Image: Jeffrey J Lin on Unsplash

How the not-for-profit organisation’s studies have informed the latest concussion in football guidelines.

Despite the football concussion stories that have hit the headlines over recent years, there aren’t any official statistics on concussion rates in professional English football. But this could soon change: New research suggests that football could be linked to an increased risk of brain disease. Amongst this new research, the not-for-profit organisation The Drake Foundation has invested over £2.2 million into studies that investigate the potential links between sports-related head impacts and poor brain health outcomes.

These studies include the following.

Mixed Pathologies Including Chronic Traumatic Encephalopathy Account for Dementia in Retired Association Football (Soccer) Players

In 2017, one of The Drake Foundation’s studies, Mixed Pathologies Including Chronic Traumatic Encephalopathy Account for Dementia in Retired Association Football (Soccer) Players, published its landmark findings. During this study, researchers examined the brains of 14 retired football players for signs of chronic traumatic encephalopathy (CTE). The researchers divided the study into three phases: The first focused on football injury rates, the second examined behavioural changes recorded before death, and the third involved a post-mortem brain examination of six players. The study was the first to identify CTE in retired football players.

The HEADING Study

In 2018, The Drake Foundation launched the ongoing Health and Ageing Data IN the Game of Football (Heading) Study. The research team is working with approximately 200 retired elite footballers (aged 50+) to examine any connections between repeated head impacts and neurodegenerative disease. Participants are undergoing neurological clinical examinations, face-to-face consultations, blood samples, and tests to capture their physical and cognitive capabilities. The study aims to gain a better understanding of the long-term neurological effects that head impacts and concussion in football can cause. The England Men’s team manager Gareth Southgate and former Arsenal and England player Tony Adams are advocates for this study and have encouraged players to participate in the research.

The Drake Football Study

In October 2019, The Drake Foundation announced its most comprehensive study to date: the Drake Football Study. This longitudinal study measures the mental and physical impact of a professional football career on a player. The world footballer union FIFPRO’s chief medical officer Vincent Gouttebarge is leading this research with the Chair of the Department of Orthopaedic Surgery at Amsterdam University Medical Centers Gino Kerkhoffs. The research team will collect data surrounding over 200 professional footballers’ neurocognitive, musculoskeletal, cardiovascular, and mental health over 10 years, covering the players’ transition into retirement. The participating players come from a range of countries, including the UK, France, Sweden, Norway, Finland, Switzerland, and the Netherlands.

The Drake Football Concussion Study

The University of Birmingham and University Hospitals Birmingham NHS Foundation Trust are collaborating to run the Drake Football Concussion Study[CM4] , which involves pro players from the Premier League and uninjured control players. These players are providing urine and saliva samples over several seasons (up until 2023/24). The research team will analyse these samples using the revolutionary microRNA-based Birmingham Concussion Test, which aims to detect biomarkers that indicate brain injuries. The findings from this study could inform return-to-play decisions and could be used in a range of amateur and professional sports.

The FIELD Study

Outside of The Drake Foundation, another study is taking place that could generate more evidence of links between playing professional football and the later onset of neurodegenerative disease: the Football’s InfluencE on Lifelong Health and Dementia Risk (FIELD) Study. The Football Association (FA) announced that it would fund this study in 2017. Led by pathologist Dr Willie Stewart, the study analyses data from Scottish medical records to examine whether degenerative neurocognitive diseases are more common in ex-professional footballers than in the average population. The latest findings from this study have revealed that retired footballers in Scotland are 3.5 times more likely to die from brain disease than non-footballers of a similar age and background. The study is continuing to publish more data about disease risk, mental health outcomes, and risk vs playing position.

New Concussion in Football Protocols

As a result of increased public attention and the ongoing results of these studies, leading football bodies and organisations have started to make changes that aim to minimise football-related head impacts.

The Football Association

In June 2020, the FA updated its heading guidance for youth football in association with the Scottish and Irish FAs. The new guidelines cover all ages, from under-6 to under-18 groups. The amendments include a ban on heading in training at foundation phase level and a gradual introduction of heading between the under-12 and under-16 age groups.

In July 2021, the FA updated its heading guidelines again, this time at all levels of professional and amateur football in England. Players can now perform a maximum of 10 ‘higher force’ headers during training each week, and clubs should create player profiles that detail each player’s gender, age, position, and the number of headings they should perform per match.

Although English football doesn’t currently permit concussion substitutes (unlike cricket and rugby), in January 2021, the FA announced that it had successfully applied to the International Football Association Board (IFAB) to introduce additional permanent concussion substitute trials. These trials started in the Premier League in February 2021 and were originally due to run until the end of the season. The trials have now been extended to the 2021/22 season. As of October 2021, the trial extended to all Premier League reserve and youth-team matches. Trials are also taking place in the Barclays FA Women’s Super League, FA Women’s Championship, and Emirates FA Cup.

FIFA

FIFA, football’s governing body, endorses the Return to Play criteria, which recommend that players should spend at least six days recovering from a concussion. FIFA also follows the concussion diagnosis and treatment guidelines that were established at the 2012 International Conference on Concussion in Sport.

Following IFAB’s approval of protocols for concussion substitutes in January 2021, FIFA announced that it would trial “additional permanent substitutions for cases of actual or suspected concussion” at the FIFA Club World Cup. After this trial, FIFA followed up that it would explore concussion substitutes “in as many competitions as possible to support the research” before considering proposals to update the Laws of the Game. By March 2021, England, Portugal, Japan, the Netherlands, and the U.S. had trialled concussion substitutes.

About The Drake Foundation

The Drake Foundation provides funding for collaborative sports science research that will pave the way for healthier sports practices. The Foundation has funded several studies that examine concussion in football and the potential links between sports-related head impacts and neurodegenerative disease. This is a special area of focus for the Foundation’s founder and chairman James Drake, who launched the philanthropic organisation after witnessing players sustain serious head injuries during sports matches and deciding that something needed to change.