Football should consider banning heading altogether after new findings showed that defenders were more at risk of dying from brain diseases compared with other outfield players, the leading researcher into dementia among former players has said.
Professor Willie Stewart also called for footballs to carry a health warning that heading them could increase the risk of dementia. Alzheimer’s UK insists, however, that more research is needed.
Previous findings from Stewart’s FIELD study, part-funded by the FA and Professional Footballers’ Association, showed that former footballers in Scotland were 3½ times more likely to die from a brain disease compared with men of a similar age and background.
The latest research led by Stewart, a consultant neuropathologist at the University of Glasgow, has shown that a player’s position and the length of their career also affects that risk.
For goalkeepers, the risk of developing a neurodegenerative disease was similar to general population levels, but for outfield players the risk was almost four times higher, and five times higher for defenders. The era in which the footballers played made little difference to the findings. Stewart said the latest study was the “missing link” of evidence connecting heading and brain disease.
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“The game of football has to consider if heading is required,” Stewart told The Times. “Is heading necessary for the game of football? Is dementia necessary for the game of football? I believe football should not be permitting that risk.
“Do you want to put young men and women at risk for the pleasure of watching them head the ball?
“If I were making the decision I would say we need to consider what a game without headers would be like. If it is decided it is required I’d say footballs should be sold with a health warning that heading can increase the risk of dementia.”
The FA announced last week that professional players will be limited to ten high-impact headers a week in training and is trialling concussion substitutes to try to reduce the risk of damage from head injuries. Youth players are already restricted in the amount of heading they can do, with a ban in place for under-11s.
Stewart sits on the FA’s advisory panel for head injuries and was scathing about the new rules, saying he was “mystified” by the figure selected.
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“They seem to have used video footage of Premier League matches to estimate the high-force headers and on the basis of that dictated what they think is safe for training,” he said.
“It is like standing on a motorway bridge to guess the speed of the cars and then formulating traffic policy on the basis of that. These ten high-force headers — it may well be that in training 50, 60 or 100 low-force headers may be more of a problem.
“The FA knew this work was coming and I’m not sure why they rushed it [the new guidelines] out a week before. They should take a step back and think again.”
Stewart predicted a rash of legal claims for football-related dementia in the decades to follow if the sport does not take more radical steps. He said the evidence strongly indicates that heading the ball is responsible for the increased risk, rather than concussions, as the number of actual head injuries suffered by those in the research group was so low.
Stewart’s other research has found a condition linked to brain injury exposure, known as chronic traumatic encephalopathy, in a high proportion of the brains of former contact sport athletes, including former amateur and professional footballers.
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He has previously criticised football for bringing in trials of permanent concussion substitutes rather than temporary substitutes, as used in rugby union, where medical staff are given ten minutes to carry out a head injury assessment. The player is allowed to return to the pitch if they pass the evaluation.
The FIELD study looked at the health records of 7,676 Scottish former professional footballers, born between 1900 and 1976, and compared them to 23,000 controls from the general population.
The findings, published in the journal JAMA Neurology, showed that the risk of dying from neurodegenerative disease diagnoses varied: there was approximately double the risk in those with the shortest careers, to about a five-fold increase in those with the longest careers.
Dr Susan Kohlhaas, director of research at Alzheimer’s Research UK, insisted that more work was still needed in this “largely unfinished jigsaw” when it comes to understanding dementia risk and football.
“Dementia risk is complex, caused by an interweaving mixture of age, genetics and lifestyle,” she said. “This is interesting and useful insight into the difference in risk based on player positions and career length and could help inform future research or player management.
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“However, there is still more to do in order to fully understand what is causing increased dementia risk in outfield players. This study did not look at all aspect of players’ lives on or off the pitch to determine what may be behind the increased risk.”
Maheta Molango, the PFA chief executive, added: “The welfare of our players, past, present and future is at the forefront of everything we do and this data will inform us how best to protect them and improve our services.”
