Football’s alleged culture of bungs and backhanders was thrown under the floodlights in September – culminating in the sacking
 of England manager Sam Allardyce.

In the same month as the Telegraph’s exposé of under the table deals, came another revelation to unsettle the custodians of the game.

The University of Stirling delivered the first piece of evidence to suggest heading footballs may be damaging to young people’s brains. With only 19 youth players tested, the study was relatively small.

Its findings, however, could have significant repercussions.
A machine fired balls to replicate corner 
kicks, with players heading them numerous times.

Brain function was tested before and after, with small but significant changes 
noted over the subsequent 24 hours among players who headed the ball at least 20 times.

“If I were a parent of a kid with an exam on a Wednesday, I would suggest they miss football training on the Tuesday,” warned co-author and neuropathologist Dr Willie Stewart.

The news was no surprise to Dawn Astle, whose father Jeff (pictured), the former West Brom and England striker, died of ‘industrial disease’ caused by heading footballs.

Having been diagnosed with early onset dementia, a coroner’s report revealed the true impact his career as a prolific scorer of headed goals had on his brain.

Dawn (pictured at a recent brain injury event) says: “If John Terry saw what my dad went through, not even remembering he had been a footballer, and choking to death, he would never head a football again. I honestly believe that.”

Jeff Astle was the first known case of chronic traumatic encephalopathy (CTE) – traditionally known as boxer’s brain – in a footballer. CTE is a progressive degenerative brain disease in individuals with a history of repetitive brain trauma, including symptomatic concussions and asymptomatic subconcussive hits to the head.

The trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau.These changes can begin months, years or decades after the last brain trauma.

They are associated with memory loss, confusion, impaired judgement, impulse control problems, aggression, depression and progressive dementia.

Following her father’s death in 2002 at age 59, Dawn launched the Jeff Astle Foundation to encourage research into the dangers of heading footballs.

Concussion in football campaigner Dawn Astle at the UKBIF eventHer battle has been marked by indifference, silence and mostly empty promises from footballing authorities.

“The coroner ruled that being a footballer killed my dad. In any other industry that would have had earthquake-like repercussions.

“Think of asbestos in factories, for example. But not football. They tried to sweep his death under the carpet. It was the last thing they wanted the coroner to say. The FA wasn’t interested and initially didn’t acknowledge what had happened to dad.”

The FA and PFA did promise a 10-year investigation in 2002 into the risks of heading a ball but this ultimately amounted to nothing.The 20 to 30 young people involved dropped out of the game and the investigation was discontinued.

Dawn discovered this years later from a journalist, much to her surprise.“We were stunned. It was a disgrace, especially from the PFA whose job is to represent players.”

Parallels are clear between Dawn’s campaign, and the struggles of Bennet Omalu, a forensic pathologist who discovered links between American football and CTE.

For Dawn’s cold shoulder from the FA and friends, read the opposition of legions of lawyers, doctors and brand protectors in the lucrative NFL club.

Although his fight for change goes on, the game did eventually donate US$12m to support CTE research.

For Dawn too, there are signs that the footballing world is finally listening.This winter she will attend an FA symposium at which the risks of CTE in football will be discussed with medical experts.

In the longer term, she hopes for robust, in-depth research to be undertaken.“Firstly we need a longitudinal study into the impact of heading footballs and it must be independent. If you look at the NFL, they initially did their own study and said there was nothing happening.

“It later transpired that they did know the risks. A lot of people say CTE in football is a generational thing and that it won’t happen nowadays because the balls are lighter.

“But that’s a red herring because they travel at a greater speed now. We don’t know whether a big heavy leather ball soaked in water would make a difference.

“Personally I don’t think it would because new balls still result in a blow to the head causing the brain to move in the skull.

“Another thing that could be done relatively cheaply is to look back at our former players and simply ask, have a disproportionate amount of them been diagnosed with dementia?” 

The evidence Dawn has accumulated from emails and letters from concerned families, suggests the answer would be yes – but unequivocal proof is needed.

“One lady’s dad played in the 50s and 60s at a local level. He never smoked or drank and was very strong and active. He collapsed when he was 52 and died days later of a brain bleed.

“He would always suffer headaches which o en kept him in bed for a few days. He was a centre half and often said heading the ball left him with headaches.“Another footballer’s daughter told me that her dad was one of three brothers who were all professional footballers. All three ended up with a brain disease. Also, my dad was the number nine for West Brom. The number nine before him died from Alzheimer’s and the same thing happened to the number nine before him.

“If you look at the 1966 World Cup winning team, Martin Peters, Nobby Stiles and Ray Wilson have all been diagnosed with Alzheimer’s.”If the scale of CTE problems in ex-footballers is to be properly investigated, more brain samples must be donated by families and loved ones of the deceased.

“It’s brutal to see a dad, brother or husband going through these problems. It can be a very distressing time but some are willing to agree to it. Not one person has mentioned anything about suing for compensation. They just want to find out the truth.“It’s the not knowing that drives you mad. Once that person has been buried or cremated it’s too late and they will never know.”

Dawn hopes her upcoming date at FA towers will be a catalyst for change. She would also like to see more measures to protect grassroots players from brain injuries.

“Grassroots football does not have a doctor on the sideline. Kids would carry on playing even if their leg was hanging off so if there is a head collision the choice of whether they come off or stay on, should not be with the parents. It should be in black and white in guidance from the football authorities.”

Investigating CTE in future

Dr Michael Grey, a motor neuroscience expert at Birmingham University, envisages future research into CTE and football as being cross-sectional, ideally following groups of players throughout their careers.

Grey is also hopeful that new research aimed at developing new tests for concussion will lead to greater player safety in future.

“Researchers around the world are looking at blood and urine tests and I think we are going to make some headway soon.

“One thing we’re working on is a breathalyser which could potentially detect concussion.

“Concussion causes brain chemicals known as metabolites, to change. If they get into the blood, as we believe they do, they should then transmit into the lungs and into the breath.

“So we should be able to detect them. We are working on this now but its use in the game could be a few years down the line.”

In terms of better protecting grassroots footballers from concussion, Grey says: “We need better tests that are inexpensive and can be rolled out to every football club across the world.

“We need a physiological test. Tests which rely on the compliance of the person involved don’t always work because players often just want to get back onto the pitch.“In some cases they don’t even realise there is a problem. There are no pain centres in the brain so it is difficult to detect.”