Last week, a study found former footballers are three-and-a-half times more likely to die from brain diseases than others. Here, Dr Bennet Omalu, a world expert who first identified chronic brain trauma in American footballers, makes an impassioned call for the authorities to outlaw players under 18 heading footballs . . .
A large, heavy object is hurtling towards you — so what do you do to block it? Use your hands, maybe, or your feet? But why would you use your head?
Yet that’s what happens on playing fields up and down this country on a daily basis. Children are encouraged to head footballs — sometimes weighing up to a couple of pounds.
I am not given to dramatic language but sometimes situations call for it — and to my mind the need to ban heading footballs among the under 18s, when their fragile brains are not yet fully developed and are most prone to damage, is an urgent situation.
Each time a child guides the ball into the net with their head, it can cause microscopic injuries to the brain. This isn’t idle speculation, it is scientific fact.
Each time a child guides the ball into the net with their head, it can cause microscopic injuries to the brain (stock image)
As the head hits the ball, the brain, which floats freely around the skull, will be shaken about, potentially causing sub-concussive injury, damage to brain cells that is not severe enough to cause symptoms instantly but which cumulatively, as the heading is repeated, can be devastating.
What’s more, the brain is a post-mitotic organ — meaning it doesn’t have any reasonable capacity to regenerate itself.
Which is why heading the ball could lead to a devastating diagnosis of, say, dementia in years ahead — and at an earlier age than it might normally strike. My eyes were opened to this risk, when, in 2002 I was assigned to perform an autopsy on the legendary American football player Mike Webster, who had died at 50.
The cause of death was a heart attack, but as a neuropathologist, I was naturally interested in any changes to the brain.
During the autopsy I made an astounding discovery — finding changes that shouldn’t have been present in the brain of a man of his age.
I found signs of a disease never previously identified in football players — chronic traumatic encephalopathy, or CTE, a neurodegenerative disease caused by repeated head injuries. As such it was the first hard evidence that playing football could cause permanent brain damage.
Depsite findings like this, the Football Association in the UK does not currently believe there is sufficient evidence to remove heading from children’s football, but in the U.S., the authorities take a different view.
In 2015 the United States Soccer Federation announced a pioneering ban on headers for children aged ten and under, and a limit on the same practice for children aged 11 to 13. It was an admirable safety initiative but in my view it isn’t enough.
The ban should extend to 18, when the brain becomes fully developed and therefore more able to withstand damage.
In 2015 the United States Soccer Federation announced a pioneering ban on headers for children aged ten and under, and a limit on the same practice for children aged 11 to 13 (stock image)
I also believe younger children should play a modified type of football where there is less contact and the football is bigger and lighter, so reducing the amount of impact when it hits them.
As for adults — well, I can’t tell anyone what to do. But it is my duty as a physician to highlight the inherent risk.
The more you hit your head, the greater the chance you will damage your brain whatever age you are.
Some will argue that if we remove heading it will spoil football as a sport. I disagree. It’s just about adapting techniques to ensure safety without discouraging participation.
In 1976, The Lancet journal published an editorial saying it was foolhardy for mankind to intentionally cause brain damage in sport when it could be avoidable. Of course, accidents happen. But to intentionally and foolishly make people suffer brain damage makes no sense at all.
Football, or soccer as we call it in the U.S., is the biggest sport in the world and the UK is the pace-setter. We need to embrace the truth no matter how inconvenient.
No one wants to ban sport. This is about managing the risk. Heading simply shouldn’t have a place in soccer.
- Dr Omalu is an associate clinical professor of medical pathology at the University of California.
INTERVIEW: ANGELA EPSTEIN