Reducing repetitive head impacts in football must remain ‘a priority’ – expert

Footballers’ heightened risk of neurodegenerative disease is not driven by general health and lifestyle factors, according to new research.

The University of Glasgow FIELD Study’s latest research published on Monday found general dementia risk factors were similar or lower among professional footballers compared to the general population, and were not behind the increased likelihood of death due to neurodegenerative disease among footballers identified in earlier study findings in 2019.

That data found footballers were three and a half times more likely to die from neurodegenerative disease than age-matched members of the general population.

Research lead, consultant neuropathologist Professor Willie Stewart, said the new findings underlined why reducing or removing exposure to repetitive head impacts in football remains “a priority”.

The general health and lifestyle dementia risk factors looked at across the footballer and general group in the new study included smoking, depression, alcohol-related disorders, diabetes, hypertension, hearing loss and obesity.

The footballer group consisted of 11,984 individuals, with the matched general population group numbering almost 36,000.

Professor Stewart said: “Our latest results suggest the relationship between higher rates of neurodegenerative disease among former professional footballers is not driven by those wider general health and lifestyle factors, widely recognised as dementia risk factors.

“As such, while interventions to address general health and lifestyle risk factors should remain recommended, the priority for neurodegenerative disease risk mitigation among contact sports athletes should continue to focus on the reduction, if not removal, of exposure to repetitive head impacts and traumatic brain injury, wherever practical.”

The latest study was funded in part by the Football Association and the Professional Footballers’ Association.

Additional FIELD study research in 2021 showed a direct association between career length and dementia risk, with the risk of neurodegenerative disease increasing up to fivefold for those with the longest careers.

Since the publication of the 2019 data, professional players’ heading practice has been limited to 10 “higher force” headers per week. “Higher force” headers include those from crosses, corners, free-kicks, or long passes.

Additional, permanent concussion substitutes have also been introduced to the sport, though many campaigners believe a model using temporary concussion substitutes would be more beneficial.

An FA spokesperson said the governing body noted the new findings and added: “We continue to invest in and support multiple projects in order to gain a greater understanding of this area through objective, robust and thorough research, and we have already taken many proactive steps to review and address potential risk factors which may be associated with playing football whilst ongoing research continues.”

Earlier on Monday, the Head Safe Football charity wrote to Culture Secretary Lisa Nandy calling on the Government to designate repetitive head impacts (RHI) in football as a public health issue.

Former Middlesbrough defender Bill Gates, the husband of the charity’s founder Judith Gates, died in October last year. Subsequent postmortem examinations found he had chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease.

Judith Gates has called on the Government to promote the Head Safe Football slogan ‘Think Head Safe: reduce heading in training’.

Her letter suggested adding public health messaging on footballs, football-related packaging and equipment, and for posters, signs, messages and motifs on uniforms to promote the key message in training environments.

“Our commitment is wholly focused on player safeguarding,” her letter concluded.

“As his legacy, my late husband asked his family to try to ensure that future players are protected from the disease which cruelly devastated his life together with the lives of so many others. We have a promise to keep.”

Head Safe Football wants existing heading bans to be extended further throughout youth football, and specific and monitored limits to be introduced to heading in training throughout the game.

She also wants an independent body to be established to oversee brain health and safety.

The letter also calls for a requirement on coroners to record CTE and other brain diseases in professional players and those with a history of playing contact sports in order to establish a more detailed understanding of the prevalence.

The FA is phasing out deliberate heading in youth football up to under-11s level by 2026-27.

Heading is banned in training by the FA for under-11s, and then strictly limited up to under-18 level.

In adult grassroots football, it is recommended that heading practice is limited to 10 headers per session and only one session a week where heading practice is included. Players should be responsible for monitoring their own heading activity.