A hit where it hurts

While professional lip readers and translators continue to puzzle over the exact nature of the salutations that prompted French midfielder Zinedine Zidane to throw himself headfirst into the buff midsection of Italian defender Marco Materazzi at the World Cup final, some soccer fans might be chewing over a weightier question: Is this type of encounter, though admittedly unneighborly, possibly dangerous to players?

*

Although the effects of a direct head butt into a world-class soccer player’s midsection aren’t well documented in medical literature, most physicians suggest that the odds of a serious injury are probably slim.

Nevertheless, there are some sobering possibilities. The most notable, though extremely rare, would be an event known as commotio cordis -- a sudden disturbance in heart rhythm, usually leading to death.

This is a recognized syndrome in young people who have a structurally normal heart, says Dr. Allison Kean, an assistant clinical professor of medicine and cardiology at UCLA with a clinical interest in sports cardiology. It most often occurs in high school or college athletes, hit, for example, by a high-velocity baseball, softball or hockey puck.

There is a period during the electrical cycle of the heart, or T wave, where the heart is particularly susceptible.

“If that blow occurs during the vulnerable part of the heart cycle,” says Kean, “it can interfere with the heart’s electrical system, resulting in an unstable heart rhythm such as ventricular fibrillation.” Attempts at resuscitation are usually unsuccessful.

A more likely consequence of a head butt, but still not all that common, would be a cracked sternum or ribs. There is also the possibility of a lacerated liver or pancreas, although most physicians suggest that injury to internal organs is unlikely, particularly given the physical condition of the players.

“These guys are fit athletes with good muscle tone,” says Dr. Larry Baraff, professor of emergency medicine at UCLA. “So this type of injury seems unlikely. A head butt is not the same as running at him at full tilt at a football game and jamming him in the chest with a football helmet. It wasn’t anywhere near that amount of energy. And the guy got up and continued to play.”

In fact, the most likely scenario would be Zidane hurting himself, says Demetrios Demetriades, professor of surgery and emergency medicine and director of the trauma unit at Los Angeles County-USC Medical Center. Zidane could have sustained a concussion, intracranial hemorrhage or neck injury.

This type of injury is not unprecedented in sports history. When ex-Washington Redskin quarterback Gus Frerotte administered a celebratory head butt to a concrete wall in 1997, he landed in the hospital briefly with a neck injury.

This type of blow to the head is particularly dangerous for someone on aspirin or blood thinners, says Demetriades, because those medications would promote intracranial bleeding. So, although the biggest damage sustained in this case was probably to the reputation of Zidane, players contemplating a satisfying head butt might want to heed the advice of Demetriades.

“Don’t do that,” he says. “It’s a potentially dangerous thing.”

-- Janet Cromley