By Yvette Martyn
Football players could be at risk of developing cognitive problems from heading the ball and from experiencing concussions. However, researchers have told delegates at Occupational Health 2019 that more evidence is needed to understand the long-term consequences of mild traumatic brain injury in football players.
Professor Damien McElvenny and Professor John Cherrie from the Institute of Occupational Medicine in Edinburgh gave a presentation to delegates at the conference outlining their involvement in The HEADING research study, which is currently underway. It is looking into concussive and subconcussive head impacts to see if there is an association with long-term cognitive decline.
The effects of sustaining head injuries in other contact sports such as boxing have been known for decades and it is thought that footballers could be at risk of similar health problems. Current Return-to –Play policies cannot take account of possible long-term consequences of head impacts because the results of good quality research are not available.
Concerns about head impacts in football players have featured in the media for a number of years. On 11 November 2002 coroner Andrew Haigh said that former England football player Jeff Astle’s death was the result of an industrial disease. His death in January 2002 had been caused by a degenerative brain disease. He had previous described heading the ball during his career as being similar to heading "a bag of bricks".
In May 2016 the Industrial Injury Advisory Council (IIAC) looked at evidence when considering if motor neurone disease, Parkinson’s and Alzheimer’s Disease should be considered as industrial injuries. Based on epidemiological evidence available at the time it was deemed that evidence was insufficiently convincing to recommend these conditions as prescribed diseases. However, IIAC has said it will look at the issue again should new evidence emerge.
Footballers can sustain head impacts through contact with the ball, with other players or objects on or around the pitch as well as when diving. The researchers want to understand whether heading the ball more or receiving concussions could be putting players at a greater risk.
Professor McElvenny and Professor Cherrie who are involved with the HEADING study said they will be looking at around 300 former football players between the ages of 50-89 years of age. The study will focus on the exposure to heading and concussion in the game and assess the player’s physical and cognitive abilities. Recruitment for the study is about to commence.
There are a number of different factors affecting how much a professional football player heads the ball including: the footballer’s playing position, the type of ball used, the speed of the impact, the level of club played in and the physical fitness of the footballer.
The researchers detailed how the exposure to head impacts in footballers could be assessed. They said that looking at the sequence of events as opposed to one off events is likely to be beneficial. Questionnaires will be used to ask footballers about the frequency of head contacts, previous research and validation exercises will be carried out that may include analysing video recordings of matches between the 1950’s to 1990’s.
The researchers are also looking at how the impact of the ball can be quantified by measuring the acceleration from impacts using sensors attached to a footballer’s head.
Researcher Professor Damien McElvenny said: “There is currently no strong scientific evidence that the occasional concussion or repetitive heading of footballs has a long-term effect on a player’s cognitive or general health. However several studies have been carried out that suggest this might be a possibility. It is thus important that the long-term cognitive and general health consequences of playing professional football are evaluated as soon as possible.”
In 2015 The United States Soccer Federation announced a ban on headers for children aged under 10 years and a limit on headers for children aged 11 to 13 years. If this research finds an association between headers and cognitive health, then this could have wider consequences for heading in football in the future.
The HEADING study is coordinated by world-leading scientists from the London School of Hygiene and Tropical Medicine, Queen Mary University of London and the Institute of Occupational Medicine. The study has been funded by an Independent not-for-profit organisation (The Drake Foundation - https://www.drakefoundation.org/). It has the support of the Football Association (FA) and the Professional Footballers Association (PFA).
For more information on the HEADING study see: https://www.lshtm.ac.uk/node/79341