Recent findings that professional footballers are three and a half times more likely to die of dementia are certainly serious but they should not surprise us.
Contrary to much of the coverage, the research by the University of Glasgow is not the first to find a link between football and neurocognitive degenerative conditions. Previously, a Norwegian study found that CT scans showed evidence of brain damage among former international footballers, and research identified a heightened prevalence of amyotrophic lateral sclerosis (ALS) or motor neurone disease among Italian professional players.
These findings should also not surprise us because all professional sports – and football in particular – provide incredibly dangerous workplaces. One study suggests that professional footballers experience 500 times more injuries than those in the second most dangerous UK occupation. Equally, we also know that knee osteoarthritis is two to three times more common in ex-footballers than in males more broadly.
The response to findings such as these must be measured, or it will only serve to perpetuate sport’s concussion crisis and make it more difficult to resolve.
These latest findings are however based on the most robust evidence to date. They correlate with findings from New Zealand about the link between rugby union and post-retirement “neurocognitive deficits”, and they need to be understood in the context of findings about the prevalence of CTE among former professional athletes in North America. They are important.
The concussion crisis often leads evidence to be extrapolated to public health. Should heading be banned? Heading is how most football concussions occur, and there is an intuitive link between concussion and/or the sub-concussive trauma of heading and later neurocognitive developments. Against this, the causal link isn’t established and the only evidence we have relates to a distinct, and distinctly high risk, occupational group. Given that around two-thirds of those diagnosed with dementia are elderly females, the idea that heading footballs represents a major public health risk seems far-fetched.
But equally unconvincing is the common response that the health benefits of sport outweigh the potential harms. Of course the FA want to emphasise the Glasgow findings that professional footballers live on average three years longer, but the claim that playing football is a fundamentally healthy pastime is again difficult to sustain. Sports injuries are under-researched and as a society we under-estimate their economic and social impact. Keep playing football, but do it because you enjoy it, not because it’s particularly healthy.
A third common feature of concussion research is the subsequent call to further regulate children’s lifestyles. (We see this in relation to obesity and physical activity as well as concussion). As a society, we generally feel that adults should have the freedom to do what they want as long as they don’t harm others; hence we can smoke tobacco but not in confined public spaces. Concussion campaigners target the behaviour of children not because they are the most relevant target, but because they are the softest. Changing how often children can practice heading is not the logical policy outcome of the Glasgow findings, restructuring professional football may be. Paradoxically that’s not even up for discussion.
Finally, consider the role of dementia in driving these concerns. Of course dementia is important, but this focus obscures the notable increased prevalence of motor neurone disease. This in turn backs up earlier Italian findings, and indeed need to be considered in relation to some high-profile cases of motor neurone disease in rugby union (South Africa’s Joost van der Westhuizen, Wales’ Ken Waters, and Scotland’s Doddie Weir). The relationship between evidence and the storyline reflects how we are both obsessed by dementia and in a panic about its impact on both individuals and the broader society. The Glasgow findings suggest that the greater risk of dementia is partly (note not wholly) balanced by the reduced risk of heart disease and lung cancer within this population, but the entire research project is predicated on the implicit assumption that dementia is the main illness to be feared.
The nature of the concussion crisis in sport means that this study tells us as much about the dangers of playing football as it does about the society in which we live. The concussion crisis in sport is particularly revealing; because neuroscience has so far proven so little there is a lot of room for extrapolation and speculation. There is no doubt in my mind that sports participants need much better information about how to recognise and respond to concussion, and concussion protocols need to be more effectively implemented at all levels of sport. But equally the response to findings such as these must be measured, or it will only serve to perpetuate sport’s concussion crisis and make it more difficult to resolve.
Dominic Malcolm is Reader in the Sociology of Sport, at Loughborough University and author of The Concussion Crisis in Sport, published by Routledge