Football’s Uncomfortable Heading Conversation
The last couple of years have seen football trying to come to terms with the possibility of a horror that has been hiding in plain sight for as long as people have been playing the game. The recent deaths of Jack Charlton, Nobby Stiles and Maurice Setters, all of whom died with dementia, have thrown a conversation that many parts of the game seem to have been shying away from in recent years. Could it be that the link between heading footballs and developing dementia later in life might result in changes to the game more profound more than any rich club owners could wreak?
The evidence isn’t quite conclusive yet, but it certainly seems to be heading irrevocably in one direction. A small study in early 2017 which was published in the British Journal of Sports Medicine was among the first to show a greater risk of dementia in professional footballers. Researchers studied the brains of former footballers with memory problems. They found that most had signs of a form of dementia called chronic traumatic encephalopathy (CTE), and all had signs of Alzheimer’s disease.
This was followed by a larger study carried out by the University of Glasgow which compared the causes of death of 7,676 former Scottish male professional football players born between 1900 and 1976 against over 230,000 matched individuals from the general population. This study revealed that former professional football players had an approximately 3.5 times higher rate of death due to neurodegenerative disease than expected. In the case of Alzheimers disease, that rose to 5.1 times, and in the case of motor neurone disease to 4.3 times.
Still, though, there are gaps in the data. The 2017 research didn’t study former players without memory issues, while the 2019 study confirmed the link but couldn’t shed any light over why there would be higher rates of neurodegenerative disease amongst them than in the general population. And these gaps have meant that it has been relatively easy for the game to side-step inconvenient questions regarding what the game itself can do in order to try and alter this appalling situation.
Current received wisdom on the subject at present is that repeatedly heading a football is to blame for this state of affairs, and it is commonly supposed that this was exacerbated in the past by the weight of footballs. Match balls only started to move over from being made of leather to other materials in the late 1970s. The first World Cup finals to be played with a non-leather ball came in 1982, and even then there were repeated problems with match balls falling to pieces during match.
The use of leather for match balls had been ongoing since the codification of the game, but leather would absorb water and increase the weight of a ball, and even when waterproofing them became more commonplace in the 1950s and 1960s this was often imperfect. So, it is assumed, the players of the past were not only inadvertently harming themselves through repeatedly heading footballs, they were increasing the risk to themselves by using considerably heavier balls than are found today.
It’s a seductive answer, but there’s a problem with it: further research has found that the weight of footballs might not even be the determining factor in assessing the damage done by heading them. At the start of September 2020, a report published in the Scandinavian Journal of Medicine & Science in Sports stated that the weight of a football was not the determining factor in how much damage might be done to a player’s brain by repeatedly heading a ball. Instead, they found that, “The force experienced by the head during football heading appears to be mainly influenced by the speed of the ball rather than its mechanical properties.” In other words, it’s not how how heavy a ball is that counts when you head it, it’s how fast it’s travelling.
There remain critics of the growing talk that football is going to have to take drastic action, should it be serious about addressing this issue. Some have argued, for example, that the greater physical nature of the game in the past could also have been to blame for this state of affairs. The ball spent considerably more time in the air in the past, and there were frequently flailing limbs that could quite easily crack a player on the head during aerial challenges.
It’s certainly the case that the game at all levels didn’t take the effects of concussion seriously for a very, very long time. As recently as the 2018 Champions League final, the Liverpool goalkeeper Lorus Karius was found to have been suffering from concussion following a collision early in the second half with Real Madrid’s Sergio Ramos, resulting in “visual spatial dysfunction”, which impacts a player’s ability to process visual information regarding where objects are in space. Predictably, media attention after the game focussed on Karius being “to blame” for Real’s second and third goals, rather than asking difficult questions about the extent to which the goalkeeper was impaired and the fact that he probably shouldn’t have been on the pitch for much of the second half in the first place.
The 2017 study noted that there was practically no existing data on the effects of heading a football, and even now the Dementia Society tells those concerned over whether they should be heading a football or not that, “It’s very rare for dementia to be caused by a single factor”, and that, “Although evidence of a link between playing football and dementia has increased, the studies so far have not considered all these other factors.” Taking a holistic approach to health, they advise that, “Evidence does show that exercise is one of the best ways to reduce your risk of dementia”, and that, “We encourage everyone to enjoy any kind of sport as safely as possible.”
For all of this, though, national associations are starting to make moves in a more protective direction. In February, the associations of England, Scotland and Northern Ireland jointly confirmed that their new training guidance would ban children under the age of eleven from heading the ball. The FA said at the time that the new guidance had been issued to “mitigate against any potential risks”, but the question of how far the game will be prepared to go in order to protect its players remains very much open to question.
The nuclear option, of course, would be to ban heading the ball across the game entirely, but the cultural importance that heading the ball holds within the game means that seeing through such a radical change to the game would undoubtedly be met by significant resistance. What shape would such a game take? Might the game be forced to ban the ball from going over head height? Would some players – who might be described as “good in the air” – be negatively affected by such aa choice? It’s all very well to offer sweeping statements such as “We should just ban headers”, but we need to think very carefully about what the game might look like in this eventuality.
There are questions that still need to be answered, but the truth is that we might never be able to get the answers to them. Why, for example, does dementia seem to have taken such a terrible toll on England’s 1966 World Cup winning team? The fact remains that there is still a vast amount of research into this that still needs to be done, but we also need to be prepared for the fact that there will likely be questions – particularly relating to the way the game was played fifty or sixty years ago – to which we may never get satisfactory answers.
There have been, as we’ve seen, incremental moves towards taking brain injuries in football more seriously, in recent years. Doctors – in theory, at least – now have the final say over whether a player who’s received a head injury. Balls are lighter and better waterproofed than they used to be (even if the value of this in and of itself disputed), children are not carrying out the sort of heading drills that their predecessors may have done, and which may have put considerable numbers of them at risk. And we shouldn’t blithely dismiss concerns about how the game will change with significant rule changes. Football is in no small part the game that is because heading the ball has been a part of it for longer than anything of us have been alive, and it may well be that some – or even many – of us may drift away from the game should it become, should stop being aesthetically pleasing to us. If there are trade-offs to be made, how far are we prepared all to go?
None of this is easy, and the conversation over what the game might choose to do in relation to heading it is one that may well turn fractious, in these culture war-stained times. But the effects of dementia are awful to witness, and if one person can be spared the later years endured by the Charlton Brothers, Maurice Setters, Jeff Astle, Nobby Stiles, and a whole host of others, then that opportunity should be grasped with both hands. We shouldn’t, however, lose sight of the fact that this subject has difficult conversations ahead, and that scientific research may never be able to find us the sweeping and definitive answers that we want and need. There will likely come a point, however, when definitive decisions over the future of heading a football have to be faced, and it seems fairly clear that at the point at which consensus within the medical community is beyond caveat, we have to put the ongoing health and safety of players before any other considerations.