Traumatic brain injury doctor questions football’s approach to heading the ball

Headers have always been a fundamental part of football but medical experts and administrators appear to be in agreement about the increased risk of dementia caused by skulls and synthetic spheres coming into regular contact.

The science behind calls to end heading the ball seem undeniable.

"We have advanced this story in football quite some way," says Dr Willie Stewart, a neuropathologist at the forefront of traumatic brain injury. "Not just looking down the microscope but looking at the population of footballers.

“What we have seen is that the risk of dying of dementia if you play professional football for 15 years or play in defence is five times higher than it should be.”

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None of this information is new. Just facts, like 46 of Alan Shearer's Premier League record of 260 goals between 1992 to 2006 were headers. In 2017 the former England captain and the BBC pundit produced a sobering documentary titled 'Dementia, Football and Me' that explored the damage Shearer may have already suffered.

The "emotional hell" suffered by ex-footballers and their families was starkly revealed when Shearer visited the home of Matt Tees. The Scottish striker played most of his career for Grimsby Town, where he settled to raise a family, but also existed under the fog of dementia until his death in November 2020. A heartbreaking conversation with Matt's wife May was eventually interrupted by their three grandsons, Matthew, Joe and Alex.

If we stop banging our heads against things repeatedly we could stop this happening

“You’re a centre half and you’re a right back,” Shearer said to the teenagers, “so you take after your granddad and head the ball?”

“Supposedly” they giggled.

Matt Tees chimed in, “They never saw me when I was at my best!”

Shearer: “Does it worry you boys, about heading the ball?”

“I don’t really think about it,” replied Joe, the centre half, “but if there is a link . . . like, I wouldn’t stop doing it.

“It has changed a bit because obviously when grandpa used to play, when it was wet, the leather balls were heavy, whereas nowadays they are quite light.”

Stewart is determined to dispel this myth.

“No,” his Twitter bio states, “old footballs were not heavier than modern ones”.

Recently he used social media to debunk 'The Match of the Day hypothesis' – alongside a studio shot of Gary Lineker, Martin Keown and Shearer – that claims there are less headers in the modern game.

“They were a bit upset about calling it ‘The Match of the Day hypothesis’ because maybe they thought I was taking a poke at them. But it is punditry that says the game is all played on the floor now. Fans watching real world football disagreed so the only way to answer this was to get proper data which showed there are far more headers now.”

Using the World Cups as a case study, Stewart showed that headers have increased from an average of 71 per match during the 1966 to 1990 tournaments to 93 per match up to 2018.

“And the ball has been 14 to 16 ounces since the 1870s. People say ‘oh well, the old balls were leather and used to soak up water and that made them heavier to the modern synthetic balls’. It made them a bit heavier but with that it travelled at slower speeds.

“When you do the physics you find that what the changing of mass doesn’t really change is the impact forces. Change the speed, though, and the impact forces go through the roof. Modern balls, because they are not soaking up water, are travelling consistently faster.”

Recently published research by Glasgow University prompted the English FA to announce guidelines that restrict the number of "higher force headers" in training to 10 a week, a figure that Stewart baulked at despite being on the FA's advisory group.

“First I knew they were producing these numbers was half an hour before they were released to the media,” he said. “Essentially, what they did was largely look at Premier League matches and used a computer algorithm to translate the video data into some measure of force. They haven’t measured the impact on the players. They have used a computer to guess what they might have been. They have decided that if they cut back what they perceive as high-impact headers in training it might make a difference in 30 years’ time.

“Of course none of this makes any sense. It is the equivalent of you and I standing on the motorway near Dublin Airport and guessing how fast the cars are going and then heading into the city centre to tell the policy makers how fast cars should travel in town, based on what we saw out by the airport. It just doesn’t relate.”

Stewart’s deepest concern about the FA’s proposed solution is a coach will realise his players are only doing two or three high-impact headers a week and increase the workload. Or the coach will fuel the epidemic by switching focus to “200 low impact headers a week”.

I am yet to see anyone present any data whatsoever that says heading the ball is beneficial to your health

"The FA response was not ideal but it is better than what is happening in global football. A quarter of a billion people participate and yet we are hearing nothing from Fifa. They haven't changed their recognition of concussion.

“Unlike any other degenerative brain disease this is entirely preventable. If we stop banging our heads against things repeatedly we could stop this happening.

“Is it possible to play the game of football without heading or does it have to be there? Another way of asking that question, is a risk of dementia entirely necessary for the game of football to exist?

“That is essentially what we are saying. Boxing has that risk of dementia, and it carries on, but professional boxers are checked out regularly by independent neurologists and they are stood down after a technical knock-out for a month.

“I am yet to see anyone present any data whatsoever that says heading the ball is beneficial to your health. We have more than enough evidence in sport, specifically in football, that says this needs to be acted upon.”

Not that concussion is the major issue in football, unlike rugby’s unfolding tragedy, but subconcussive blows are what had May Tees distraught by the sight of her grandsons repeatedly heading the ball.

“I don’t want my grandchildren’s partners and wives to go through what we go through now,” she told Shearer in 2017. “Life is quite frightening for Matt.”