Gerard Piqué has taken on thousands of aerial challenges in his career, but one incident stands out to Andreu Gabarrós, head of neurosurgery at Hospital de Bellvitge. Reflecting on a match in which the defender briefly lost consciousness, Gabarrós recalled thinking, “If he gets another impact, he could die.” That moment, he says, illustrates how dangerous head trauma in football can be.
Gabarrós noted that Piqué was initially on the verge of returning to the pitch before medical staff intervened. Their decision, he believes, was crucial. A second blow before full recovery can trigger what specialists call second-impact syndrome, a rapid and severe brain swelling that can be fatal without immediate intervention. Cases in American football exposed the phenomenon years ago, and the same mechanism can apply in any contact sport.
The neurosurgeon emphasized that a concussion should sideline a player for at least a couple of weeks, regardless of how mild the symptoms may seem. Dizziness, headache, nausea, instability, or simply a sense that “something isn’t right” should prompt immediate evaluation. While athletes often push to continue, he stressed that medical teams must override them when necessary.
Beyond dramatic incidents like the one involving Piqué, football continues to grapple with the potential cumulative effects of repeated heading. Each impact moves the brain within the skull, and although cerebrospinal fluid provides a degree of protection, it is not always enough to prevent minor injuries. Gabarrós explained that repetitive heading can amount to microtrauma. Some studies have detected proteins in players’ blood that act as markers of mild brain injury after controlled heading drills. While he said there is still no conclusive structured evidence linking football to widespread chronic neurological decline, there are clinical parallels to conditions seen in boxing, where repeated blows are far more frequent and intense.
Even so, chronic traumatic encephalopathy remains an area in need of more research. According to Gabarrós, only a very small share of players appear to develop long-term cognitive issues, suggesting that personal factors may play a significant role. He cautioned that current science cannot justify claims such as “don’t play football because you’ll get dementia,” especially given how rare these outcomes appear to be.
The tragic death of young goalkeeper Raúl Ramírez, who suffered a fatal acute brain injury after a single accidental collision, underscores the difference between sudden severe trauma and long-term, low-grade damage. Gabarrós explained that an acute event can involve hematomas, brain swelling, or contusions that require intensive care, surgery, and in some cases cannot be reversed. Such incidents, while uncommon, are inherent to any contact sport.
Protocols in Spain vary by club, and Gabarrós believes national guidelines from La Liga or the federation would help standardize prevention. Trainers and players, he said, should be better informed about the risks, since symptoms can be subtle and easy to ignore. Given that most incidents occur during training sessions, oversight cannot be limited to match days.
