Footballers heading for trouble

As a footballer, and a centre back, I love heading a football. Strikers get satisfaction from scoring a goal, midfielders from getting assists. But for us defenders, who occupy the tiniest sliver in the pie chart of game glory, joy is found in more prosaic ways.

The crunching tackle, the last-ditch slide in to deny a striker who is clean through on goal and even the perfectly-executed offside trap.

For me, though, nothing beats winning a towering header: timing the jump, beating your opponent and feeling the ball thump against your forehead and flying out of danger.

However, last October researchers from the University of Stirling explored the true impact of heading a football and they identified small but significant changes in brain function immediately after routine heading practice.

Heading

Credit: Hannah Louise McNicol

The study from Scotland’s University for Sporting Excellence published in E-Bio Medicine was the first to detect direct changes in the brain after players are exposed to everyday head impacts, as opposed to clinical brain injuries like a concussion.

It has since lead to many calls for the FA to follow US Soccer and ban heading for U10’S and limit the amount of heading 11-14 year olds are subjected to.

If we can ban tackles from behind to save players’ legs, can we ban what are effectively tackles in the air to save players’ brains?

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 his coaches and medics.

The FA – in fairness – announced rules in 2014 concerning the treatment of brain injuries. Any player in England who falls unconscious, or even appears to, is no longer be permitted to continue in a match.

Any player suffering a head injury undergoes an assessment on the pitch and those who suffer two such head blows will be sent for psychometric testing. The decision of whether or not a player returns to action, moreover, belong to club medics and not members of the coaching team or the player himself.

But most of us are still stuck in a way of thinking which dictates a player with an overstretched leg muscle is substituted but one who’s had his brain jostled around his head to the point of confusion and memory loss shakes it off and stays in the game.

What is not in doubt is 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.

The study conducted at the University of Stirling involved football players heading a ball 20 times, fired from a machine designed to simulate the pace and power of a corner kick. Before and after the heading sessions, scientists tested players’ brain function and memory.

Increased inhibition in the brain was detected after just a single session of heading. Memory test performance was also reduced by between 41 and 67%, with effects normalising within 24 hours.

Played by more than 250 million people worldwide, the beautiful game often involves intentional and repeated bursts of heading a ball. In recent years the possible link between brain injury in sport and increased risk of dementia has focused attention on whether football heading might lead to long-term consequences for brain health.

I interviewed the brains behind the study, cognitive neuroscientist Dr Magdalena Letswaart from the Psychology department at the University of Stirling:

DR

Dr Magdalena Letswaart; Credit: University of Stirling

Firstly, what made you want to carry out the research in the first place? 

“There is little to no science out there about what football heading does to the brain. One of the main reasons for this seems to be that it is very difficult to show brain changes after concussion, so it’s even harder to show brain changes after even milder head impacts that we call sub-concussion.

“In my basic science lab I have a brain stimulation technique called TMS that we thought might be sensitive enough to pick up the small brain changes we expect after ball heading, and this turned out to be the case. This is really helpful because the technique allows us to give really direct answers to the issue and look at the actual brain processes in a direct way.”

Were the results better than you expected?

“We were pleased that the first time we did the experiment we saw very clearly the brain changes after ball heading. These are small but significant brain changes that have direct relevance to brain health.”

Are you planning on carrying out any further research into the matter? 

“Absolutely, we have not yet got out of the starting blocks really. What is needed is a big research drive to really understand how heading the ball affects the brain. We now have the neuroscience technologies to give really quite direct answers to these questions, but much more research is needed.”

 Are you in favour of a ban on younger children heading the ball, like in America? 

“While we need to protect footballers who will be experiencing small, but significant short-terms changes to their brain chemistry after they head a football, we need to be able to pinpoint what stage this may be having the biggest impact and uncover at any age the mechanisms that relate to brain health in the long-term, before we can make any concrete decisions about the game among young players.”

 In the long-term can you see heading being eradicated from the game completely? 

“From what we understand about the brain, it is the frequent heading drills that we are particularly concerned about. One header is not going to give you brain damage but we don’t yet know what happens when you disrupt the normal balance in the brain over and over again when participating in regular heading practice.

“We want the brains of the millions of players worldwide to last as long as possible so it’s important to know whether heading the ball increases the risk of dementia, for example, and that is something that we now may be able to start to answer using the research techniques of modern day neuroscience that we have here at Stirling.”

What’s the next step?

“Now that we have this sensitive but robust way of detecting brain changes with our neuroscience technology, we hope to cast some light on the safe limits on football heading. At the moment there are no known safe limits for football heading because there is no science to give answers.

“We are particularly interested in players in their late teens and early twenties when the front part of the brain is still under construction. If any students are interested in taking this research forward by volunteering to take part, than please get in touch with me via StirlingBrains.org.

“The more people we can recruit to take part in our research, the more we can do and more answers we may be able to offer the sport.”

After showing a group of footballers this information, I asked whether or not they think banning heading for younger players would be a good idea and whether or not it would affect their decision on heading the ball themselves in the future.

Northborough FC centre back Ollie Waghorn said: “I think it’s an awful decision to remove heading. I think the older heavier leather balls would have had a greater impact than the lighter balls used in today’s game. I think the game wouldn’t be the same without it and would cause more bad tackles and injuries due to people trying to control the ball in other ways I.e. high foot.

“I hope that heading is never removed from football.”

A key issue which many academics are keen to point out is that heading a football shouldn’t necessarily be dangerous. But if you head away thunderbolt shots or goalkeeper’s clearances regularly there is a risk that the brain can suffer several sub-concussive injuries – those impacts with no readily observable symptoms that can cause injury to the brain.

What next? First and foremost, the academics believe there needs to be much more research in this area. That won’t surprise people. They’re academics after all. That’s what they do. But few would dispute we need a better understanding of these risks from junior level, where brains are growing, to the professional game.

And greater awareness too. A major problem is that with sub-concussive injuries people don’t realise they have damaged their brains. And so they keep going. You can bruise any other part of your body and it feels sore, but when the same thing happens to your brain it doesn’t have the pain receptors to tell you to ease off for a few days.

Already this calendar year there have been high profile head injuries; If Ryan Mason, Hector Bellerin or Fernando Torres were boxers and were carried from the ring in the manner they were carried from the football field after suffering their head injuries this year there would be widespread calls for something to be done.

Ryan.jpg

Hull City’s Ryan Mason; Credit: BBC Sport

No one could fail to have been moved by the sight of those stricken players; Hull’s Mason hooked up to an oxygen tank, in a neck brace, being rushed to hospital for emergency surgery on a fractured skull.

Bellerin – whose momentum carried his exposed head into the thrusted elbow of Marcos Alonso – held his arms outright unnaturally and crashed to the turf flat on his back, spark out.

It is no exaggeration either to say many feared the worst for Torres a few weeks ago. Gabi – Torres’s team-mate – reached into his friend’s mouth to ensure his tongue did not slip back in his throat.

For some reason in football traumatic brain injuries are considered some sort of occupational hazard. This needs to change.

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