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Brain injury

Maximum of 10 headers a week in football training, new guidance recommends

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English football will introduce heading guidance across every level of the professional and amateur game from the start of the 2021-22 season, it was announced today. 

The new guidance, which is specifically focused on training sessions where the majority of heading occurs, has been designed to meet the requirements of each level of English football. The guidance will apply to clubs in the Premier League, EFL, Barclays Women’s Super League, FA Women’s Championship, the National League System, the Women’s Football Pyramid Tiers 3 and below, all grassroots football, and across the England national teams.

The new heading guidance has been agreed between the FA, Premier League, EFL, the PFA and the LMA.

It will be recommended that a maximum of ten higher force headers are carried out in any training week, in a move designed to protect player welfare which will be reviewed regularly as further research is undertaken to understand more regarding the impact of heading in football.

The guidance also recommends that clubs develop player profiles that consider gender, age, playing position, the number of headers per match and the nature of these headers.

These profiles can be used to ensure that all training sessions reflect the type and quantity of headers that a player could expect to undertake within a match. Club staff will also be encouraged to work with players following each match to ensure they have adequate time to recover from their heading exposure.

The guidance also identifies ways in which heading techniques may still be practised while reducing the forces involved. Early evidence suggests lower forces are produced when a ball is thrown to a player rather than kicked, and when a player heads the ball from a standing jump rather than running onto the ball. The Premier League, in conjunction with partners including the LMA, will provide further guidance to club staff on ways in which they might adapt practices.

The move has been welcomed by leading experts in the field, although more action needs to be taken with regard to age and gender issues, and follows the publication of the ‘Concussion in Sport’ report last week which showed that urgent action was needed to address a long-term failure to reduce the risks of brain injury in sport.

Football and dementia expert Dr Michael Grey, from UEA’s School of Health Sciences, said: “The FA’s new guidance on this issue is welcome because there is an active debate with many researchers and medical professionals calling for a reduced heading of the ball for many years. However, it remains unclear on what basis these specific FA limitations have been made and how the new guidance will be enforced.

“The recommendations make no distinction based on gender despite growing evidence that women are more susceptible to head injury than are men. There are biological differences between male and female in both structure and physiology that warrant a more considered approach.

“Furthermore, it is notable that the new guidance is restricted to adults. There has been no change in the guidance for children where heading the ball in training has been discouraged by the FA, albeit not enforced, and heading the ball in match play is still permitted.  This is problematic due to the fact that the brain of a child is at significantly greater risk to brain injury than that of an adult.

“It is time to consider an outright ban on heading the ball for younger children – both in practise and match play, complete with an enforcement strategy. An evidenced based programme to introduce heading into the game at an appropriate age and stage of physical development would be welcomed.

“This is a global game. We have an opportunity to be leading the way internationally.”

Making the announcement, the FA said that early but limited evidence from initial studies suggested that neck muscle strength may be a contributing factor to higher force transmission from heading. A strength and conditioning expert advisory group will identify ways in which neck and torso strength can be developed safely across the professional game.

The guidance has been developed using a precautionary approach to protect player welfare where scientific evidence is limited and will be kept under review. The evidence gathering has increased understanding of the forces involved in heading, while also identifying areas that require further exploration. The Premier League with its football partners will deliver expanded research in season 2021-22 to facilitate a formal review of the guidance by the PFNCC in June 2022.

The guidance for adult amateur grassroots football includes clubs up to and including Step 5 of the National League System and Tiers 3 and below of the Women’s Football Pyramid, and is specifically tailored for this level of the game.

The aim of this guidance is to reduce overall exposure to heading without compromising development of technique and the role heading plays in the English game. The role of the coach in supporting players’ skill development for heading is to ensure a safe and controlled technique.

This new heading guidance for the adult amateur game follows the FA’s introduction of heading guidance in youth football in February 2020 which has also been updated and published today.

FA chief executive Mark Bullingham said: “We already have the most comprehensive guidelines in the world for youth football and now we are introducing, in partnership with the other football bodies, the most comprehensive adult football guidelines anywhere. Our heading guidance now reaches across all players, at all levels of the game.

“These measures have been developed following studies with coaches and medics and represent a cautious approach whilst we learn more. We are committed to further medical research to gain an understanding of any risks within football, in the meantime this reduces a potential risk factor.

“Overall, it’s important to remember that the overwhelming medical evidence is that football and other sports have positive impacts on both mental and physical health.”

Premier League chief executive Richard Masters added: “Our priority is to make the game as safe as possible for all players. We have worked collaboratively across football to undertake these initial research projects to help us further understand the impact of heading and inform guidance for all levels of the game.

“This is a long-term piece of work. We will now build on these studies and we remain committed to further research to ensure we have the right approach in place to protect the welfare of all players.”

EFL chief executive Trevor Birch said: “Maintaining the health of players, both in the short and long-term remains of paramount importance for the EFL, and it’s vital that English football continues to innovate and act upon the latest research and insight available.

“Collectively we must do all we can to make sure heading is practised safely and these protocols will provide us with a foundation upon which we can develop the game’s collective work in this area.

“As always, we will continue to monitor any developments based on the advice of medical experts and will work with the football bodies and clubs to ensure the protocols are implemented effectively.”

PFA chief executive Maheta Molango said: “The PFA welcomes the collaborative approach to understand further the impact of heading in football. Our members’ health and wellbeing are paramount. We hope these initial steps and enhanced protections will make a vital difference to players’ long-term health.

“The introduction of this guidance represents one part of developing a coordinated game-wide strategy and needs to be combined with other areas, such as improvement in head injury management and greater collective support for retired players.

“Critically, the guidance is only a first step. As identified within the paper, more research is required to improve how we protect current players and future generations.

“We look forward to working collaboratively with football’s stakeholders to continue research and educate managers, coaches and players regarding the new guidance.”

LMA CEO Richard Bevan said: “It’s absolutely essential that all clubs are working with the same guidelines and that the health and wellbeing of the players is the most important factor.

“This guidance is just the beginning and we need, as a game, to continue to invest and develop good quality research to further understand the risks and impact of heading within the game.

“The LMA is committed to playing our part in increasing awareness, supporting our stakeholders and most importantly ensuring that the players’ safety is the principle factor in all future decision making.”

 

Brain injury

ABI strategy confirmed by Government

Huge breakthrough in support for people with brain injuries comes after Chris Bryant MP introduced the ABI Bill

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The Government has today committed to producing a strategy to deliver better support to people living with acquired brain injury (ABI), following efforts from MP Chris Bryant and an array of charities and leading figures to force them into action. 

In a statement, it was confirmed a strategy will be drafted with a call for evidence being launched early in the new year to help shape its development. 

Gillian Keegan MP, Minister for Care and Mental Health, said the development of the strategy would be co-chaired by herself and Mr Bryant, with senior officials in all relevant Government departments invited to join the board. 

“Following publication, the strategy will be kept under review and may be revised periodically to ensure that it continues to reflect the priority areas and actions needed to best support people living with ABI and their families,” the statement said. 

The move by the Government marks a huge step forward in ABI provision, following years of campaigning from charities and survivors for more support. Mr Bryant recently introduced a Private Members Bill with the aim of forcing the creation of such a strategy, which was due to have its second reading in Parliament tomorrow. 

Mr Bryant – chair of the All Party Parliamentary Group (APPG) on ABI and a tireless campaigner for the cause – had called on the Government to take action to ensure a more joined up approach from Government departments in supporting individuals and families affected by brain injury. 

Last month, he delivered a letter signed by over 200 MPs, charities, brain injury survivors and other providers to 10 Downing Street, calling on the Prime Minister to take action. Following that, Boris Johnson confirmed in Parliament that the Department for Health and Social Care would be looking at the development of such a strategy. 

It has also been supported widely by the public and via social media.

But today’s confirmation is a huge step forward and will ensure the development of an appropriate strategy, with input from families and professionals across the world of ABI. 

Announcing the development on Twitter, Mr Bryant said: “ The Government has just announced it will draft a strategy on Acquired Brain Injury, set up an ABI programme board which will be co-chaired by Gillian Keegan and me, and will call for evidence very soon. 

“So my ABI Bill won’t be needed. Many thanks to all who’ve helped!”

Charities who have been vocal in their support of Mr Bryant’s Bill were keen to celebrate the move, which comes after years of campaigning. 

UKABIF hailed the announcement as “a gift” and the Disabilities Trust said it was “just amazing”. 

The Child Brain Injury Trust added: “Fantastic news to hear. A strategy for ABI has been needed for so long. We are thrilled!”

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Brain injury

UEFA concussion charter urges protection and education

The importance of educating players, coaches, referees, doctors and the public about dangers of concussion in football is highlighted

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A European-wide football concussion charter has been launched, stepping up efforts to safeguard players and urging the education of those involved in the game around the dangers of impacts to the head. 

UEFA has launched its concussion charter, which will apply to all teams taking part in men’s and women’s club and national team competitions across Europe. 

The charter aims to reinforce the importance of good practice in concussion management and highlights the concussion procedures that should be followed. 

It also promotes the education of players, coaches and staff about the concussion procedures in force at UEFA games. Team doctors are being asked to organise specific education sessions to brief players, coaches and staff about the concussion procedure to be followed at UEFA matches.

Furthermore, its 55 member associations are ‘strongly encouraged’ to deploy where possible, a medical video review system at their stadiums to enable immediate and informed injury assessments.

UEFA will facilitate the installation of the system with the host broadcaster. Home teams using a medical review system should offer the visiting team the same system.

Club and national teams are being urged to sign the charter to underline their commitment to safeguarding the health of their players.

In doing so, the signatories pledge their full support for UEFA’s guidance on how to recognise and manage a head injury from the time of injury through to the safe return to football.

“Everyone should know how to react and what to do,” said Tim Meyer, UEFA Medical Committee chairman. 

“Concussion is undoubtedly a serious injury which needs to be managed and treated properly. 

“The health and safety of any players taking part in Europe’s club and national team competitions is of paramount importance not only to UEFA, but also to national associations across the continent.

“Although research studies report a low incidence in football, everyone should know how to react and what to do in the event of a concussion on the pitch.

“By signing this charter, clubs and national teams will demonstrate their support for UEFA’s concussion awareness activities – and take a considerable step forward in helping to protect their players.”

The measure is the latest stage in efforts to safeguard players, following steps including UEFA’s implementation of a keynote concussion awareness campaign in 2019 and the Premier League becoming the first competitive league in the world to introduce concussion substitutes. 

UEFA’s head injury procedure is:

• In the event of a suspected concussion, the referee will stop the game to allow the injured player to be assessed by the team doctor. Players should remain calm during the situation and not interfere with the assessment.

• The assessment should in principle not take more than three minutes, unless a serious incident requires the player to be treated on the field of play or immobilised on the field for immediate transfer to hospital.

• If the assessment cannot be made after the three minutes and/or a suspicion for a concussion arises, the player should not be allowed to continue playing.

• A player suffering a head injury that requires assessment for a potential concussion will only be allowed to continue playing after the assessment, on specific confirmation by the team doctor to the referee of the players fitness to do so.

The decision remains entirely with the team doctor. Coaches, referees and players are not allowed to interfere in the assessment and decision of the doctor.

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Brain injury

Calvert Reconnections delivering positive outcomes

Only months after opening, patients are already realising the benefits of the groundbreaking neurorehab centre

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Participants at ground-breaking neurorehabilitation centre Calvert Reconnections are already realising the benefits of the centre’s unique approach.

Calvert Reconnections opened its doors in June 2021, bringing a new, goal-focused, outcome-based approach to ABI rehabilitation.

Five months on, feedback from participants is now demonstrating how Calvert’s programme is delivering tangible results and pathways back to everyday life.

“Our programme is transforming the lives of our participants,” explained Claire Appleton, Head of Service at Calvert Reconnections.

“One of our recent residents said that his stay at Reconnections had transformed his quality of life, enabling him to return home, to his wife, rather than going into permanent 24-hour care.

“Such was the life-changing progress of another resident, he recently walked to the summit of Latrigg having only been able to walk a few hundred yards when he first came to stay with us.

“The whole team is hugely excited about the difference we are making to people’s lives.”

During meetings with other residents, Calvert Reconnections received the following feedback:

  • “I feel comfortable here, all the staff are really nice, they put up with me being confused or disagreeing, they are very patient.”
  • “You have made me realise you can get me closer to how I was before my accident. I accept who I am, I couldn’t do that before, I am OK with myself now.”
  • “I now have confidence to go about my ways.”
  • “You have improved my ability in lots of ways.”
  • “I cannot think of anything you could do differently or improve.”
  • The staff have a great can-do attitude.”
  • “I feel like I am getting better, getting fitter every day – my friends say I am getting better.”
  • “Doing different things all the time matters.”
  • “The specialist bike, the other people and the staff are all great.”
  • “I have a special bond with one of the participants – we love the banter.”
  • “It’s good to feel fitter again.”
  • “The staff are prepared to alter the programme with the weather and any other reasons.”
  • “It’s the people – we all keep an eye out for each other.”
  • “The food is great.”
  • “I have a lot of trust. I am asked to do things which seem difficult but it’s been possible, I’ve managed to be a metre or 2 off the ground on the climbing wall.”
  • “The cycling was good.”
  • “I am working on my dorsiflexion and this is brought in to my activities each day.”
  • “Reconnections has given me the opportunity to achieve my independence.”
  • “You asked me how we could improve Reconnections.  I have no criticisms – this is different to other rehab units, in a good way.”
  • “This is the best place for me to be.”

Calvert Reconnections has also recently announced its winter activity programme which includes walking and star gazing, bushcraft sessions, environmental art, photography projects, rock climbing (Calvert sports hall available), canoeing (Calvert swimming pool available), equine therapy, basketball (Calvert sports hall available), curling (Calvert sports hall available), badminton (Calvert sports hall available), sledging, cycling, ghyll scrambling and orienteering.

The centre has also been shortlisted for Best Initiative in Care at the Caring UK Awards.

Calvert Reconnections has places available now.  For further details, visit here

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