases has already done so.” Earlier, the global football players’ union, FIFPro, also asked for temporary substitutions in global football.
The IFAB does not want to do that for the time being, it turned out during the general meeting this summer. First, the Laws Authority wants to proceed with the test that allows permanent substitutions. Only when it has been completed and all football clubs apply the protocols, will the organization look at further tightening up.
The KNVB agrees with this, reports a spokesperson. The football association finds temporary substitutions “a logical idea”, but “at the moment it is not yet sufficiently clear what the added value is compared to the current situation. Moreover, the risk of abuse is present.”