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Brain injury in football – heading for trouble?

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Ipek Tugcu - specialist brain injury lawyer and Southampton fan

Football fan and specialist brain injury lawyer Ipek Tugcu has become a leading analyst of the concussion in sport debate. Here, she discusses the crucial issue of player safety with NR Times.

Whether you’re a football fan or not, you’re likely to have seen that the sport has recently been in the headlines for all the wrong reasons.

The focus has been on how football has dealt with the increased risk of neurodegenerative disease suffered by professional players. The quick answer? Not well.

I initially became involved in this campaign as I was a football fan and also work as a brain injury lawyer, representing those harmed by medical negligence or an accident.

Attempting to change any sport is a sensitive matter. Now more than ever, fans rely on sports as a means of escape from their busy lives.

People invest a lot into their favourite team, and the idea that tradition could change often causes immediate uproar. So it’s important to look at the facts, and to understand what the issue is and how the sport could evolve, to allow it to safely continue.

So what is the issue?

While it may just be hitting the news now, none of this is new. For decades, campaigners have raised concerns about the increasing number of professional players diagnosed with neurodegenerative disease, namely dementia.

Of course, neurodegenerative disease can affect anyone, but a worrying correlation has been apparent in the sport.

One of those players affected was West Brom legend Jeff Astle, who died in 2002, aged 59. His death was due to chronic traumatic encephalopathy (CTE) – a progressive, degenerative brain disease usually suffered by athletes with a history of head injury, such as multiple concussions.

Sadly, his situation is not an anomaly, and a growing number of former footballers have been diagnosed with dementia, including Gordon McQueen, Sir Bobby Charlton and Nobby Stiles.

So what exactly are the risks?

In October 2019, a research study commission by the FA and PFA (the “FIELD” study – Football’s InfluencE on Lifelong health and Dementia risk) revealed that former professional footballers were 3.5 times more likely to suffer from neurodegenerative disease than the general public.

Within this, former footballers were 5 times more likely to develop dementia or Alzheimer’s and twice as likely to have Parkinson’s.

These statistics are alarming, and working in the field of brain injury – we know the widespread devastation that such conditions cause, not just to the individuals diagnosed but to their friends and family, their local community and the NHS, who are often left to pick up the pieces and care for them.

The reality is that brain injuries, by their nature, cause significant administrative and financial pressures on individuals and authorities caring for the patient. The sporting world needs to take on the burden of finding solutions to problems they have created, before the younger generation is put off sport for good.

So what is it about football that puts players at increased risk? Whilst the FIELD research study didn’t pinpoint the exact aspect, research tells us that:

  • It’s nothing to do with the argument that ‘the balls back in the day were heavier than the current, modern ones’. This is an incorrect misconception which has been debunked. The old leather balls and the new synthetic ones both weigh around 15oz. Whilst the older balls were heavier when wet, this means they would also have been slower so would have had less of an impact when hitting a player’s head. As such, today’s players face the same risks as footballers from decades ago.
  • Subconcussive hits may be the main culprit. People often focus on concussion in sport, but it’s easy to forget that even those blows to the head that don’t formally cause concussion (i.e. are subconcussive) will impact the brain. In respect of football, players suffer most of their subconcussive blows during training, when practising heading. This type of training can usually mean hours every week of repeated hits to the head. Multiply this by the likely duration of their career, and a bleak picture emerges of the extent of trauma suffered to the head.

Despite the above, the current rules in football have not changed.

Whilst injuries, including head injuries, are part and parcel of any sport, it doesn’t negate the fact that players should be protected from known risks. It’s reckless and not to anyone’s advantage to ignore the research.

There’s also the legal side to this. Professional footballers are employees merely doing their job and, as with anyone in this situation, their employer has a duty of care to take reasonable steps to protect them from foreseeable harm.

Ignoring known risks will only cause a headache for governing bodies in the future, making them vulnerable to legal claims against them for ignoring the known dangers and failing to establish and follow proper protocols. You only have to look to the NFL to see that this is not a far-fetched prediction.

So what’s the solution? Do we ban all forms of heading in football? What about the fact that footballers choose to play the sport, and with that comes an element of risk – do we just have to eliminate all potential injuries from the sport?

The truth is, the authenticity of football does not have to be compromised in order to protect a player’s health. There have been a number of proposed enforcements, however as a fan and campaigner, temporary football concussions has been one option which I hope could really make a difference.

As of 6th February 2021, the Premier League became the first in the world to introduce a trial for permanent concussion substitutes. So, what exactly does it mean – and how does it compare to the campaign for temporary concussion substitutes?

The current trial means that where a head injury has occurred, or is suspected, the injured player’s club can make a concussion substitution. This means:

  • They can substitute that player, even if they have used up all their normal substitutions. The player will be removed from the pitch and sent for head injury assessment in a private room. The substitution is permanent – once the player is off the pitch, they cannot return to the match, even if the assessment finds that they are absolutely fine.
  • To ensure a level playing-field, the opposing team is afforded an additional substitution at the same time too
  • A team is allowed two concussion substitutes, per match

The intended aim is to put the player’s health at the forefront and ensure that this is the priority, over team tactics.

At the moment, there’s a fear that players aren’t being substituted for proper head injury assessments because the club is focussed on their match strategy. The trial hopes to encourage clubs to be reassured that they will not be at a disadvantage by having their player assessed for a potential head injury.

Temporary substitutions are similar, but crucially allow a footballer to return to play if they are deemed safe enough to do so. In this case, the player would be temporarily replaced by a teammate, but then would be able to resume play if they had the all clear.

The concern is that permanent substitutions don’t encourage players, or clubs, to proactively engage with the trial – because they know that starting this process will automatically rule that player out for the rest of the match, regardless of the outcome of their medical check.

So you’re left with a situation where the manager needs to make a quick decision on the spot as to whether they’re willing to lose that player for the remainder of the match.

Even for the most caring manager, this puts them in a position of choosing team tactics over player safety and we’re back to square one.

A perfect example of this happened in a recent FA Cup match, where West Ham’s Issa Diop suffered a nasty head collision. He played on, whilst clearly struggling, until finally being substituted at half time.

Of course, we don’t know why a decision was not made at the time of the injury to engage with the trial – but it makes you wonder whether not wanting to lose their player factored into the club’s decision and they decided to chance it to see if he could be safe to play on.

Temporary substitutions offer a win-win situation for clubs and footballers.

Teams can be reassured they won’t be at a tactical disadvantage, as the substitution could just be temporary, and players can be reassured that their health is made a priority and they can undergo a thorough head injury assessment privately.

Doctors will be well-versed in the mantra ‘if in doubt, sit them out’ – so the risk of putting a potentially injured player back on the pitch is minimal.

This continues to be an ever-evolving situation affecting footballers here and abroad. It will be interesting to see what permanent steps, if any, are taken by the Premier League and other leagues across the world.

Of course, the issue of brain injury mismanagement in sport isn’t just limited to football. It’s my hope that a balance can be achieved between protecting players, reassuring the new generation and still allowing fans to experience the thrill of the sport as they have always known it.

* Ipek Tugcu is a Senior Associate in the Adult Brain Injury team at Bolt Burdon Kemp and an avid Southampton fan. She is a well-known campaigner for brain injury in sport, particularly football, to be taken more seriously.

Twitter: @Ipek_Tugcu

Neuropsychology

Video gaming ‘can increase cognitive ability in children’

Above-average time spent on video games can lead to an increase in IQ over time, a new study reveals

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Children who spend an above-average time playing video games can increase their cognitive ability, a new study has revealed. 

Researchers at Karolinska Institutet in Sweden have studied how the screen habits of children correlate with how their cognitive abilities develop over time. 

While they found that watching television or being on social media had neither a positive or negative effect, video gaming increased their intelligence more than average. 

On average, the children spent 2.5 hours a day watching TV, half an hour on social media and one hour playing video games. 

The results showed that those who played more games than the average increased their intelligence between the two measurements by approximately 2.5 IQ points more than the average. No significant effect was observed, positive or negative, of TV-watching or social media.

Over 9,000 boys and girls from the United States took part in the study, which saw them perform an array of psychological tests aged nine or ten to determine their cognitive abilities. 

The children and their parents were also asked about how much time the children spent watching TV and videos, playing video games and engaging with social media.

Just over 5,000 of the children were followed up after two years, at which point they were asked to repeat the psychological tests. This enabled the researchers to study how the children’s performance on the tests varied from one testing session to the other, and to control for individual differences in the first test. 

They also controlled for genetic differences that could affect intelligence and differences that could be related to the parents’ educational background and income.

“We didn’t examine the effects of screen behaviour on physical activity, sleep, wellbeing or school performance, so we can’t say anything about that,” says Torkel Klingberg, professor of cognitive neuroscience at the Department of Neuroscience, Karolinska Institutet. 

“But our results support the claim that screen time generally doesn’t impair children’s cognitive abilities, and that playing video games can actually help boost intelligence. This is consistent with several experimental studies of video-game playing.”

The results are also in line with recent research showing that intelligence is not a constant, but a quality that is influenced by environmental factors.

“We’ll now be studying the effects of other environmental factors and how the cognitive effects relate to childhood brain development,” says Prof Klingberg.

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Tech

GripAble praised by MP

Stephen Hammond MP hails its innovation and “extraordinary” success to date and potential

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The progress of GripAble has been hailed as “extraordinary” by its local MP, who praised its innovation and ongoing progress in transforming neurorehab and wider healthcare.

GripAble, the UK technology company digitising upper limb rehabilitation from hospital to home, welcomed Stephen Hammond, MP for Wimbledon, to its international sales and distribution centre.

Mr Hammond visited GripAble’s office in Wimbledon to learn how private equity investment has helped it to scale its industry-leading data platform and therapy services and expand GripAble into Europe and the US, as well as how an international company has successfully stemmed from the local business community. 

During his visit, the MP met the GripAble team and listened to a presentation by GripAble co-founder and CEO Dr Paul Rinne, who shared the background to GripAble and its growth story to date, as well as plans and ambitions for the future.

Prior to becoming an MP, Stephen Hammond worked for a leading fund management company and multiple investment banks, so was particularly interested in the funding GripAble has received to date, including the recent close of its $11m funding round. 

With more than 8,000 individuals having already used the platform, GripAble has established itself as a leading technology in the remote-rehab space in the UK, recording 100,000 activity sessions and 27 million movement repetitions across its users.

Stephen Hammond MP said: “GripAble proves that innovative companies of the future that are building products that will transform healthcare can be based anywhere, but I’m particularly proud that GripAble has started out in Wimbledon. 

“It’s been wonderful to see the development of the company over the last two years since first meeting Paul, and I’m sure the developments over the next three years will be equally extraordinary, particularly with the backing of private equity investment.”

Dr Rinne said: “Today’s visit was a fantastic opportunity for us to showcase GripAble’s story and vision to a Member of Parliament and explain how private equity investment can help UK-based entrepreneurs take ideas from seed stage through to global scaling, and compete on the international stage. 

“The investment we have received will accelerate GripAble’s journey to delivering end-to-end patient rehabilitation and connecting millions to their own personal home-based clinic. 

“With the backing of investors such as IP Group and Parkwalk, we will benefit from a wealth of insight and experience that will support us in growing our platform in the US and expanding our clinical and commercial evidence base. 

“It is great to be able to work with such supportive investors that make our lives so much easier.”

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Neuropsychology

Social media break ‘can improve mental health’

A one-week break can deliver improvements in wellbeing, anxiety and depression, research reveals

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A week-long break from social media could lead to significant improvements in wellbeing, depression and anxiety, and could potentially be recommended as a way to help people manage their mental health. 

A new study has looked at the effects of taking a break from social media, which for some participants meant sacrificing up to nine hours otherwise spent on Instagram, Facebook, Twitter and TikTok. 

The results of the research, from the University of Bath, suggest that after just one week, these individuals saw their overall level of wellbeing improve, as well as reduced symptoms of depression and anxiety.

Over the past 15 years, social media has revolutionised how we communicate, underscored by the huge growth the main platforms have observed. 

In the UK the number of adults using social media increased from 45 per cent in 2011 to 71 per cent in 2021. Among 16 to 44-year-olds, as many as 97 per cent of people use social media and scrolling is the most frequent online activity.

Lead researcher from Bath’s Department for Health, Dr Jeff Lambert, explains: “Scrolling social media is so ubiquitous that many of us do it almost without thinking from the moment we wake up to when we close our eyes at night.

“We know that social media usage is huge and that there are increasing concerns about its mental health effects, so with this study, we wanted to see whether simply asking people to take a week’s break could yield mental health benefits.

“Many of our participants reported positive effects from being off social media with improved mood and less anxiety overall. This suggests that even just a small break can have an impact.

“Of course, social media is a part of life and for many people, it’s an indispensable part of who they are and how they interact with others. But if you are spending hours each week scrolling and you feel it is negatively impacting you, it could be worth cutting down on your usage to see if it helps.”

For the study, the researchers randomly allocated 154 individuals aged 18 to 72 who used social media every day into either an intervention group, where they were asked to stop using all social media for one-week or a control group, where they could continue scrolling as normal. 

At the beginning of the study, baseline scores for anxiety, depression and wellbeing were taken.

Participants reported spending an average of eight hours per week on social media at the start of the study. 

One week later, the participants who were asked to take the one-week break had significant improvements in wellbeing, depression, and anxiety than those who continued to use social media, suggesting a short-term benefit.

Participants asked to take a one-week break reported using social media for an average of 21 minutes compared to an average of seven hours for those in the control group. Screen usage stats were provided to check that individuals had adhered to the break.

The team now want to build on the study to see whether taking a short break can help different populations, such as younger people or people with physical and mental health conditions, who research shows can experience adverse effects at different times.

The team also want to follow people up for longer than one week, to see if the benefits last over time. If so, in the future, they speculate that this could form part of the suite of clinical options used to help manage mental health.

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