It's been clear for some time that all sports involving contact and risk of head trauma may have a safety problem. The phenomenon of the punch drunk boxer has been around so long it is part of folk lore and the risk of both short and long term injury has pretty much always been there. In comparison there is a much smaller risk of acute critical injury or death in high contact ball sports such as rugby and a very much smaller such risk in contact sports such as football.
However, the risk of long term harm such as dementia, not really considered until recent years, may mean that both rugby and football - and others - may face ultimately having to make significant changes to the mode of play. While in both cases head injuries are the main concern, in rugby it's the contact between bodies and in football it seems to be primarily the issue of heading the ball that is the focus of current concern.
For me, at the moment some folk are barking up the wrong tree. Perhaps understandably the daughter of ex Man United and Scotland centre half Gordon McQueen is blaming his dementia on heading footballs, saying she didn't realise he headed it so much in training (eh??) But Gordon has vascular dementia. I sympathise: Mrs H's mum suffered from that awful, personality destroying disease. Vascular dementia is essentially caused by a lack of blood supply to the brain. The main causes are a narrowing of small blood vessels deep inside the brain, strokes or a series of mini-strokes. People with high blood pressure, smokers, the obese and people with high cholesterol and diabetics are at particular risk. The failure of the blood supply effectively kills off whole areas of the brain as shown in this sobering image:
There is more that is not known than is known about the causes of the many forms of dementia. But strokes or transient ischaemic attacks (TIAs) which are the prime causes of vascular dementia aren't associated with head trauma and therefore not with heading footballs. However, I suppose it is conceivable that repeated trauma could cause extensive damage to small blood vessels in the brain. Though why deep in the brain? Nevertheless, I wouldn't totally rule out a connection, especially since what little is understood about dementia includes the fact that victims can have brain changes that are associated with several different types of dementia, e.g. Alzheimer's and vascular dementia or CTE (see below) at the same time. But for me whether repeated heading of footballs using the forehead would produce the widespread impact on the brain shown in the picture above for the vascular and Alzheimer's forms must be doubtful. But there are plenty of other forms of dementia besides the one that Gordon McQueen is suffering from and it's hard to rule anything out on current knowledge.
Proving that a condition that affects many people had a particular cause in some victims, i.e. footballers, isn't straightforward. And my very non-scientific view is that professional football has never been one of the occupations linked to high longevity. But to me it's not an intuitively obvious connection in the case of vascular dementia. There is an excellent and very readable item on the Alzheimer's Association website (see below) on traumatic brain injury from head impacts which disrupt normal brain functions. That source reports that older adults with a history of moderate traumatic brain injury had a 2.3 times greater risk of developing Alzheimer's while for those with a history of severe traumatic brain injury it was 4.5 times, so roughly double and then double again. There is no evidence that a single mild traumatic brain injury can cause dementia (phew!) but:
"emerging evidence does suggest that repeated mild traumatic brain injuries such as those that can occur in sports such as American Football, boxing, hockey and soccer may be linked to a greater risk of chronic traumatic encephalopathy (CTE), a form of dementia".
I wonder whether the omission of rugby and inclusion of hockey is in that list and the reference to "soccer" means they are quoting from an American source. After all you don't head the ball in hockey so I guess they mean ice hockey. But they do note that, in boxing, the link to CTE correlates with the number of rounds boxed, not the number of times knocked out, meaning that the repetitive nature of mild or very mild traumatic brain injuries may be the issue.
With the overdue research initiatives in football and the court cases in the offing from rugby players as young as 42 year old World Cup winner Steve Thompson against World Rugby and the English and Welsh rugby football unions more information will slowly emerge on the risks.
So am I concerned about this prospect of a link between playing football and contracting dementia? Yes, but primarily as a spectator rather than an ex-centre back. Oh, I can recall suffering concussion playing football - so at least I have that recall! Neither was due to heading the ball but the result of collisions. The one I remember most clearly was when I'd been pressed into playing as an emergency centre forward, all available strikers being unavailable, in the case of the normal centre forward for a few weeks. So I got to play up front despite never being particularly happy (or useful) with my back to the direction of play. I think in three matches I got one goal - and that was an intercepted back pass. On a bare, dry and dusty pitch late in the season I chased a through ball with the keeper coming out quickly and going down to gather with his arms. Both of us thought we could get there first and neither gave way. I presumably didn't get there first as I went up in the air over the sprawling keeper and - I think - did a Tom Daley impersonation and came down head first into the dirt. I can remember being attended to with the game stopped and suspect I was out for more than a few seconds but I felt fine, not even particularly shaken up. My team mates seemed relieved and, after I'd suffered the cold, wet magic sponge and got back to my feet, one of them told me it was quite funny because I'd sat up looking like an extra from one of my parents' favourite TV shows - the Black and White Minstrels now seen, retrospectively but understandably, as the epitome of insensitivity and political incorrectness. Or, as they say now, wearing "black face", so I guess that's what I landed on.
The other time was a bit scarier because I didn't remember the incident at all, just coming round. It was usual in such situations for someone to hold up of fingers and ask the injured party "how many?" Apparently this is still part of the concussion protocol and it is normal to hold up one finger, I guess because that's the easiest way to spot double vision, though maybe also allowing for how well some footballers can count. I always held up two fingers in the traditional non-Churchillian manner because, if I got a ribald repsonse on the lines "you can eff off as well" then I knew not only could the victim count but also that they could think and hadn't lost their sense of humour.
Anyway I must have said I was fine and the game restarted. I was playing in midfield and as the game carried on and I jogged about following the play up and down I realised that there was still quite a bit of fog that was slowly clearing. And then it slowly dawned on me that, if I got the ball, I had no idea which way my team was kicking. Following which more fog cleared, I figured it out, carried on jogging around and tried not to get involved in the actual action for a while longer.
That must only have been a mild concussion as it can't have lasted more than a few minutes and I don't remember any after effects at all. Oh, I often had a sore forehead the evening after a game with plenty of headers but that was from the skin being pushed back as I headed the ball, frequently leaving me with a sensitive area along my hairline (or at least where it was then, just above my forehead). But that doesn't give me any concerns, for several reasons. Firstly, there's nothing that can be done about it now if heading is proved to be dangerous. Secondly, I would have headed footballs a tiny fraction of the amount that the pros do. For a start we hardly ever headed the ball in our once or twice a week training sessions. Thirdly, I wouldn't prejudge the outcome of the studies that will now belatedly take place. Despite the smoking gun of the number of ex pros being diagnosed with dementia I've seen anecdotal evidence that that incidence amongst goalkeepers isn't much lower. Of course, they might have been joining in the habit of joining in general training - I hardly ever met a keeper who didn't want to play out in training sessions.
But I admit, despite the gathering circumstantial evidence, I still find it hard to believe that heading a modern football a modest number of times a week could pose much risk. You hardly notice the impact of a well-timed header. I was always much more concerned from the risk of clashing heads, which was a fairly frequent occurrence for centre backs and centre forwards. Sometimes with your own team mate going for the same ball. And then you can get impacts on the back and side of your head, not just the bony forehead. And, unlike when you head the ball, you aren't ready for the impact, the power in a header coming from the combination of the speed of the ball, the timing of the contact and the strength of the neck muscles. The "glass jaw" some boxers suffer from making them prone to knock outs is more to do with their neck not their jaw. The punches that harm boxers are the ones they don't see coming.
And anyway, I've had an irritating habit of banging my head quite hard and frequently. Up and over garage doors that slipped down slightly in the wind were an ongoing source of self inflicted injuries on many occasions. I always thought motorised doors were for convenience but actually....
And sloping ceilings. After we had a house in the 90s with very sloping upstairs ceilings I swore we would never live in such a house again. Probably after standing looking out of a window and then turning walking briskly into the window reveal for the umpteenth time. And what do we have now? An upstairs with sloping ceilings after doing a loft conversion. On which I banged my head this very day. Indeed once, going rather briskly to catch a goal or wicket replay on the upstairs TV, my forehead hit the slope of the ceiling and my lower body's momentum left me, Tom and Jerry style, lying flat on my back groaning. For the life of me I struggle to see that a handful of headers a week for a decade could do as much damage.
No, my main concern is simply that, if it proved necessary to ban heading in football the game might become unwatchable. Oh I enjoyed playing in 5 and 6 a side games as much as anybody but they don't make for great watching. And the current fad of ultra short goal kicks often leads to an untidy scramble for the ball between a ruck of players between the penalty area and half way line, often penned in against the touchline. It looks for all the world like the under 8s before they have the strength to kick the ball far and before they have any positional appreciation or discipline.
You can just about watch this 5 a side style tripe with 22 players on a full size pitch on the TV without screaming (OK, Mrs H would say I can't) but what would be the point of going to the stadium to watch the match live?
I've seen it argued that heading on the pitch could be limited to the areas close to goal with a benefit being an onus on the skill in bringing the ball under control if it could not be headed in midfield. No it wouldn't. It would just increase the number of ugly tangles with the centre back trying to hook the ball away from the centre forward from behind, often resulting in a free kick randomly awarded to one side or the other by the referee.
It's one of the reasons I don't enjoy watching Manchester City. The brave clearance, followed by a quick long pass out of defence, a run down the wing and cross for a flying header, turning a defence under pressure to a goal in seconds makes for much more exciting watching.
If it has to go I'll miss it to the point I may well stop watching football.
Meanwhile the game goes on and the current generation of pros get on with it and take the money. One thing they won't be able to say is that they didn't know there might be a risk.
https://www.nhs.uk/conditions/vascular-dementia/causes/
https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/traumatic-brain-injury
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