Heading Footballs – Is Dementia the Only Potential Occupational Health Risk?

Impending Structural Change for English Professional Football Body?

In 2001, the Professional Footballers’ Association (PFA) and the Football Association (FA) instigated research to discover whether there was a link between exposure to head trauma (through heading footballs) and a type of dementia, called dementia pugilistica, also known as chronic traumatic encephalopathy (CTE).

However, in 2014, The Mail on Sunday revealed that the study had failed. It had long since been abandoned, though PFA Chief Executive, Gordon Taylor QBE, had failed to make the public aware of this.

In 2018, the Association committed £125,000 of its £50 million budget to resume research into the association between football and CTE, amid growing demand to classify CTE as an ‘industrial disease’. Football's InfluencE on Lifelong health and Dementia risk (FIELD) is led by Dr. Willie Stewart, the first and only medical practitioner to diagnose CTE in an ex-professional footballer.

However, crisis talks took place at the PFA last November[1] and at the annual general meeting this March,[2] Mr Taylor announced that he would be standing down after 38 years of leadership, but only after an independent review had been completed. This could potentially take months.[3]

Pundit, commentator and retired professional footballer, Chris Sutton, believes that Mr. Taylor has failed both ‘union members and their families’ and ‘hundreds and thousands of footballers around the world’.

Alleged Cases of CTE in Living Footballers?

Mr. Sutton’s father, Mike, played professionally from 1962 to 1974 at Norwich City, Chester and Carlisle. Aged 74, he has been diagnosed with Alzheimer’s.

He considers that the best candidate to replace Mr Taylor as Chief Executive of the PFA is current PFA Chairman, Ben Purkiss, who wants to put dementia research at the forefront of the union’s agenda. However, Mr. Purkiss is barred from running for the position for 5 years.

Elsewhere, George Reilly, the 61-year-old veteran, who played at Corby Town, Northampton Town, Cambridge United, Watford, Newcastle United and West Bromwich Albion, has also been diagnosed with Alzheimer’s. He had ‘more than 250 stitches’ in his head throughout his career, in an era where concussion ‘wasn’t known’.[4]

In an interview with Backpass magazine, he shared more information about his condition:

‘My short-term memory is terrible, but long-term is fine. It's called chronic traumatic encephalopathy, and there's research going on all the time. Mine seems to be at the back of the skull, not the front. I think it was more centre-halves heading me in the back of the head rather than heading balls that has caused the problem. It's a degenerative illness, and I need to take tablets. The football authorities have brushed this under the carpet, because they've had this knowledge for some time. There are lots of former gridiron players and footballers who have suffered severely. Men never used to talk about these things, but now, in 2019, more and more players are talking, because they know by sharing they can help themselves and others. ‘I am doing OK but many other centre-backs and forwards are struggling. I have not had a scan for three years. It can only tell me it is worse ...’[5]

When Mr. Reilly was diagnosed, his treating specialist told him that his brain disorder was likely caused by repetitive concussive events in the course of his employment, i.e. heading footballs. Consequently, he approached an official at a ‘footballing body’, but was dismissed because he was not ‘dead’.

Mr Reilly considers that the official was ‘ignorant about the situation’, but as reported in previous editions of BC Disease News, CTE has only been diagnosed in Jeff Astle (here) and Rod Taylor (here) post-mortem.

Nevertheless, Boston University neuroscientists believe that they are close to unearthing a technique for detecting CTE in living athletes.[6]

Even though, according to Dr. Stewart, three-quarters of football and rugby player brains exhibit dementia pathology (study results were reported here), he and 59 other medical experts have warned against unbalanced reporting on CTE issues in the medical, scientific and media communities (also reported in BCDN here).[7]

Dr. Stewart’s fears are illustrated by tabloid reporting on Mike Sutton and George Reilly. Mr. Reilly has jumped to the conclusion that he has CTE, when he may not, while Chris Sutton has assumed that his father has CTE. Both of these presumptions are based on Alzheimer’s diagnoses.

In fact, scientists at the Indiana University School of Medicine, University of Kansas and the UK Medical Research Council dismantled the belief that Alzheimer’s and CTE pathologies are identical in a research paper published last month. Cryogenic electron microscopy imaging of brain cells revealed that the shape of CTE-induced tau proteins were different from Alzheimer’s-induced tau proteins. Thus, it was inferred that Alzheimer’s and CTE are distinct conditions, despite both resulting in the formulation of excess, abnormal tau.[8]

It is fair to say that, until the FIELD study provides further insight, CTE remains undefined, with unknown prevalence, while diagnostic criteria constitutes a mere preliminary assessment.

New Study on Football-Induced Head Trauma and Motor Neurone Disease

Interestingly, in an article published in the Neuron journal, researchers found that malfunctioning TDP-43 is behind a high proportion of both amyotrophic lateral sclerosis (ALS) (97%) and CTE (80%) cases.[9]

Complimenting this, in a recent investigation, connecting football and a different type of neurodegenerative disease, Italian scientists have expanded on prior research, which identified repetitive head trauma as a risk factor of ALS, a condition with unknown cause.

ALS is a slow-progressing form of motor neurone disease. Patients suffer with neurodegeneration, i.e. damage to motor neurone cells in the brain and spinal cord. In turn, this impairs muscle function that affects walking and talking. ALS is incurable and patients have an average life expectancy of between 3 and 10 years.

Researchers at the Mario Negri Institute for Pharmacological Research, in Milan, reviewed the medical records of 25,000 male professional footballers, who played in Italy from 1995 to 2000.[10]

They observed 33 ALS cases (3.2 cases per 100,000 per year).

In an average Italian population, one might have expected 1.7 cases per 100,000 per year, meaning that the rate of developing ALS was doubled in professional footballers. Among players aged 45 and under, the rate of development was 4.7 times higher (approximately 8 cases per 100,000 per year).

What is more, the average age of ALS development was roughly 20 years younger in the study group (43), compared to the general population (63).

It is hypothesised that cumulative head trauma may damage the white matter in the brain, responsible for memory and thought process, which could lead to brain damage.

That being said, lead author, Ettore Beghi, cautioned that ‘... heavy physical exercise ... substance use ... [and] ... genetics may play a role’ in increasing ALS incidence among footballers.

Full study findings will be presented at an upcoming neurology conference in Philadelphia.

 

[1] Chris Sutton, ‘Why Gordon Taylor has to go... he could have made a real difference but he's failed my dad and many more’ (20 November 2018 Daily Mail) <https://www.dailymail.co.uk/sport/football/article-6411801/Why-Taylor-real-difference-hes-failed-dad-more.html accessed 10 April 2019.

[2] Bethany Whymark ‘Ex-Norwich City striker attacks PFA boss for leaving players ‘rotting and dying’ from dementia’ (28 March 2019 Eastern Daily Press) <https://www.edp24.co.uk/sport/norwich-city/chris-sutton-norwich-city-attacks-gordon-taylor-pfa-dementia-1-5963745> accessed 10 April 2019.

[3] Chris Sutton, ‘PFA chief Gordon Taylor failed my father on dementia – he should go now’ (27 March 2019 Daily Mail) <https://www.dailymail.co.uk/sport/football/article-6857567/CHRIS-SUTTON-Gordon-Taylor-failed-father-dementia-now.html> accessed 10 April 2019.

[4] Miles Starforth, ‘Former Newcastle United forward reveals Alzheimer's diagnosis’ (Shields Gazette 5 April 2019) <https://www.shieldsgazette.com/sport/football/newcastle-united/former-newcastle-united-forward-reveals-alzheimer-s-diagnosis-1-9693679> accessed 10 April 2019.

[5] Lee Ryder, ‘Former Newcastle United striker makes sad revelation after being diagnosed with Alzheimer's’ (5 April 2019 Chronicle Live) <https://www.chroniclelive.co.uk/sport/football/football-news/former-newcastle-united-striker-makes-16087406 > accessed 10 April 2019.

[6] Marilynn Marchione, ‘Doctors May Have Found a Way to Reveal Concussion Damage in Living Football Players’ (11 April 2019 TIME) <http://time.com/5568192/brain-scan-concussion-athletes-football-nfl-cte/> accessed 12 April 2019.

[7] William Stewart et al., Primum non nocere: a call for balance when reporting on CTE The Lancet Neurology (March 2019) VOLUME 18, ISSUE 3, P231-233 DOI: <https://doi.org/10.1016/S1474-4422(19)30020-1> accessed 14 February 2019.

[8] Benjamin Falcon et al, Novel tau filament fold in chronic traumatic encephalopathy encloses hydrophobic molecules. Nature, 2019; <https://www.nature.com/articles/s41586-019-1026-5> accessed 12 April 2019.

[9] Jacob R. Mann et al, RNA Binding Antagonizes Neurotoxic Phase Transitions of TDP-43. Neuron, 2019; <https://www.cell.com/neuron/fulltext/S0896-6273(19)30075-3?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0896627319300753%3Fshowall%3Dtrue> accessed 12 April 2019.

[10] Vanessa Chalmers, ‘Footballers are FIVE times more likely to develop the same condition that killed Professor Stephen Hawking because of how often they head the ball’ (28 February 2019 Daily Mail) <https://www.dailymail.co.uk/health/article-6756919/Footballers-FIVE-times-likely-condition-killed-Professor-Stephen-Hawking.html> accessed 10 April 2019.