Football, Dementia & All Of Us

by | Oct 29, 2019

In amongst the blizzard of stories concerning VAR, the undulating crises of various clubs, and all the other froth with which the football media busies itself, a major, major story is broadly being ignored. It’s a story with ramifications that could completely change the way that the game is played across the entire planet, but it is broadly being overlooked at the moment, quite possibly because it is raises such uncomfortable questions. Last week saw the publication of a landmark report by University of Glasgow’s Brain Injury Group, which confirmed what an increasing number of people have suspected for some considerable time, that there is almost certainly a link between the game and serious brain injury.

The numbers are so frightening that looking the other way is, in a sense, understandable. The report demonstrated a five-fold increase in the risk of Alzheimer’s, a four-fold increase in motor neurone disease and a two-fold increase in Parkinson’s disease, using NHS Scotland data to compare the causes of death of 7,676 former male professional players who were born between 1900 and 1976 against those of more than 23,000 people from the general population. The FA, for example, confirmed that despite the study’s findings, they believe that there is still not yet enough evidence to change any aspect of the game at present.  Instead, they will be setting up a task force to examine the potential causes of these figures in greater detail.

The canary in the coalmine for all of this was, of course, the former West Bromwich Albion and England striker Jeff Astle, who had shown the first overt signs of his on affliction at just 54 years of age and died just five years later, choking to death in an incident at his daughter’s house. It was described by the coroner as an “industrial disease” brought about by the repeated heading of football’s that were heavy to start with and would only end up weighing more and more in wet conditions. A later examination of Astle’s brain confirmed that his rapid mental decline had been caused by chronic traumatic encephalopathy, a brain disease caused by repeated blows to the head which has otherwise been found to be prevalent in boxers.

Players starting out today might not even believe how much heavier the footballs of the 1950s, 1960s and 1970s were in comparison with today, still less that waterproofing them was so haphazard that it didn’t offer any guarantees that a ball wouldn’t come to weigh even more with repeated use. Those amongst us with recollections of them (quite plausibly dimmed a little by having to use them in the first place), however, seem unsurprised by last week’s news. Clenching your neck muscles has always been part of heading a football 101, but in the past it might have felt as though this was as much about the possibility of your neck completely collapsing into your chest as anything else. Compared to the match balls of the 21st century, they were unimaginably heavy.

Heavy match balls aren’t the only issue here, of course, and the other hot button issue surrounding this isn’t as easily batted away by mentioning that footballs are now considerably lighter than they used to be. There have been question marks concerning how both the professional and amateur games deal with concussion on the pitch during matches, with claims made that the balance and memory checks used by team doctors to check on potential concussion are unreliable.

The FA’s guidelines on concussion seem pretty clear – “If in doubt, sit them out” – but whether clubs are even capable of thinking beyond the final whistle during matches is debatable, while there haven’t been any sanctions brought against clubs who have returned players with haste after potentially concussive incidents, none of which fills us with a great deal of confidence with what the game’s reaction might be to last week’s report in the long-term.

We all know already what their response was to the inquest into Jeff Astle’s death. Full of good intentions, the Football Association and Professional Footballers’ Association stated at the time there would be a joint 10-year study to investigate the risks. After the headlines had died down at the time, though, Astles’s family received two letters from the FA. The first was from their solicitors, advising against considering legal action. The second was from an FA official asking if the family if they would like tickets for the next England friendly, but also letting them know that it would be impossible to accommodate them all in, offering just two tickets to Wembley instead. It later transpired that the FA had identified some young apprentice footballers to analyse, but that they then closed the file when those players didn’t made the grade as professionals. They later stated that previous studies had been “inconclusive.” One can only wonder what would persuade them, conclusively.

Progress on concussion has been a little better. UEFA protocol states that there should be a minimum six-day rest period before a player ‘returns to play’ following a suspected concussion. Non-professionals lacking ‘enhanced card’ should wait 19 days. In the event of a suspected concussion, the referee should stop the game for up to three minutes to allow the player to be assessed by the doctor. A player will only be allowed to continue playing on specific confirmation by the team doctor to the referee of the player’s fitness to carry on. In the Premier League, a third, independent, “tunnel doctor” must be present at Premier League games to support and advise the two club doctors present.

In terms of the risks associated with heading footballs, it’s unlikely that what happened during matches specifically had an enormous effect on players. The issue, it is considered more likely, would have been the amount of effort that went into practising heading the ball in training in an era when the ball seemed to spend at least much time in the air as it did on the ground. Indeed, in defending the FA’s approach over the issue, the FA’s chief executive Mark Bullingham said that, “Our research shows the number of aerial challenges has already been reduced significantly over the years as we have changed to smaller pitches and possession-based football.” And perhaps that’s the best case scenario for this, that a combination of different training techniques, superior equipment, and simply changes in the way in which the game is played, will mean that the risk to younger players may already be lower than it was for players of Jeff Astle’s generation.

This, however, is far from guaranteed and, with the FA and the PFA both already having been accused of being far too slow in reacting to this story as it grew, the risk is that they will stand accused of a far more serious degree of negligence should they continue to appear inert in the face of this growing body of evidence. Three and a half years ago, the Daily Telegraph accused compared football with the 1960s tobacco industry, arguing that the authorities risked legal action because of a “scandalous” failure to research dementia amongst former players. Such reticence may be understandable in a sense – the threat of lawsuits is real, and the financial cost could be enormous – but the defence that correlation doesn’t equal causation runs the risk of casting a lengthy shadow over the reputations. It might be argued that it already did.

The former Norwich City defender Duncan Forbes died last week, at the age of 78. He was suffering with Alzheimer’s disease. Amongst a multitude of others who have or had this most destructive of illnesses are Danny Blanchflower, Dave Mackay, Bob Paisley, Nat Lofthouse, John Charles, Gerd Muller, Jimmy Hill and Stan Bowles. Martin Peters, Ray Wilson and Nobby Stiles from England’s 1966 World Cup winning team, as well as their manager, Sir Alf Ramsey. There are plenty more besides. It should be added, however, the players themselves can occasionally be a part of the problem themselves, if they play on through injuries that they shouldn’t or cover up the effects of a blow to the head out of a concern at losing their place in a team. This isn’t intended to victim-blame. We recognise that the pressure that they are under is immense. But if this is a problem to anything like the extent that the recently published report from University of Glasgow’s Brain Injury Group seems to indicate, everybody may have to realign what we should expect from professional football.

And ultimately, this does feel like a cultural issue within the game. Nobody, not even the Alzheimer’s Society itself, is seriously suggesting the banning of headers in football at the moment, and it is possible that the risk has been substantially diminished by lighter weight balls and the game increasingly being played on the ground. However, we all know that there is a “winning at all costs” culture in the professional game which has the potential to warp people’s judgement at times of high pressure. If the game does need a quick fix in this respect, this must surely be in creating an environment in which players can be completely honest with themselves and others in judging whether they should continue in incidents where they may have been concussed, without a fear of losing out as a result of their honesty.

It should also be remembered that this isn’t, by any stretch of the imagination, entirely about professional players. If the damage from heading is done from training, then it’s plaausible that children could be doing themselves long-term damage, even without playing any competitive matches, and critics argue that the benefits of balls now being lighter are unwound by the fact that they now travel at a considerably higher speed than they ever used to. In short, though, the whole of this debate is clouded in uncertainty caused by a lack of certainty over what the facts of the matter might be. And it isn’t necessarily important to leap to any conclusions just yet. It is, however, important that this conversation is held within the game. Life is an ongoing exercise in risk management, and we have an obligation to continually reassess it, especially when new or defining information about something comes to light. There may well be decisions to be made, and they may change one or two fundamentals about the game that we love. It’s important that we have that discussion now, soberly, and in good faith.