What Lionel Messi can teach us about the brain’s ultimate performance system
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Elite performance depends less on one ‘fast brain’ skill than on how quickly an athlete can take in visual information, predict what is about to happen, make a decision, and execute it accurately.
—Rab Nawaz, MD, internal medicine physician
Lionel Messi is back in the news as Argentina builds momentum ahead of the 2026 World Cup. His recent performances are reinforcing why he is central to the team’s strategy even in the later stages of his career. []
Media coverage is focused on his continued goal-scoring impact and leadership. [] So, what actually separates an elite athlete’s performance from an ordinary player’s? Is it just his strength, speed, or technical skill? Or is there more to it?
Related: People who play this sport live longest'It is the brain that plays football'
Jes Buster Madsen, a neuroscientist who works in elite football, put it simply for the FIFA Training Centre: “It is the brain that plays football.” He argues that football intelligence involves scanning, inhibition, executive function, and visual intelligence, all of which are trainable to some extent. []
Researchers now propose that the central nervous system is actively involved in reading a scene, predicting what comes next, selecting a movement, suppressing the wrong options, and executing the right one under pressure, according to Madsen. Internal medicine physician Rab Nawaz, MD, says, “Elite performance depends less on one ‘fast brain’ skill than on how quickly an athlete can take in visual information, predict what is about to happen, make a decision, and execute it accurately. In football, anticipation and decision-making often separate elite players because reacting after the play unfolds is usually too late.”
A 2025 study published in PNAS examined 204 elite footballers from Brazil and Sweden and 124 controls. Elite players performed better on cognitive flexibility, planning, and working memory. Cognitive and personality measures also predicted goals, assists, and successful dribbles. [][]
Writing in 2024 in Frontiers in Psychology, Madsen and colleagues proposed a three-stage model of cognition in elite soccer. [] The first stage is situational assessment. The player scans the field, attends to the relevant cues, recognizes patterns, and anticipates the next event. The second stage is action selection and execution. The brain narrows competing options and initiates the motor program. The third stage is outcome assessment. The player updates behavior based on feedback.
Michael Kane, MD, Chief Medical Officer at Indiana Center for Recovery, says, “The major difference between elite athletes and non-elite is the ability to integrate, read visual cues, anticipate what is coming, make quick decisions, and turn those decisions into well-coordinated movements prior to when the moment is lost.”
Findings matter beyond football
That framework aligns closely with clinical understanding of neuroplasticity and neurorehabilitation. Neuroplasticity means the nervous system changes in response to repeated experience, injury, training, and feedback, akin to the visual-motor learning in sports medicine.
A 2024 review on exercise-induced neuroplasticity described exercise as a rehabilitation tool linked with structural and functional nervous system adaptation. The review highlighted neuroplasticity as one mechanism through which exercise may affect cognition, mood, recovery, and performance. []
After injury, the brain adapts, too
ACL injury is a good example of a condition that can lead to altered neurocognitive function. Although patients may regain strength after ACL reconstruction, they may still experience changed physical function from before their injury when attention, reaction, or decision-making is considered.
Recognizing the existence of a residual “maladaptive neuroplasticity,” authors of a 2024 review described the role of neural-targeted rehabilitation after ACL injury. Such rehabilitation would include external focus of attention, differential learning, implicit learning, sensory reweighting, and visuomotor training. []
A 2025 American Journal of Sports Medicine study also found greater cognitive-motor interference in patients after ACL reconstruction compared with uninjured controls. The authors concluded that clinicians should consider cognitive and dual-task screening and training during ACL rehabilitation. []
Related: 8 pillars of brain health by a brain doctorConcussion care and return to play/function
A similar recovery model can also apply to concussion care and the timeline for returning to play/function. The patient may feel better at rest before the brain is ready for sport, school, driving, or work.
So, what are the return to play/function guidelines? The Amsterdam 2022 Consensus Statement, published in the British Journal of Sports Medicine in 2023, supports multimodal assessment, updated return-to-learn and return-to-sport strategies, early symptom-limited activity, and graduated sport progression. []
In the US, the CDC’s 6-Step Return to Play Progression is based on the Amsterdam guidelines. []
As Dr. Kane explains, “The CDC's Return to Play guidelines include six steps of gradual increase in both physical and cognitive demands after a concussion.”
The 6 steps are:
Back to regular activities, school, and normal daily routine
Light aerobic activity, walking, light jogging, stationary bike
Moderate activity, more heart-rate increase, body or head movement
Heavy, non-contact activity, sprinting, sport-specific drills, no contact
Practice and full contact, only after medical clearance
Return to competition
“Each step requires a minimum of 24 hours of recovery due to the need for each step to test the level of recovery of the athlete,” adds Dr, Kane.
Clinicians in an office environment can use the SCOAT6 tool, which was designed, in conjunction with the Amsterdam Consensus, for office assessment in the sub-acute phase, from about 72 hours to 30 days after a sport-related concussion. It covers multiple domains, including symptoms, cognition, balance, gait, vestibular-ocular function, and mental health screening. []
Dr. Khan concludes, “The main lesson is that brain recovery is multidimensional. Attention, vision, balance, reaction time, mood, sleep, and exertion tolerance may recover at different speeds, so no single test should determine return to play or return to function.”