Divided over Messi v Ronaldo, but neurologists agree headers cause long-term damage to footballers

New Delhi: A striker who scored more than 200 goals in a legendary career for Notts County and West Bromwich Albion and even played for the England team, Jeff Astle died in 2002, aged 59, having would have suffered from Alzheimer’s disease at the end of life.

His daughter Dawn, remembering the death of her father, had Told a local British newspaper in 2015: “He choked to death in front of his whole family… It was the most horrible thing I have ever seen.”

Media reports dating back to 2002 show that the coroner at the inquest linked Astle’s death to head trauma suffered during his playing career, and set a precedent in to declare a verdict of “death by occupational disease”.

But it wasn’t until 2014 that Glasgow-based neuropathologist Dr Willie Stewart specifically determined that the medical cause of Astle’s death was chronic traumatic encephalopathy (CTE).

The BBCat the time, appointed CTE a “boxing brain condition”, since this neurodegenerative disease was common in boxers who suffered from repeated head trauma.

In other words, the CTE that Astle suffered from was the result of what he did best in his playing career – repeatedly heading footballs. Headers were a crucial part of his style of play and made him a goalscoring threat, from his debut in 1959 for Notts County until his retirement from professional football in 1977.


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Field study, The Jeff Astle Foundation

Jeff Astle’s detailed retrospective diagnosis was a boost to the growing movement to phase out headers from football.

In addition to research funding, the foundation set up by Astle’s family – with the help of Dr Stewart’s football influence on lifelong health and dementia risk (FIELD) study — pushed for institutional change.

Led by Dr. Stewart, the FIELD study spearheaded to research on the link between headers and neurodegenerative diseases diagnosed in footballers, having regularly published new research and studies since 2019.

Although initial results from the FIELD study revealed that footballers were three and a half times more likely to suffer from neurodegenerative diseases, a more direct link was established in the FIELD player-specific study. published in August 2021.

The results showed a reduced risk of neurodegenerative disease for goalkeepers compared to outfield players, with defenders reported to be the most affected, which is in line with the notable tactic of central defenders repeatedly pushing the ball away from attackers. coming in the opposite direction.

Another peer-reviewed study published in 2019 discovered that thousands of former footballers had suffered from a neurodegenerative disease later in life, including five members of England’s 1966 World Cup-winning squad.

Several football confederations and nations, such as the United States, Scotland and England, have either banned the heading of the ball for children under 12 or started attempts to phase out the act among young players.

While the Union of European Football Associations (UEFA) has published general guidelines on header safety for young footballers, FIFA (International Federation of Association Football) has yet to issue universal guidelines in this regard.

There is a long way to go and the impact of removing headers in the future would be significant, fundamentally changing the way football is played on the pitch. However, even suggestions and policies to ban children from participating in the act have always been met with a “mixed reception”, The Guardian had reported in 2020.

What the experts say

So how does heading the ball actually affect the brain of a long-term professional footballer? According to experts in the field of neuroscience, the answer lies not so much in individual cases of acute head trauma as in repetitive subacute trauma.

“The brain floats in a fluid inside the skull. It’s inertia – when you have a sudden stoppage of your skull, your brain keeps moving and can hit the skull. More than back and forth, it is shear force and angle of rotation that causes more microscopic neurological damage by killing neurons,” says Dr. Anurag Gupta, Gurugram-based neurosurgeon at Narayana Health.

But Dr. Gupta adds that this damage is less apparent than concussions caused by incidents like clashing heads or colliding with a goal post. Rather, they are subtle impacts that lead to loss of neurons and later dementia over a period of 10 to 15 years, synonymous with the average career length of a professional footballer.

Symptoms such as confusion, memory loss, disorientation, emotional lability and inability to perform routine tasks may be apparent after retirement and similar to standard cases of dementia, says Dr. Gupta, adding that imaging methods like MRI or CT scan only show brain atrophy. and make it difficult to accurately diagnose such neurological damage in footballers.

“It’s only through a post-mortem autopsy or brain biopsy that you see evidence of CTE [in footballers]….children have been found to be particularly prone to the problem due to the fact that the brain is not fully developed,” he adds.

For young players or college-level players aspiring to a future professional career, improper technique for directing the ball can also risk causing lasting damage, as Dr. Surajit Nundy, a neuroscientist working in the Health RN who played college football in USA and continues to play recreational football in Delhi.

“As a central defender at an American university in the early 90s, I was forced to mark the attacker and deflect the ball repeatedly, 20 times a game. If I didn’t head, I was replaced, but my technique was faulty.

“Instead of using my forehead, I would sometimes aim the ball from the fontanels – a fairly weak part of the skull – and I felt dazed immediately afterwards. People would just say well done, but I often worried because traumatic brain injury is a bad idea,” says Dr Nundy.

The line of acceptable number of heads for professionals per training session and per game remains a gray area, according to Dr Gupta. But the efforts of the Jeff Astle Foundation and the FIELD study have established a baseline level of evidence linking headers to “lower mental functioning.”

But for Dr Nundy and many others, the issue of headers ultimately comes down to sporting trade-offs, as “no one has really understood the medical benefits” of the header, but on the pitch it adds to the diversity of styles of play.

This diversity is visible when looking at the goalscoring records of the two most prolific strikers of the 21st century – Lionel Messi has scored 24 headed goalsseven of which led his side to victory, while Cristiano Ronaldo scored 112 headed goals29 of which won the game for his team.

“While I think heading the ball has interfered with the functioning of parts of my brain, by banning them you are essentially banning Cristiano Ronaldo and favoring Lionel Messi. If you think the future of football is more about Messi, that’s fine, but that’s not how I see it,” Dr Nundy told ThePrint.

Manchester United supporter Dr Nundy is firmly in the ‘Ronaldo camp’ and has even joked about the number of headers Nemanja Vidic has achieved throughout his career, while acknowledging the long-term head trauma the defender central Serbian would have risked.

Dr Gupta sees the ‘effective and entertaining qualities’ in both styles of play, but agreed with Dr Nundy, saying ‘it is too early to outright ban’ the rubric in professional football,

However, he added a caveat — “Players should be aware of the potential dangers. Children absolutely must be restrained from steering until they are old enough.”

(Editing by Amrtansh Arora)


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