Professional sport is under increasing pressure from ex-players, politicians and advocates to confront the long-term dangers of brain injury caused by repeated head impacts.
In football, a Columbia University study published earlier this week suggested that amateur players may sustain structural brain changes from routine heading.
The study found that the damage leads to concerning cognitive deficits.
Study leader Michael Lipton, MD, PhD is professor of radiology and biomedical engineering at Columbia University Vagelos College of Physicians and Surgeons.
He said: “What’s important about our study is that it shows, really for the first time, that exposure to repeated head impacts causes specific changes in the brain that, in turn, impair cognitive function.”
A second study from Lipton’s lab used a different imaging technique to look at the brain and found related damage in the same area.
Lipton said: “The fact that both techniques, looking at two different features, find the same association strengthens our conclusion that these changes are mediating heading’s cognitive effects.”
The study comes as the UK Government moves to introduce new regulations to support ex-players diagnosed with brain conditions.
Amendments to the Football Governance Bill would treat conditions caused by heading footballs as an “industrial injuries issue.”
Ex-players including former Liverpool and England player Neil Ruddock lobbied MPs in Parliament in May this year.
Ruddock said at the time: “A professional footballer, greatest job in the world, but no one knew the dangers, and that’s scary.
“Every time someone heads a ball it’s got to be dangerous to you.
“You know, I used to head 100 balls a day in training. I didn’t realise that might affect my future.”
A 2019 study, jointly funded by the PFA and the Football Association (FA), revealed that footballers were three and a half times more likely to die from neurodegenerative diseases compared to non-players of the same age.
In January, David Beckham supported a campaign urging football authorities to provide better care for former players living with neurodegenerative diseases.
The issue is even more stark in rugby, where tackles, rucks and scrums are integral to the game.
Two studies published in July this year found that retired professional rugby players showed changes in their brains and elevated levels of proteins in their blood that may increase the risk of developing dementia later in life.
In a study of 200 former professional rugby players (aged 30–61), researchers from Imperial College London, University College London and the UK Dementia Research Institute found no cases of early-onset dementia.
However, some players did exhibit higher levels of key brain markers, which could be early signs of neurodegeneration and a potential increased risk of developing dementia in the future.
Dr Thomas Parker, NIHR Clinical Lecturer, from the Department of Brain Sciences at Imperial College London, said: “This study highlights the significant brain health concerns of individuals who have played rugby at the elite level.
“These findings support the introduction of larger scale brain health screening programmes for former athletes exposed to head impacts.
“This will help us to better understand the long-term outcomes and provide the appropriate care to these individuals.”
In August this year, a prominent New Zealand rugby player and a vocal advocate for closer study into the connections between concussion and long-term brain injury, died at the age of 39 of a suspected suicide.
Shane Christie had a history of concussions and was forced to retire from the game in 2018 as a result.
Christie suspected he might be affected by Chronic Traumatic Encephalopathy (CTE), a degenerative brain condition that has been associated in the US with several suicides among NFL players.
In 2013, the NFL reached a settlement with more than 4,500 former players for an initial US$765 million, which grew to over $1 billion in approved claims by 2023.
The settlement aimed to compensate former players who developed brain injuries, including CTE, during their careers.
However, recent investigations have highlighted serious issues with how the settlement has been managed, including unreasonable delays and denial of compensation for some former players.
In 2021, the NFL also agreed to eliminate race-based adjustments in dementia testing, which critics argued had made it harder for Black retirees to qualify for settlement payments.
With links to CTE, Alzheimer’s an other neurological disorders increasingly hard to ignore, professional bodies have little choice but to find new ways to mitigate risks and support players, both during their careers and in retirement.
Meanwhile, the next generation of young players may already be asking: Is it worth the risk?
