The German player Christoph Kramer was helped off the field after suffering a blow to the head during the World Cup 2014 final against Argentina in Rio de Janeiro in July. Credit Chema Moya/European Pressphoto Agency
DURHAM, England - Three months have passed since the World Cup in Brazil, and still FIFA seems unaware or unwilling to grasp that head trauma has become the most serious - and potentially most litigious - issue threatening all of sports.
The images of players' apparently knocked senseless but then revived and allowed to stagger on in a confused state have marred some of soccer's most-watched games. At the World Cup, those endangered players included Germany's Christoph Kramer during the final, Argentina's Javier Mascherano during a semifinal, and Uruguay's Álvaro Pereira in a first-round game against England.
Pereira and Mascherano were in some quarters hailed as macho men who "persuaded" medical personnel that they were fit to continue.
Kramer couldn't have persuaded anyone of anything because, he later admitted, he didn't know where he was or what was happening around him after being struck in the head in the 17th minute in the final against Argentina.
Yet Dr. Hans-Wilhelm Müller-Wohlfahrt, one of the most experienced physicians in sports, examined Kramer and deemed him fit to play on. After 15 minutes, a still groggy Kramer was removed and taken to the dressing room.
The alarm bells were ringing, but FIFA wasn't listening.
One imagines that even the world governing body of soccer is cognizant of the situation in the N.F.L. and its efforts to settle a class-action lawsuit brought by thousands of former players over brain trauma linked to repeated hits to the head during play.
If FIFA sees no connection there, it cannot sidestep the implications after a group of soccer players and parents filed a class-action lawsuit accusing the soccer group of being negligent in its management of head injuries.
The initial response from Zurich, where FIFA is based, was that it could not address court proceedings about which it had no detailed information. But just days later, FIFA announced a new mental health research project while pointing out that "almost no scientific study has yet investigated the mental health among football players. To respond to this gap of knowledge, FIFA has established the new research area, so that those in the game feel more comfortable coming forwards to talk about issues and in order to ease access to treatment."
This statement might seem 40 years too late to doctors and researchers who have been calling for such studies for decades. In the early 1970s, I collated reports of 44 deaths in English soccer that were related to trauma from heading the ball or from collisions between heads and the feet, knees and elbows of opponents.
While those reports were anecdotal and admittedly involved the heavy, old leather ball that went out of fashion many years ago, there was enough circumstantial evidence - compiled with the help of a leading neuropathologist and the then-medical officer of England's Football Association - to inspire a later study led by Norwegian medical researchers.
Over time, the ball, the equipment and the professionalism shown by players have all advanced. But so has the speed of the game. So while the ball itself might be lighter and made of materials that do not soak up weight during play, players rarely are given a yard of space today to head the ball correctly. Instead, they are crowded and jostled so they cannot make clean or deliberate contact. That, in the modern game, would be deemed a dereliction of duty by the defenders, who are instructed to deny both the time and the space need to attempt what is called a "clean" header.
So FIFA's research study will be complicated indeed. But it dare not be complacent with the findings.
Pereira graphically described what happened to him at the World Cup as "the lights going out" after he was concussed when his head collided with the knee of England's Raheem Sterling.
That followed other televised incidents of head trauma, such as last November, when Tottenham Hotspur goalkeeper Hugo Lloris was knocked out during a Premier League match. Lloris and his coach, André Villas-Boas, overruled the club doctor, who advised that the keeper be taken out of the game and sent to a hospital for observation. Lloris played on.
As a consequence of that and other incidents, the English F.A. and the Premier League have ruled that from now on a third doctor, independent of the two teams, should be at games to make the final on-field assessment as to whether a player can continue.
Rugby, which unlike the N.F.L. is played without helmets and padding, has declared this summer that there will be "a zero tolerance approach to gambling with the welfare of players regarding head injuries."
There is no doubt that sports heavy on the physical contact - the N.F.L, soccer, rugby and Australian Rules football - are worried about litigation that could make them pay for life-altering injuries caused both by collisions and by outdated ideas that "manliness" means allowing concussed players to continue.
Officials from those four sports met in New York in August to discuss common ground and how they could join forces to respond to what some are calling a concussion crisis.
It is good that they are talking. It will be better if they get the word across that athletes must be saved, if necessary, from their own misguided bravery.
But if it is found out that the leagues have been gambling with - and profiting from - the welfare of so many sports heroes, the price will be heavy.
Already, a federal judge has rejected one proposal by the N.F.L., saying it did not include enough money to cover all the former players who might have been affected, and the league responded with a revised settlement that included an open-ended commitment to cover decades of care. And the lawsuit by the parents and players against FIFA is looking not for financial damages, but to change the rules of the game to make it safer.
FIFA President Sepp Blatter is now 78 and will seek fifth four-year term, most likely without opposition. His head has never been in danger, unlike so many others in his sport.
