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Concussion within professional English football and its long-term effects is something that’s been talked about by sporting bodies, players and spectators for years: however, it’s still happening all too much. No official statistics on concussion rates in football are released, although data from a number of sources demonstrate sporting concussions to be a significant source of head injury hospitalisations, particularly in the youth and school settings.

When we think of professional footballers, we imagine them to be the epitome of health. However, the head injuries that they are being subjected to during play may be having detrimental effects on their health. The Football Association (FA) has released its own concussion guidelines, with the motto ‘if in doubt, sit them out’ yet unlike in rugby and cricket, English football does not currently permit concussion substitutes.

The Drake Foundation

Established in 2014, The Drake Foundation is a not-for-profit organisation committed to improving the understanding of concussion in sports and its effects on long-term brain health, gaining insights into the processes underlying neurodegenerative diseases, such as dementia. They have already committed over £2 million in research funding and invested in open access educational resources.

Their work in football began with the funding of a project examining the brains of former professional players with a history of repetitive football head impacts. The study was published in February 2017 and despite being only small, the work is an important step in bringing the conversation around sports concussion to light in the world of association football – and the findings were very telling.

The research

In the study, brains from a group of retired football players were studied for signs of neurodegeneration: in particular, a disease called chronic traumatic encephalopathy, a neurodegenerative disease associated with repeated head injuries, otherwise known as CTE. A total of 14 former players were included in the study and a post-mortem brain examination was conducted on six of these. All were skilled headers of the ball and had played football for an average of 26 years.

The results

The first phase of the research looked at football head injury rates. It found that five out of the 14 players experienced unconsciousness at least once during gameplay. Head injuries were more likely to result from collisions with other players than the ball (40%), as opposed to 12.6% of head-to-ball head injuries. The study found that players had head-to-ball contact an average of 2000 times throughout a 20-year career.

So what effect did this have on the 14 footballers later in life? The second phase of the research looked into behavioural changes recorded prior to their death. 12 out of the 14 displayed behavioural changes, with 10 of these becoming aggressive and experiencing explosive episodes. 12 out of 14 also displayed mood changes, becoming apathetic.

After death, the brains from six of the participants also underwent a post-mortem brain examination. Of these six, CTE was identified in the brains of four (all of whom showed evidence of dementia, and had headed a ball many times, leading to 1000s of sub-concussive head impacts): this is 12% above the average CTE prevalence rate, indicating a link between repeated head impacts and CTE.

Next steps

The Drake Foundation are currently working on their HEADING Study together with retired footballers to further investigate associations between a history of heading the ball or concussion and neurodegenerative disease. Former elite football players over the age of 50 will be asked about their heading and football concussion history and a range of data will be gathered to see how this has affected them. Hopefully, this project will help to increase understanding of the long-term effects of heading and concussion on neurological health, which will enable both players and officials to make informed decisions on and off the pitch.

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Drake Foundation

The Drake Foundation is a not-for-profit organisation committed to improving understanding welfare and health or sports players through scientific research and collaboration. Much of their work-to-date has focused on concussion injuries in sport, knowledge that will serve not only to improve sports safety but also provide valuable insight into the processes underlying neurodegenerative diseases including dementia.