The union representing soccer players in the UK is set to unveil on Tuesday a comprehensive protocol aimed at preventing the brain disease CTE, which expands the focus on concussions to include potential damage from the less forceful impacts of heading the ball.
According to the guidelines from the Professional Footballers’ Association (PFA), which advocates for both current and former players in leagues such as the Premier League, the FA Women’s Super League, and the English Football Leagues, professional players are advised to limit their heading of the ball to no more than 10 times per week, including practice sessions. For children under 12, the PFA recommends avoiding heading the ball entirely, as part of a strategy designed to prevent chronic traumatic encephalopathy (CTE) by minimizing head impacts over a player’s lifetime.
“CTE is preventable. Period,” stated Dr. Adam White, Director of Brain Health at the PFA, during the inaugural Global CTE Summit held in San Francisco on Monday, coinciding with the NFL’s Super Bowl weekend.
“Key principles to mitigate this issue include reducing the frequency and force of heading, as well as delaying it until later in life,” White emphasized in an interview with The Associated Press. “These practices can be applied across all sports and represent our best chance to protect current and future players from the same fate as previous generations.”
CTE, a degenerative brain disease, was initially recognized as “punch drunk syndrome” in boxers over a century ago and was first diagnosed in American football players in 2005. It has since raised alarms in other contact sports, such as ice hockey and soccer, as well as among combat veterans exposed to repeated head trauma.
A study conducted in 2017 revealed CTE in 110 out of 111 brain samples from former NFL players. The diagnosis of the disease can only occur posthumously through brain examinations.
While organizations such as the NFL and numerous colleges have implemented concussion protocols that guide athletes on returning to play after head injuries, the newly proposed British soccer protocol is the first all-encompassing strategy aimed specifically at preventing CTE through the regulation of even minor, subconcussive impacts that frequently occur during practice. Chris Nowinski, founder of the Concussion and CTE Foundation, highlighted the importance of addressing CTE prevention in contact sports as being potentially more critical than the management of concussions.
Concerns have also been raised regarding the head impacts sustained by football linemen and the practice of heading the ball by soccer players. Research conducted by the PFA and the Football Association indicated that professional football players in Scotland have a 3.5 times higher risk of developing dementia than the general population. Additional studies on the brain health of former British soccer players have uncovered a significant prevalence of CTE, affecting figures like Jeff Astle, Gordon McQueen, and Chris Nicholl.
“Given what we know today about this disease, it would be irresponsible not to act,” White asserted. “The science is clear, as are the potential solutions, but it requires commitment from sports organizations to prioritize the long-term health of athletes. I am pleased that we are taking such steps in England, and I urge all sports to invest as much, if not more, into CTE prevention protocols as they have with concussion protocols.”
The new protocol includes annual education, research support, and assistance for former players who suspect they may be living with CTE. It follows a CTE prevention framework released in 2023 by researchers from the Concussion and CTE Foundation and Boston University’s CTE Center.
Nowinski called upon sports leagues and their medical advisors to integrate CTE prevention protocols into their practices. “There is now overwhelming evidence linking more head impacts in sports to an increased occurrence of CTE in athletes,” he stated. “While sports administrators may not face the risk of CTE personally, the policies they establish can condemn some athletes to a life afflicted by this disease, ultimately impacting their families. This cannot continue.”