In our first two parts of our mini blog series we explored the impact of head injuries in sport in the NFL, football and the research and measures that are currently taking place. Most of the problems we have cited are from historic cases and in our final piece we look at how the face of sport has changed and if there is still a danger to professional sportsmen and women.

It is former players, the likes of Alan Shearer, who are paving the way and highlighting that there are people willing to investigate the matter. In the BBC Documentary, Alan Shearer: Dementia, Football and Me, it showed that the University of Stirling launched a study into the effects of heading a football 20 times in quick succession and what impact that would have on the participants brain functionality. The results showed that there was a decrease in the participants’ inhabitation immediately after one session.


Head injury in sport: Football injuries


The documentary also evidenced that footballs today are in fact heavier than those that Jeff Astle and Rod Taylor, two former footballers whose recent deaths were linked to heading footballs, would have used when in the dry. Therefore it is possible that even sports players today could be in danger of contracting Chronic Traumatic Encephalopathy (CTE) as the ball is struck at a lot higher pace in today’s game. The modern synthetic  balls were replaced around 1986 and the  effect of the  changes have not been fully explored yet but this is a subject that  Dr Stewart and his team are investigating especially as he believes the amount of heading  has increased and that the part of the head used may be  relevant.

Alan Shearer admitted in his documentary that he would head a football over 100 times a day in training. Centres of excellence affiliated to professional clubs, are known to partake in drills where heading a football was an essential skill that you needed to have regardless of your position.  Repeatedly heading balls either fired in from colleagues or by the coaches and especially on a cold evening or day has been described as feeling like they were frozen with ice and coming away with stars and headaches.

In January, Sue Lopez became the first female footballer to report that her diagnosis of dementia may have been linked to heading footballs during her career with Southampton. Both the  studies  from Glasgow University and University of East Anglia have indicated that they believe that women  are twice as likely to suffer from concussion and that they have an increased  risk to suffer more  severe consequences as a result of head trauma. The studies in the United States have indicated that the fact that more women started playing football regularly over the last twenty years   together with their likely ages would mean that we may see an increase of reported cases.

Should the FA be doing more?

Some  people in the media have wondered should the FA have obtained further research and evidence to find a definitive answer as to whether heading a football would cause a person to suffer from an injury following the coroner report? Potentially, it could be said that they therefore have been negligent in their actions for the past 16 years in not doing so when other organisations around the world were capable of that feat. Also,  should  they  have  considered  greater  protection  in relation to the  semi  professionals and  amateurs  playing the  game?

Did they have an obligation to do so following Jeff Astle’s initial coronary report where it specifically states that Jeff Astle’s death was caused by actions within his employment?  There could have been developments adopted across the football community to introduce less heading outside of games or the use of softer balls where possible in order to reduce the risk of trauma, particularly in relation to games played by younger age groups or amateur clubs who may not have a doctor available to examine the player straight away.

The PFA should definitely have done more to push the issue in order to protect the health of their members. It became known that the players union has in excess of 50,000 members and they do not know how many of those suffer from dementia and other brain- related damage. The union was set up to help and protect former players as well as present players which seem to have gone by the way side.

It may be argued that a knock to the head from an elbow or heading the back of an opponent’s head may have caused the impacts that could lead to a diagnosis of CTE but this is not likely to happen anywhere near as much as heading a football throughout a professional game consistently and repeatedly.  It is more likely that the repetition of heading drills is the natural cause of the condition as it is the most similar action to being constantly being hit in the face as a boxer.

Granted the FA and PFA have previously jointly agreed for a study to be conducted by Dr William Stewart and his colleagues at the University of Glasgow and Hampden Sports Clinic. This study, called the  FIELD report , has shown that former footballers are three times more likely to die from dementia than someone in the same age demographic and had increased  levels of  risks of various brain injuries  including a  5 times  greater risk of  Alzheimer’s.  Dr Stewart  branded   the  current  brain injury  management in  football as  “ a shambles” and  recommended   that  further  steps were taken  for  concussion  substitutes , a  uniform  protocol  for limiting  the amount of  heading  carried out  in training at all age groups especially  11-13 and the establishment of  a  national  database.

However, has this come too late? Maybe this should have been granted 16 years ago instead of “passing the buck” onto FIFA.  The  FIELD  study  also  demonstrated that the  FA  were  aware of the  dangers of  heading  back in  1966 with  a specific leaflet  being  produced warning   that  heading  the  ball  too often  may  cause  headaches and  advising  taking aspirin.  The  Chief medical officer  said that  “ concussion  is the bogey  to be aware of…”  and  this  warning  was  given to  club  doctors over  50 years ago!  Training and  information  in relation to  this danger  ought to have  been fed  down  from the elite sport into the  training of all  club  doctors and  physiotherapists at every level.

The FA have recently banned the heading of the football in practice for children under the age of 12  and provided  updated  guidance   up to   under  18  age groups   as of February 2020 following the  FIELD  study  but this was only through England, Scotland and Northern Ireland and does not include Wales. I recall, as I am sure many of the ex-professionals will support, you could be heading a ball for hundreds of reps a session. Why have the FA chosen 12 as an age is the question? Are children at the age of 13 not as susceptible? Are their necks that much more developed to deal with this constant impact? Ryan Mason, who retired as a result of a fractured skull, has come out and believes that children ought to practice heading techniques with a sponge ball. He is the under-18 coach at Tottenham Hotspur’s youth academy and whether this should go up to a senior level seems to be down to the individual.

Most recently, the footballing law makers and International Football Association Board have announced that they are implementing to give trials the green light this month (December 2020) with regards to concussion substitutions. There is no reason whatsoever to delay these trials and there has been no reason as to why these delays have lasted numerous years in the making. Football is just as a physically demanding sport as rugby, American football, cricket, and lacrosse, for example, all of which seem to have had the welfare of the players as humans at the forefront of their governing minds rather than the action on the pitch.

Recent incidents and the modern era of serious sporting injuries

With the knowledge, the technology and the money that is invested into football surely could be invested into researching and helping to protect players that young children idolise and want to grow up to be. The FA was quick to resolve any flaws that they had when it came to screening players for heart conditions following the incident involving Fabrice Muamba. The same proactive considerations should be extended to protect players in all potential areas of illness, especially ones that have been exposed.

When Petr Cech suffered a fracture to his skull, it is not known whether the PFA and his club took any further measures to ascertain the extent of damage and indeed potential damage to his brain in the future. There have been further incidents since such as Liverpool goalkeeper Loris Karius suffering from multiple concussions during the loss in the Champions League Final, and also reportedly England’s Jesse Lingard suffered from concussions during England’s Victory against Tunisia at the recent World Cup.

Most recently, the incident between David Luiz and Raul Jimenez occurred in November 2020. Raul Jimenez, as a result of the incident, ended up being stretchered off and taken to hospital where it was confirmed that he had sustained a fracture to the skull. The issue in regards to this incident was not the assessment and treatment of Jiminez but of David Luiz. The sickening head clash happened in the 5th minute of their Premier League fixture and a ten minute period elapsed so both players could be assessed and treated. Arsenal Football Club has since come out and advised that they followed all the relevant protocols allowing Liuiz to stay on the pitch for a further 40 plus minutes before being substituted at half time.

Doctors have advised that it can take up to 10 minutes for them to make a decision whether a player is fit to play on but this decision can be taken out of their hands in the current standard by the managers and the players themselves and the desire to stay on the pitch for want of victory and not consider their future health.  This was the explanation given by the Arsenal manager in the immediate aftermath but many felt that the player was not the right person to make the decision and this would not have been allowed in rugby or cricket.

Implementing similar rules to the blood replacement protocol in both codes of rugby could be a good starting point for other sports. Should an impact to the head occur during play, in any sport not just football, then allow that team to replace that player freely without penalty so that they can be assessed thoroughly before determining if he can play on or not. If they are fit to play then reverse the concussion sub, but if they are not then the substitution becomes permanent.  In  the recent T20 match  between  India and Australia,  an  Indian player was  struck on the  helmet  in the last  over and  he  was  replaced by a  concussion  substitute  rather than  returning to  the  field of play.

In December 2020 of a group of70 former rugby union players have launched a group lawsuit in relation to concussions that they suffered on the field and then played on.  Steve Thompson, England rugby’s World Cup winning hooker from 2003, now suffers from dementia to the extent that he does not remember the game.  He draws a clear distinction from the way that they were training when the game turned professional in 1996 to later on in his career.

Whilst the  game  is  trying to  find their   position in  elite  sport,  there are  hundreds   of players  every  weekend   who  enjoy  five a  side  games,  Sunday  League  and  semi  professional  games who will be  equally  affected  by   head trauma or knocks  who  may not  be  treated  adequately or  cleared  by the  club’ s medical  staff  to   return to  playing  too soon  which h  may  cause long –term  injuries.  This  is  true of other   bodily  injuries  but clearly  a brain  injury  will require  greater  protection.

The  time for  action to  prevent  further  injury and damage to our players currently  playing is now as the authorities seem to be taking the line of ‘Que sera,sera’, whatever will be will be, far too literally.

It will be interesting to see how this continues to develop.

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