Every four years in June, a peculiar epidemic bursts into the world-view. Healthy young men, most with an elite level of physical fitness, are stricken down. This affliction is sudden in onset; these men drop to the ground at the slightest hint of physical contact and proceed to roll around, hands clamped to their faces as is they’re mourning the death of a loved one. Thankfully, this horrible condition is but fleeting, lasting for only seconds, a minute at most, before the diseased bounce back to their feet as right as rain. It’s odd actually, and even more strangely it seems to almost exclusively affect those who find themselves on a soccer field. What exactly is this mysterious soccer affliction (shall we call it “flop-roll-and-face-itis”) and does it bear any resemblance to better understood conditions?

Well, let’s see…people with kidney stones often rock back and forth in misery, unable to find a comfortable position. Patients with migraines frequently hold their hands to their faces, to shield their eyes from the light. Narcotic abusers may shift dramatically from a pose of comfort to one of excruciating distress when they realize they are being watched. Seizures are often spastic, and sometimes quite brief in duration. But, in terms of traumatic injury, these soccer-induced spells are original. Take the Brazil-Portugal match from the 2010 World Cup, a defensive struggle that ended in a 0-0 tie. In this game, between two elite teams, there were more stricken players then quality shots on goal. For example… a Portuguese player feels a soft hand to his back and is launched onto the ground, arms splayed, emulating Dicaprio in The Titanic. His head rests on the ground for a moment and then he rolls to his back, his hands go to his face, he flexes his knees and rotates back and forth on the turf. What is hurt? Is it his head? Is it his Achilles tendon? The referee runs in with a yellow card for the Brazilian who touched him, and suddenly the Portuguese player is cured. He pops up, ready for another run on goal. Later, a Brazilian takes cleats to the heel and falls to the ground, clenching both ankles with his hands, and rolls, 1, 2, 3, 4, 5 times! What an unusual injury this is! The announcer, a Brit, dryly takes note; “If you roll around a lot you are not as hurt as if you are lying still, in real pain.”

Could it be that these players are faking their injuries? In 2010, Dr. Joseph Centeno, an orthopedic surgeon and sports medicine specialist, said “Let’s put it this way, I’ve never had to operate on a flopper.” Has Chris Ballard, a writer for Sports Illustrated who covers the NBA, ever seen this type of injury in the sport of basketball?

“Only on rare occasions,” he said, “and strangely enough it seems to only afflict European or South American players such as Vlade Divac or Manu Ginobili.”

Where then, might find an explanation? Perhaps, surprisingly for a game of the feet, the cause may just be the head. Head trauma, of course, is a problem in many sports, but soccer players are exposed in a rather unique manner because they are trained to repeatedly strike a rapidly moving ball with their unhelmeted craniums. A Canadian study, in the journal Injury, found that 15% of soccer-related ED visits were for head injuries, of which 11% (of these) were concussions. Another Canadian study found that a disturbingly high number of youngsters (age 12-17) playing team soccer had evidence of concussion (over 50%) and that this percentage was significantly lower in those wearing protective headgear. A third study, published in the journal Neurosurgery, found decreased neuropsychological scores and reaction times in professional soccer players who had suffered a head injury the day before — even when these players claimed they did not feel any ill effects.

So, does any of this help explain the puzzling frequency of dramatic injuries we are sure to see at this year’s World Cup? I think it does. Some of these players, it seems, are damaged by years of forceful headers and contested corners. And thus, they have developed the deluded judgment that turf flopping is an acceptable strategic play (and one that the referee and the public won’t notice). From a strategic standpoint, their delusions may have some merit, but from a purely clinical standpoint, they are plain crazy. The intent of flop-roll-and-face-itis may be difficult for a referee to recognize in real time, but with a remote control and a little clinical perspective, it’s a remarkably easy diagnosis. Fortunately, a treatment (immediate administration of a yellow card) does exist; one wonders if better compliance with treatment guidelines might just be the cure that the sport needs.

For the next week, I’ll be tracking this disease closely from its epicenter in Brazil and sending along public health alerts when I see illness strike.