Five members of the famous World Cup 1966 winning England side have since developed dementia, four of whom have passed away from the syndrome. Ray Wilson, Martin Peters, Jack Charlton and Nobby Stiles have passed since 2018 and it has since emerged that Bobby Charlton has been suffering with the same condition.
The NHS define dementia as a ‘syndrome associated with an ongoing decline of brain functioning’. It’s a term used to describe the symptoms occurring as a result of a decline in brain function, it is not a single disease.
The worry is that the heading of the ball when done over a long period of time can cause potentially traumatic brain injuries and cause severe medical problems later in life. Short term, the action can cause concussions. Concussion is a type of traumatic brain injury caused by hitting your head very hard (Nunez, Bell 2020).
Approximately twenty two percent of football injuries are thought to be concussions.
There is also the threat of sub concussive injury which are caused by hitting your head, not enough to cause symptoms, but still enough to cause brain damage. This type of repetitive head injury has been linked to encephalopathy, a neurodegenerative disease, as well as dementia (Nunex, Bell 2020).
Post concussion syndrome is also a large risk in this area, with the effects of the injury not coming to fruition until sometimes a few days later, meaning the player could have played on and lived their life as normal with a trauma injury to the brain (Bowman, Han 2019).
Through this we can see that there is a risk present of causing long term health problems by simply playing the game 3.5 billion love. There have been many studies and inquiries have shown evidence pointing both ways, some that it does cause harm and some that it does not.
In a 2016 study, Ling et al found that fourteen of twenty tested footballers had developed dementia later in life. They were noted as ‘all skilled headers with half playing in positions that required frequent heading of the ball’. With their careers lasting twenty to thirty years, and most of them starting to head the ball during childhood. One can see that the evidence points towards heading potentially leading to dementia (Ling, Morris, Neal, Lees, Hardy, Holton, Williams 2017).
Gouttebarge, however, stated that the call to ban heading in professional football was not evidence based. They stated that ‘empirical knowledge needs to be gathered in large cohort studies’ throughout mens and womens professional football. They also called for more accurate assessment of heading exposure with it being observed and not self reported (Gouttebarge 2021).
In another sport, Australian Football League officials also lean towards the lack of evidence and described the concerns of head injuries being linked to longer term risks as ‘anecdotal’. Partridge and Hall described their argument as there being no evidential reason to enact their ‘professed ethical imperative to protect player welfare’. (Partridge, Hall 2014). There is scepticism among the officials that concussions cause serious long term neurological harm. So if there is doubt that concussions do so, there will be more doubt that heading the ball without serious harm can lead to neurodegenerative conditions.
Partridge and Halls findings came seven seven years ago in 2014, before the diagnoses of the 1966 England players and before the modern acceptance of head injuries causing further harm later in life. The AFL have since accepted and sought to deal with the problem through the introduction of concussion protocols for adults and youth players.
A study from Vann Jones, Breakey and Evans found there to be some evidence linked to heading and impairing cognition in short and medium term, although it’s stated that little is known about long term. All members of the Former Player Association from four professional clubs in the United Kingdom were invited to participate through completing a self assessed cognition test.
The study found that ten of the ninety two players screened positive for mild cognitive impairment or dementia. There was also no association between so-called ‘high risk’ and ‘low risk’ playing positions (Vann Jones, Breakey, Evans 2014). They also found that the results suggest that once a player’s career ends, their risk of harm falls in line with the normal population, therefore suggesting that changes caused by heading are reversible or not as harmful as previously thought.
This suggests that while there is evidence of harm caused to an individual, it could also be the case that this is not as serious as expected or that the effects aren’t as long term as once thought. With the news of players being diagnosed is what makes the headlines, the ‘news’ that the majority of those involved have not been reported to have had problems caused by heading the ball is far less advertised.
But does this mean it’s not a problem? No. The evidence shows that damage is caused, although arguments over how much are common, the fact that it happens at all is cause for concern.
The FA introduced heading guidance to come into all levels of the professional and amateur game for the 2021/22 season, this has come on following multiple studies undertaken by a subgroup of the Professional Football Negotiating and Consultative Committee which found the threat came with heading from passes over thirty five meters (The FA 2021).
They decided that such headers will be limited to ten times per week in training. The guidance has been introduced to protect player welfare, The FA seemingly admitting the risk that the action brings and aiming to lower the risk of future harm, a step in the right direction for sure.
In youth football, heading cannot be introduced in training until the under twelve age group where it is limited to five headers in one session per month. From under fourteen to eighteen it is still limited but allowed more often, with ten headers in one session per week. (The FA 2021).
But what about what The FA can’t control? Without doubt children all over the country will be playing in local parks away from any supervision or rules. A personal favourite game being headers and volleys in which the ball would be fired into the box with everyone throwing their heads aimlessly towards the ball.
In my opinion, it is incredibly important that young footballers are taught the correct and safe way to head the ball and by limiting their interaction with this event, one may create the risk of improper technique becoming the go to method. This can then lead to further risk in the future as older players deal with higher powered footballs which are met with the wrong part of the head.
Banning it outright in youth football will also cause problems for young players in adult football. A player that has just turned eighteen facing seasoned veterans with improper technique could cause problems, as with first and second year scholars who will be unable to head the ball, or are limited, in their own sessions but must do so when with the senior sides.
Perhaps the use of a softer football, perhaps foam, to teach correct technique will be the best option moving forward and allow young players to learn the safest method and set them up for a safer career going forward.
Another option to combat the issue in adult football could be the use of softer footballs with more padding in order to lower the impact of the ball against the head. Anyone who has played will know that different balls weigh and feel different, with some already far softer than others, so this change may not be too drastic.
The change of football has been suggested before with the National Collegiate Athletic Association (NCAA) and Auger finding that when in wet conditions, size five footballs would exceed the NCAA rules on allowable weight gain after just fifteen minutes. Because of this it’s said that the current footballs be cycled out and replaced with new dry footballs to prevent water absorption. (Auger, Markel, Pecoski, Leiva-Molano, Talavage, Leverenz, Shen, Nauman 2020)
The Lancet Commission found that it was important to make known that ‘prevention is about policy and individuals’ and that ‘contributions to the risk and mitigation of dementia begin early and continue throughout life’ (Livingston et al 2020). This shows the importance of introducing preventative and protective measures in youth football and continuing them throughout the footballers’ careers to prevent head injury.
It has been suggested that protective equipment be introduced such as headbands and scrum caps but these have yet to demonstrate a ‘proven decrease in neurological impairment from head acceleration events’ (Elbin et al 2015). It has been found that heading in football can increase your risk of concussions, especially when done so over a long period of time.
The repeated sub concussive injuries can accumulate and cause brain damage, but the proper technique being used and protective headgear can make it possible to reduce your risk (Nunez, Bell 2020)
Whether it be limited exposure to headers, softer balls, or protective equipment, it is important that some measures are taken and kept in place. The introduction of The FA’s guidance on headers is a welcome change to youth training to help to prevent long term ill health, but the importance of teaching proper technique from a young age cannot be understated.
But perhaps the question is not whether to ban headers in youth football, but to ban or limit it in football as a whole. Whilst the evidence is there that the action of heading the ball has the potential to cause long term harm to the player, it could be a case of needing to halt headers until further research is done and a full conclusion is made.
Auger, J., Markel, J.,Pecoski, D., Leiva-Molano, N., Talavage, T., Leverenz, L., Shen, F., Nauman,E. (2020) Factors affecting peak impact force during soccer headers and implications for the mitigation of head injuries.
Bowman, J., Han, S. 2019. Post Concussion Syndrome. Healthline.
Elbin, R. J., Beatty, A., Covassin, T., Schatz, P., Hydeman, A., & Kontos, A. P. (2015). A preliminary examination of neurocognitive performance and symptoms following a bout of soccer heading in athletes wearing protective soccer headbands. Research in sports medicine, 23(2), 203-214.
Gouttebarge, V. (2021). Is the call to reduce heading exposure in professional football to prevent dementia evidence-based?
Ling, H., Morris, H. R., Neal, J. W., Lees, A. J., Hardy, J., Holton, J. L., ... & Williams, D. D. (2017). Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players. Acta neuropathologica, 133(3), 337-352.
Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., ... & Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413-446.
Nunez, K., Bell, Angela. 2020. Heading in Soccer, How Dangerous is it? Healthline.
Partridge, B., Hall W. (2014). Repeated Head Injuries in Australia’s Collision Sports Highlight Ethical and Evidential Gaps in Concussion Management Policies.
Vann Jones SA, Breakey RW, Evans PJHeading in football, long-term cognitive decline and dementia: evidence from screening retired professional footballersBritish Journal of Sports Medicine 2014;48:159-161.