Some of football’s most iconic moments have involved players heading the ball, but as millions tune in to the World Cup, there is renewed pressure on Australia’s governing body of the sport to limit the practice linked to dementia and chronic traumatic encephalopathy (CTE).
The Professional Footballers of Australia (PFA) and a concussion expert are calling on Football Australia to delay training children to head the ball until they are older, limit the number of high-force headers players do a week, and introduce stronger measures around concussion.
It comes as FIFA, the governing body for the sport globally, has developed an on-pitch concussion assessment protocol, with an Australian-led research team behind the test.
The aim of the test is to provide a more uniform approach for professional leagues around the world, and involves researchers sending questionnaires to medical staff with recent experience in FIFA-associated leagues, then using their responses to develop the assessment.
A study is underway to determine whether the test works in real-world settings.
Earlier this week the ABC’s Four Corners program revealed 33 former AFL players had died with CTE, a figure six times higher than previously thought.
Neuroscientist Alan Pearce said concussion was not the only issue facing soccer players, with concerns players could develop dementia, motor neurone disease and CTE.
“What we’ve found in overseas soccer players in the UK in particular is chronic traumatic encephalopathy or CTE,” he said.
Alan Pearce predominantly studies sports-related head injuries. (ABC News: Billy Draper)
Professor Pearce, who is the founder of Concussion Legacy Foundation Australia and works for the Australian Sports Brain Bank, said there were also concerns about the repetitive act of heading the ball, which affects the electrical function of the brain.
“Heading the soccer ball doesn’t necessarily create a concussion, but some people do experience a slight headache if they’re not heading the ball correctly,” he said.
“We do know that the sub-concussive nature of heading can release this protein called tau that can lead to toxicity in the brain towards dementia and also chronic traumatic encephalopathy.
“So this is the concern that we have, not necessarily just with one header in the game … occasionally, but rather when players are doing multiple headers in practise, and they’re doing it at every practice, every week, over a number of years.
“I think the concern that we have here in Australia is the fact that if players are heading the ball repetitively, they’re at greater risk of CTE.”
There has long been a debate in research and the community about whether children should head the ball, and whether the act of heading the ball can definitively be linked to neurodegenerative diseases.
Researchers previously told the ABC it was difficult to determine the long-term impact of sub-concussive head knocks from heading because it cannot be differentiated from more severe head knocks a player can experience.
Experts have raised concerns about the repetitive nature of heading the ball in football. (ABC News: Geoff Kemp)
Push for ban for Australian kids to follow overseas moves
Following the threat of a class action, children under 10 in the US were banned from heading the ball in 2015, with the practice limited for those aged between 11 and 13.
In the UK, heading the ball was banned for children under 12 in 2020 following a Glasgow University study that showed former players were three times more likely to die from neurodegenerative brain disease than non-footballers, although the findings did not establish a causal link.
Some want heading the ball restricted among the sport’s youngest players. (ABC News: Curtis Rodda)
Following the changes in the UK, the governing body, then called Football Federation Australia, told media it would review its guidelines in light of the developments in 2020.
A year later, Football Australia convened an expert medical group to respond to the British changes and, at the time, recommended children in the under 14 to 17 age range develop the skill, according to media reporting.
When asked what the outcomes of the review and expert committee were, and what the current guidelines are, a Football Australia spokesperson told the ABC the organisation had released an updated guideline on concussion last year.
The guidelines, which are aligned with the Australian Sports Commission and Australian Institute of Sport’s guidelines on the issue, “provide clear guidance and advice on how to identify the signs and symptoms of sports-related concussion (SRC) and to effectively respond and manage a grassroot player’s return to training and competitive football,” the spokesperson said.
The spokesperson said it has established an expert project team to “look at strategies to reduce the incidence, magnitude and burden of heading in youth football, commencing with a comprehensive literature review”.
PFA chief executive Beau Busch is calling for Australia to introduce similar measures where heading would be banned for those under 12, and also limiting the amount of high-force headers professional players do in training and matches.
Beau Busch wants proactive steps taken to address risks around heading the ball. (ABC News)
The players’ union is also calling for temporary concussion substitutes to be brought in so players suspected of a concussion can be assessed off the field by a doctor.
“We really think here we shouldn’t wait for a further crisis,” Mr Busch said.
“We shouldn’t wait for more players to come forward.”
Former England striker Jeff Astle was the first high-profile case of a player having been diagnosed with CTE, 12 years after his death in 2002.
In Australia, there is no known confirmed case of a former soccer player having been diagnosed with CTE.
Currently, the degenerative disease can only be diagnosed after the person’s death upon their brain being studied, which is why the Australian Sports Brain Bank is imploring former players to pledge to donate their brains to help further research in the area.
No cases of former soccer players later diagnosed with CTE have been recorded in Australia. (ABC News: Mark Rigby)
“We’re not really sure why FA haven’t really followed the international leads because we’ve been advocating for reducing exposure risk across a number of sports and that includes soccer heading for a good five to 10 years now,” Professor Pearce said.
“We shouldn’t have to wait until we get a case of CTE in Australia before the national sporting organisation acts upon it in a reactive manner.
“So I would be imploring FA now to be really putting a precautionary policy in place to, you know, to stop any future cases now.”
‘Pragmatic approach’ amid still-emerging science
APIA Leichhardt Football Club first brought in a ban for under-12s heading the ball in 2020, noting the overseas studies linking brain disease to head injuries.
Junior development program head Rick Montrone said while the club is not necessarily still enforcing a ban, it does not include heading in its curriculum for the under-12 cohort, and does not train the age group to do headers.
“We don’t train them, and we don’t encourage them to head in training or in games,” he said.
“We’ve taken a pragmatic approach to the guidelines that are there.
“We think in terms of the way that the kids train, it’s much better for them to focus on their skill and their development, their ball skills, rather than something that happens very rarely in a game.”
APIA Leichhardt Football Club’s Rick Montrone says his club doesn’t train under 12s in heading the ball. (ABC News: Simon Amery)
He said the club had taken the policy in light of the emerging science linking long-term injuries to heading at a young age.
“We ensure that we teach them skills first for using their feet and using other parts of their body rather than physically using their head,” he said.
Individual clubs have been making their own calls in relation to young soccer players and teaching heading the ball. (AAP: Joe Castro)
Later, when children hit their early teens, the club focuses on teaching proper technique and limiting the number of headers per training session.
“We recognise that heading is part of the game, it’s been part of the game for a very long time,” he said.
“So we can’t say that we’re not going to have headers all the time or we’re going to have headers and completely ban them.”
While the PFA doesn’t represent non-professional players, it said it should not be left to individual coaches or clubs, who are often volunteers, without national guidelines.
“There should be a national approach to this at all levels of the game,” the organisation said.
