Research now points towards repetitive head impacts as the contributing factor towards the risk of neurodegenerative disease. Safeguarding measures for head injuries remain under the microscope as we explore the role of head impacts in football.
With concussion as one of the recognised most common injuries and head injury hospitalisations from heading the ball. A number of high-profile diagnoses of degenerative brain diseases amongst former professional footballers have been announced in the media in recent years.
Scientists at Cambridge University have recently reported that even a mild knock can cause long-lasting brain damage, with 45% of patients suffering symptoms at least six months following a mild concussion, also known as a mild traumatic brain injury. Head injuries can be especially worrying because the symptoms of long-term brain damage may not be immediately obvious after the harm is first caused. In some cases, the effects can take many years to develop fully. Improperly treated head injuries can lead to long-term problems, including chronic traumatic encephalopathy (CTE), a condition which can cause memory, mood, and thinking difficulties.
Over time, CTE can also cause dementia, believed to be the result of CTE caused by multiple concussions from sports participation. Given there’s currently no way to diagnose CTE while a person is alive, being able to better diagnose concussions as soon as they happen may be important for preventing this condition from developing in the first place. This immediate intervention may be an important step in preventing neurodegenerative problems, such as CTE, from developing.
Traumatic brain injuries (TBI) are categorised as being either mild, moderate, or severe. It is well documented that those with a history of severe TBI are four-and-a-half times more likely to suffer from dementia. A number of studies are now reporting that there is also a link between a history moderate TBI and increased risk of cognitive decline and dementia.
Dr John Etherington CBE, Consultant in Rheumatology and Medical Director shares a Glasgow University study funded by the Football Association and Professional Footballers' Association:
“The mortality from neurodegenerative disease (conditions which lead to deterioration of the nervous system including motor neurone disease, Parkinson’s and Alzheimer’s being most common reported) was higher among former Scottish professional soccer players, than among matched controls. Mortality from other common diseases like heart disease and lung cancer was lower in footballers.
Mortality with neurodegenerative disease did not differ significantly between goalkeepers and outfield players in this study, however a subsequent study suggested it was highest for defenders and lowest for goal keepers, which might suggest a relationship to heading the ball.
Because of this and concerns raised by former players and their families - the House of Commons Digital, Culture, Media and Sport Committee on Concussion in Sport held a series of hearings and produced a report. There were significant contributions from former and current players, family members as well as professionals from the sport and sport and exercise medicine. The Faculty of Sport and Exercise Medicine contributed to the meetings.
One of the recommendations from the report was for better guidance for sport at a ‘grass roots’ level for the management of concussion. The guidance has been generated through a working group led by Professor James Calder, the Sport and Recreation Alliance and supported by Laurence Geller, the Government's Adviser on Concussion in Sport.
https://www.gov.uk/government/news/landmark-concussion-guida...
The guidance will help all those actively involved in recreational and community sport including, players, coaches, parents, teachers and National Governing Bodies. Fundamentally, it takes an appropriate precautionary approach - ‘If in doubt, sit them out’ and builds on Sport Scotland’s earlier excellent publication. Players, parents, coaches, teachers and administrators were asked to familiarise themselves with the guidance.
The guidance is a welcome contribution to grass-roots sport but does not address concussion in elite or professional sport, where the issues may be more complex and often more emotive. The adverse neurological consequence of sport is a complex area. The evidence is incomplete, the terminology is confusing and the conditions, understandably, cause considerable distress for players, family members and those trying to do their best for their sport. There can be a confusion of terms with concussion, post-concussion syndromes, dementia and Chronic Traumatic Encephalopathy often used interchangeably.
The Faculty of Sport and Exercise Medicine believes that the treatment of patients with cognitive, affective, and behavioural symptoms arising from concussion and other neurological injury has not been properly addressed. There is considerable evidence to be derived, from the literature arising from traumatic brain injury, that rehabilitation is effective. However, this evidence is not being consistently applied to the form of brain injury seen in sport. An important determinant of outcome in brain injury is the mental health of the patient, if this is ignored or the brain injury managed inappropriately, then there is likely to be a detrimental effect on patient well-being.
Pure Sports Medicine has considerable expertise in rehabilitation of all forms of sports and musculoskeletal injuries and doctors trained in Sport and Exercise Medicine and Rehabilitation Medicine, including brain injury, physiotherapy expertise in the rehabilitation of sports concussion.”
https://puresportsmed.com/team/dr-john-etherington-cbe
Since 2018, The Drake Foundation has funded several studies focussed on improving the understanding of concussion and head impacts in football. The study, also known as ‘Health and Ageing Data IN the Game of football’, is working with retired professional footballers to uncover associations between a history of heading the ball or concussion and neurodegenerative disease.
The study will feature a series of tests to capture physical and cognitive capabilities, neurological clinical examinations, face-to-face consultations and analysis of blood samples to better understand the long-term effects of a career in professional football. Current England Men’s team manager Gareth Southgate and ex-Arsenal and England footballer Tony Adams have been advocates for the HEADING study, working with retired footballers to uncover associations between a history of heading the ball or concussion and neurodegenerative disease, urging other former professionals to sign up to the study.
https://www.drakefoundation.org/the-heading-study/
A further study carried out by the University of Glasgow found that amongst footballers, goalkeepers were as likely as the rest of the population to suffer from a neurodegenerative disease, while outfield players were nearly four times as likely. Individuals who suffer from industrial diseases, such as mesothelioma resulting from historic exposure to asbestos are entitled to funds through the Industrial Injuries Disablement Benefit.
High-profile footballers have brought attention to this topic through the "Injury Time" campaign with a goal to demand that brain injuries caused in football are classified as industrial injuries. It is reported that ex-professional footballers are up to three-and-a-half times more likely to develop dementia than others.
The campaign argues that ex-players who have developed dementia and other brain-conditions should be entitled to access to government benefits and care. It also calls for government funding for further research into practical and preventative support within football, at all levels. The Injury Time campaign argues that those affected by sports-related dementia should be equally entitled.
Stephen Makinde, Osteopath and NLP Practitioner adds; “Albeit an acute injury, concussion in football can have far reaching effects on day-to-day function and in particular cognitive function. Early management is imperative to preventing long term morbidity with these cases.
Very little is known about the management of these cases and the impact simple practical applications of lifestyle modification can have on maximising chances of recovery. Recent studies point to the important role of nutrition in helping and indeed optimising recovery from brain injury.”
www.theoakpractice.co.uk
THE IMPORTANCE OF CAREER-ENDING INSURANCE COVER
Founded in 1994 by Steve Foster and run with former England, Sussex and Surrey cricketer, Tony Pigott, Pro-Secure is the only football insurance company recommended and endorsed by the PFA with tailor-made insurance policies designed to protect the PFA’s 3,000 members, ranging from Premiership superstars to apprentices in the Third Division.
Pro-Secure cover protects over £500 million of insurance cover for its 600 clients career-ending injuries, safeguarding professional players against the financial impact of unexpected accidents, on and off the pitch. Creating individually tailor-made policies for each footballer with all company insurances underwritten by American Specialty Underwriters, the market leader in sports disability insurance in North America and the UK. Policies will pay a tax-free lump sum if a player’s career is ended by injury - each year 50 to 60 players are forced to retire from injuries. Pro-Secure is the leading personal injury insurance provider for professional sportsmen founded by former England player Steve Foster.
Mick McGuire, PFA Deputy Chief Executive said:
‘Every player runs the risk of career-ending injury which makes it imperative for every PFA member, irrespective of status or income, to protect their futures. This is why we advise all players to have their own individual Pro-Secure personal accident policy in their own name. Cover is particularly important for young players who need to insure against the loss of future career earnings.’
Ashley Cole of Arsenal and England said: ‘My Pro-Secure personal accident policy provides me with 24-hour world-wide cover if I am playing in the Premier League or for England.’
Steve Foster commented: ‘Professional football is a high-risk occupation. It is essential for every player to have adequate insurance cover. Working with the PFA, we are aiming to educate players to have their own policies so they can properly plan for the future should their career prematurely end.’
John Goodman, previously of Wimbledon and Eire, whose career was ended by injury, said: ‘I was fortunate to have a Pro-Secure policy when my career was ended by an injury playing in the Premiership. This gave me the opportunity to finish a sports science degree and move into a new career as a fitness coach at Wimbledon.’