Why heading in football needs to be discouraged or at least seriously discussed


Are we waiting for a player to be killed just to preserve the cosmetics of a sport?

Fernando Torres, a striker who plays for La Liga team Atletico Madrid lies on the field after colliding during a Spanish league football match. Image Source : Wikimedia Commons

So, the headline must have got you all puzzled. Why is a biotech news website discussing football regulations? Well, as it seems, there are compelling reasons to do so! The year has begun with strong examples of why football’s governing bodies should look at outlawing headers in order to preserve the health of players, especially after the high profile on-field “concussions” sustained by Ryan Mason, Hector Bellerin and Fernando Torres.

For some reason, in football, traumatic brain injuries are considered some sort of occupational hazard. Mason, Bellerin, and Torres were injured either by an elbow to head, head to head or head to ground challenges. In February this year, scientists from University College London and Cardiff University examined the brains of five people who had been professional footballers and one who had been a committed amateur throughout his life.

Their study published in the journal Acta Neuropathologica revealed that football players may be prone to long term brain damage due to repeated blows to the head. Post-mortems were conducted on six people who played football for an average of 25 years each. All six had dementia while CTE was evident in four.

Is there any solid evidence that links heading to brain damage?

Chronic traumatic encephalopathy (CTE) is a degenerative disease found in people who have suffered repeated blows to the head. CTE has been linked to memory loss, depression and dementia and has been seen in other contact sports. Very often the damage is officially covered up as “concussion”. Another study by the University of Stirling in Scotland has found that a single session of heading the ball can significantly affect a player’s brain function and memory for 24 hours. This was published in November last year in EBioMedicine.

The difference between a healthy brain (left) and brain with CTE (right). Advanced CTE symptoms include progressive dementia, movement disorders, speech impediments and suicidality. Image Source: Wikimedia Commons

The Football Association welcomed the study and said research was particularly needed to find out whether degenerative brain disease is more common in ex-footballers. Dr Charlotte Cowie, of the FA, added: “The FA is determined to support this research and is also committed to ensuring that any research process is independent, robust and thorough, so that when the results emerge, everyone in the game can be confident in its findings.”

In contrast, an editorial in British Journal of Sports Medicine suggested that the data on the consequences of football heading is confounding, at best. “Regarding late consequences of heading, data are mixed and limited. No correlation between heading frequency and neurocognitive test performance is reported in a majority of studies, while the remainder report only minor and sometimes questionable influence of heading, with surprisingly few studies applying the recommended control for the confounding effects of a greater number of head injuries sustained by those who head more frequently,” mention the authors.

CTE was neuropathologically diagnosed in a staggering 87% (177) of players across all levels of play. 111 of these players played in the National Football League and 110 of those were found to have C.T.E.

Dr David Reynolds, at the charity Alzheimer’s Research UK, said: “The causes of dementia are complex and it is likely that the condition is caused by a combination of age, lifestyle and genetic factors.” He partially agrees with the skepticism, “Further research is needed to shed light on how lifestyle factors such as playing sport may alter dementia risk, and how this sits in the context of the well-established benefits of being physically active.”

On July 25, a study published in the Journal of American Medical Association created more furore.

Dr. Anne McKee, a neuropathologist at Boston University Alzheimer’s Disease and CTE Center examined the brains of 202 deceased football players (American Football). Her group found that CTE was neuropathologically diagnosed in a staggering 87% (177) of players across all levels of play. 111 of these players played in the National Football League and 110 of those were found to have C.T.E. This was a direct correlation that suggested that CTE may be related to prior participation in football. In her previous study in 2013 published in the journal Brain, she had proved conclusively that CTE is associated with repeated brain trauma in 34 American football players.

“The strengths of this study are that this is the largest CTE case series ever described to our knowledge, more than doubling the size of the 2013 report, and that all participants were exposed to a relatively similar type of repetitive head trauma while playing the same sport. In addition, the comprehensive neuropathological evaluation and retrospective clinical data collection were independently performed while blinded to the findings of the other investigators,” says McKee.

The evidence is not limiting. A study by the Purdue University in 2015 revealed that the impact of heading a goal kick was equivalent to a hit in American Football or a punch in the boxing ring. To prevent that sort of damage – US Soccer acted decisively. It prompted US Soccer to outlaw heading for players up to the under-11 age group. Also, “The under-12 and under-13 age groups should be “limited to a maximum of 30 minutes of heading training per week, with no more than 15-20 headers per player, per week,” according to US Soccer.

How concerned are the players?

Voices of alarm are coming from players too. Ian St. John played football for Liverpool from 1961-1971. He noticed that six of his teammates – from a group of about 16 players – now have Alzheimer’s.

Interestingly, he further adds, “How many goalkeepers have got dementia over the years? If they did a survey, it would be interesting if the answer was none, which means that the goalkeeper – the only guy on the field who is not heading the ball on the field – is OK.”

Even during the games, players are trying to stay more alert. Gabi – Torres’s team-mate – reached into his friend’s mouth to ensure his tongue did not slip back in his throat. That challenge against Deportivo La Coruna’s Bergantinos left the Spaniard facing a night in the hospital.

Cristiano Ronaldo (Real Madrid) and Robin van Persie (Manchester United) engage in a head tackle. Image Source: Wikimedia Commons

How is FIFA dealing with this issue? 

Sepp Blatter, during his time as FIFA (Fédération Internationale de Football Association) President, introduced some well-measured legislation changes due to which violent play has been mostly eradicated from the game. However, what was overlooked is the impact, participating in football has on the brain. There is no current legislation in the Fifa Laws of the Game on how brain injuries should be treated, only guidelines, which leaves the welfare of the player in the hands of their coaches and medics.

According to another study, around 50,000 concussions were suffered by high-school and collegiate players during 2010 – more than the total number for baseball, basketball, softball and wrestling combined.

There is no doubt, whatsoever, that there would be fewer cases of players suffering brain traumas – as well as sub-concussive blows caused by heading the ball – if there were fewer aerial challenges. That’s why this issue of heading the ball, needs to be seriously discussed, considering the mounting evidence against it.

In Singapore, the Football Association of Singapore (FAS) has adopted a cautious approach in its grassroots program, which includes Under-8 and Under-10 categories. Children play small-sided games that focus on passing and dribbling. Players move on to full 11-a-side games only at the age of 13.

These traumatic brain injuries are only one part of the picture when it comes to banning heading. According to another study, around 50,000 concussions were suffered by high-school and collegiate players during 2010 – more than the total number for baseball, basketball, softball and wrestling combined.

To some, the evidence might be co-incidental but even though hints of a link between even small, subconcussive impacts and long-term damage begin to accumulate, it is time to atleast consider the possibility that the leaders of the world’s most popular sport may eventually determine that heading is too much of a medical and legal risk to allow.

If we can ban tackles from behind to save players’ legs, can’t we ban what are effectively tackles in the air to save their brains?

Maybe we’ll look back in 50 years and wonder how the hell we ever let this continue so long.