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FA to be warned of ‘risk of future deaths’ over heading in football

Slovakia defender Denis Vavro heads the ball at Euro 2024
Slovakia defender Denis Vavro heads the ball at Euro 2024

A landmark inquest has heard that modern-day footballers may be more at risk of devastating brain disease than past generations, prompting a coroner to consider issuing a “Prevent of Future Deaths” report to football authorities.

In what is believed to be a first of its kind for major sporting governing bodies, the Football Association and the Football Association of Wales have been instructed to provide evidence of their assessments and mitigations into the risks associated with heading.

It followed an inquest for the former Sunderland and Cardiff City inside forward Howard Sheppeard, who died in 2021 after suffering chronic traumatic encephalopathy (CTE), a type of dementia associated with repeated head impacts.

“In this gentleman’s case, there was … as much [CTE] as I’ve ever seen – there was extensive pathology throughout the brain,” said Professor Willie Stewart, a consultant neuropathologist at the Queen Elizabeth University Hospital in Glasgow.

The inquest, which was held last month at Pontypridd Coroner’s Court, had heard that Sheppeard was “football mad” from a young age but experienced memory and cognitive impairment as well as behavioural change following a career spanning around 15 years.

Prof Stewart said that CTE was previously known as dementia pugilistica and associated with boxing but that, over the past 20 years, it had also become evident in the brains of former American footballers, rugby players and footballers. Links have been specifically evident in football to the length of a career and on-field positions in which heading is most common rather than major concussive incidents. “It seems to be the cumulative exposure to repetitive head impacts,” Prof Stewart told the inquest.

Area coroner Patricia Morgan asked about the changes in the material of footballs. Prof Stewart said that the standard weight of footballs had not altered and highlighted how, although synthetic coatings would not hold water in the same way as leather balls, the newer balls moved faster. “So arguably we have anxieties that the modern ball may be even more of a risk than the older ball,” he said, adding that the recognition of head impacts and brain injuries in matches had improved.

Morgan concluded that Sheppeard’s CTE was caused by repetitive head injury sustained as a professional footballer and highlighted her duty to issue a Prevent of Future Deaths report in cases where future risk of deaths has been revealed.

She has now written to both the FA and FAW, who have until the end of the month to provide evidence addressing what steps they have taken “to mitigate against the risk arising from the issue of repetitive head injury as a result of heading the ball”.

Morgan said: “Irrespective of the fact that the material of which a football is made of has changed, the speed at which a ball can travel with has increased and therefore the risk is still live.

“On that basis my preliminary view is that my duty to issue a Prevent of Future Deaths report is still live. However, I am going to preserve that decision and not make a final decision in terms of issuing that report until I’ve had evidence from the FA and the FAW.”

An FA spokesperson said: “The FA was sad to hear of the death of Howard Sheppeard. The FA was notified of the inquest after it concluded, and we are cooperating with the coroner. We continue to take a leading role in reviewing and improving the safety of our game. This includes investing in and supporting multiple projects in order to gain a greater understanding of this area through objective, robust and thorough research. We have already taken many proactive steps to review and address potential risk factors which may be associated with football whilst ongoing research continues in this area.

A Prevent of Future Deaths report would typically highlight the coroner’s concerns and include a section that outlines action that should be taken. The relevant organisations should then provide a response within 56 days.

The FA issued new rules last month which removed heading from under-11 matches. The FAW previously issued guidance which only phases in heading practice from under-12 ages upwards. The FA has also recommended no more than 10 ‘high force’ training headers per week among professionals. The extent to which that guidance is being practically implemented, however, is uncertain. Players’ unions have repeatedly also urged governing bodies to bring in temporary concussion substitutes and reduce the fixture demands on players.

A parliamentary report in 2021 accused sport of “marking its own homework” on brain injuries and criticised the Health and Safety Executive of a “dereliction of duty” in apparently delegating player welfare to “unaccountable” governing bodies. Research in 2019 by the University of Glasgow found that former professional football players were 3.5 times more likely to die of dementia than the wider population and reported no decline in that ratio during more recent playing eras.