Dementia. 33.3% of us are forecast to get it at some point in our lives.
There are many different types of the disease, but they all reduce a person’s cognitive functions, with symptoms including memory loss, confusion, communication difficulties and mood changes. It is a terribly cruel disease which can completely rob a person of who they are, causing untold heartache for family and friends.
The older you get the higher your chances of developing dementia, but footballers in particular are at higher risk than the general population.
Nobby Stiles, Bob Paisley and 5 members of the World Cup winning England squad all died from dementia, and they are just the tip of the iceberg.
The reason? Heading the ball.
The impact of a 14oz-16oz football hitting a player’s head is thought to cause lasting damage, especially given the frequency with which professional players have to perform headers.
Calling for heading might feel extreme or totally correct depending on your point of view. But whatever you think about the sport, mental health, personal freedoms etc., it’s difficult to argue with the evidence surrounding this.
The studies that have been done are numerous, robust, and featured large sample sizes. This is not based on research by some small activist group working out of their parents’ annex.
So why is heading the ball so potentially dangerous, and is there anything that can be done to make things safer?
Why Heading the Ball Causes Dementia
If you suffered a concussion it would be immediately noticeable and diagnosed quickly. The damage done by heading a football is not immediately noticeable, so it is known as being sub-concussive.
Even a small knock to the head causes the brain to move within the skull slightly, so the impact of a football kicked by someone like Kevin De Bruyne is really going to knock it about. This can cause the stretching and shearing of brain cells. Repetitive impacts like this can damage brain tissue and trigger inflammation.
We know it’s specifically heading that causes the damage too, due to various studies that have taken place. One discovered that outfield players – so everyone but goalies – had a 1.6 increased risk of dementia or Alzheimer’s than people who had not played the game. Goalkeepers had no increased risk.
The microtrauma of heading the ball is also thought to encourage the build-up of tau proteins in the brain which are known to disrupt brain flow. They are a leading cause of dementia.
Axonal damage is another potential issue. The brain is full of white matter which contains axons, and these axons send signals around the brain. A 2013 study found that the white matter in football players exhibited changes similar to those seen in patients with concussion.
This all clearly points to the fact that heading the ball, something which goalkeepers do not generally do, causes long-term damage.
It makes sense when you think about it.
A header is essentially no different than taking a blow to the head, albeit with a ball that absorbs some of the impact itself. But any knock to the head kills brain cells.
I remember playing in defence as a kid, and getting my head in front of a rocket of a shot that left me feeling like by brain was literally rattling inside my skull. That can’t be good for us.
The reason this has only become a known issue in recent times, is because the effects only start to be seen from around the age of 65. There will have been cases in younger ex-players too, Jeff Astle for one, but since they are rarer the connection would not have been as obvious.
We also need to think about the fact that a 65 year old in 2010 would have been enjoying their playing career back in the 1960s and 70s. The world has moved on significantly since then in terms of medical advancements and our understanding of conditions like dementia. Indeed, it was only in the 1970s and 1980s that we started understanding that dementia wasn’t simply a natural part of ageing.
It has taken time for the players of that day and age to get old enough to suffer the consequences, and for us to notice, study and understand them.
Other Studies That Prove the Theory
When I said that there had been a lot of studies showing a link between football players and dementia, I wasn’t exaggerating.
In 2019, a study led by the University of Glasgow compared the cause of death of 7,676 former Scottish professional players, with the cause of death of 23,00+ non-players, all born between 1900 and 1976.
It found that the former footballers were around 3.5x more likely to have died from some sort of dementia-related illness.
The study didn’t go into any more detail than that, but with such a massive sample size it drew a clear conclusion, even if it didn’t offer any explanations.
Another study that took place in 2023, found similar. It was commissioned by the FA and the PFA and carried out by Nottingham University.
They found that 2.8% of retired footballers had dementia or some other neurological condition, compared to just 0.9% of the general public. This equates to a similar 3.5x rate for footballers vs non-footballers.
They only studied 460 retired pros, but with the results being almost exactly the same as those in the 2019 study, the sample size was clearly big enough.
There are more, but they all essentially show the same thing, so the evidence is conclusive: heading the ball can cause dementia in later life.
What About Amateur Players?
It’s much harder to measure the impact on amateur footballers.
Most boys (and a lot of girls these days) play football at some point in their lives, and some continue into adulthood, either for fun or as part of an organised 5 a side league etc.
While they would all have headed the ball at some point, they won’t have done so nearly as often as a professional, nor are they likely to have endured the same sort of impact force.
Professionals are in peak condition and can kick the ball harder, they all train 5 or 6 days a week as well as playing once or twice. That’s a lot of headers compared to a chap running around the park once a week with his mates.
We can also assume that many of the people studied as part of the non-footballer group will have been amateur players at some stage of their lives, so they are partly accounted for within the studies.
What I draw from this, is that heading the ball once or twice is unlikely to cause any issues later in life, but doing so repeatedly over a 10-20 year period of a football career is a very different matter.
It’s a bit like smoking. Smoking socially for a few years at uni before getting growing the hell up is far less likely to kill you early than smoking 20 a day for 40 years. Obviously though, not smoking at all is best.
What Can Be Done to Help?
There have been calls to ban heading completely, but don’t worry, this is highly unlikely to happen. Not yet anyway.
Much more research is being done into the matter, looking into exactly how the damage is caused. Once this issue is better understood the FA and other governing bodies can make data-informed decisions on what to do next.
In the meantime, the FA have offered guidance that professional players should be limited to no more than 10 high force headers per week in training, and no more than one heading focused training session. In Scotland, clubs can’t train with their heads the day before or the day after a game.
Some clubs have even started using wearable tech to measure the speed and impact force of the ball when it is headed, so it sounds like they are taking this seriously. This allows them to monitor which players are taking more of a pounding than others and perhaps advise them to limit their action in the air.
In an actual game though, all bets are off. There is too much at stake to limit how many times a player can head the ball. Although, there are players who have admitted to avoiding going up for headers now they know the risks.
3rd party companies have started developing wearable headgear that claims to reduce the damage done by heading the ball. It hasn’t been used yet to my knowledge, not in the professional game anyway, but this could be a route that is explored further. Protective headgear.
There have also been rule changes discussed reducing where on the pitch heading is and is not allowed, but so far this is just spit balling.
For now, educating players and clubs to the dangers is probably the most important thing to do. Once the issue is fully accepted and understood, the next step will naturally follow.
What About Children?
The findings of all this research have already had an impact on the youth game.
The FA released new guidelines stating that children of 11 years and under should not be asked to head the ball during training.
Heading is introduced in stages to 12 – 16 year olds, but it’s certainly not to be encouraged.
It is still allowed during matches for older children, but younger children don’t tend to play with the ball in the air very often, so heading is rare anyway.
If kids deliberately head the ball it can result in an indirect free kick or a re-start of some sort. It depends on where the header takes place and the age of the kids.
Despite causing a bit of outcry from people saying “it never did me any harm”, this is probably a good idea.
Children’s bodies are still developing and our brains aren’t considered fully matured until we are around 20, so it makes sense not to cause unnecessary trauma to a child’s brain while it is still developing.
Essentially, kids aren’t introduced to heading until they are in their teens, and even then, their exposure to it is minimal.