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Football’s Last Taboos: Part 5 - We need a discussion about concussion

We need to talk about the issue of concussion in sport - it could be a matter of life and death.

England Captain's Run Photo by David Rogers/Getty Images

One of my most treasured memories takes the form of a simple gift I received for Christmas in 1991 from my sports enthusiast father. It’s was a VHS (betamaxs’ were for weirdos right?) video cassette entitled ‘Champions Forever.’

A young teenage me - several pounds lighter and many years younger unwrapped this surprise video on Christmas morning – first filmed in 1989- it’s a documentary based on the sporting heroism of five legendary pugilistic icons. Gathering together for the first time in decades for this one off special were Heavyweight greats, Kenny Norton, Larry Holmes, George Foreman, Joe Frazier and the most legendary of them all, Mohammed Ali.

Imagine my boyish happiness in owning and watching a documentary about fighters I had not seen in person, but had heard all about in whimsical tales from my nostalgic father. I still own a DVD copy of that boxing special today and for sports geeks interested in history I highly recommend it.

Sports Illustrated Tribute To Muhammad Ali At The Muhammad Ali Center
Definitely Champions.
Photo by Stephen Cohen/Getty Images for Sports Illustrated

But one negative aspect of the hugely fascinating piece of sporting memorabilia, that I still clearly recall, decades after my first viewing of these fabled boxing icons, is my reaction when I heard them speak. Ali as we know had a well-chronicled battle with Parkinson’s disease and his speech was an unfortunate mixture of mumbles and whispers as is familiar with those suffering from that debilitating condition.

Joe Frazier while physically animated was beset by slurred and difficult to comprehend speech that you carefully had to analyse before fully understanding. Kenny Norton likewise, but he had suffered a near death experience in a road traffic accident some years before, and his elongated, rambling speech could be a result of that terrible event. Even Holmes while perfectly understandable had a slurry tinge to his voice. Only Foreman of the five of these fantastical specimens of athletic glory spoke eloquently with concise clarity.

It worried me, even as a kid. It made me acutely aware of the real and present danger that an individual sportsman or woman puts themselves in whenever they participate in a sport where they quite literally offer their heads as tools to use and be used in their chosen competitive discipline. In the case of boxing we witness perhaps the most extreme example of a sportsperson taking consistent and forceful impactful blows on the head. But in many sports including football we’ll all be familiar with the glorified phrase, ‘he sticks his head in where it hurts.’

We sports fans use this jargon as a form of well-meaning compliment and I completely understand why. This terminology is a sign of respect - a verbal means by which we can show our admiration for a sportsperson’s courage and intense physical commitment. Sometimes, as in the case of Lewis ‘Mad Dog’ Moody - former England rugby captain and World Cup winner - we marvel at the irrational bravery of an athlete who is so courageous he belies the normalities usually associated with regular bravery - hence the lovingly bequeathed moniker of ‘Mad Dog.’

England v France - IRB RWC 2011 Quarter Final 2
Mad Dog.
Photo by David Rogers/Getty Images

But even when we believe a competitor’s bravery belongs outside of the acceptable uniformity of sporting combat, we continue and in many ways rightly so, to warmly accept this person into our hearts - like a hardened warrior who represents the very passions of their fans on the field or in the ring.

We recall such incidents of beautiful and ludicrous courage and hold them in such high esteem that the affection never ends. As in the case of Sunderland keeper Chris Turner breaking his jaw in the 7th minute when we played Man Utd in 1981 and playing the rest of the 83 minutes with a fractured face! Or red and white tractor John Kay who, when playing against Birmingham City in 1993, broke his leg and instead of writhing in pain, sat up on the stretcher and pretended to row it off the pitch. We love it and we love them for it.

Just three months before his fight with Larry Holmes in a fight billed as The Last Hurrah an ageing and declining Ali had undergone a two-part physical amid concerns by the Nevada Athletic Commission for his overall health. In his report, Dr. John Mitchell, tasked with checking Ali's organs, concluded the boxer appeared to be in "excellent general medical health." However, the neurological exam was not as uplifting.

Indeed its results were disturbing considering the fight itself and the long-term aftermath: Dr. Frank Howard found Ali was having difficulty speaking, hopping on one leg, and touching his nose with his finger. Yet, undoubtedly under pressure from the power brokers of the fight game, a boxer who showed obvious signs of cognitive frailty and clear evidence of dulled senses, indeed a fighter who could not place his finger on his nose was given the green light to participate in a fight with a young, hungry champion who’s physical prowess was at its peak.

This set the stage for a brutal fight that never should have happened in the first place. It shouldn’t have even been a debate- Ali should have been protected from the fierce nature of the sport, his own physical limitations and his own innate desire to compete. But he wasn’t. For you historians out there or for those old enough to remember, Ali had no reflexes that night, he landed only 10 punches and was sadly reduced to a human punch bag by the herculean Holmes who smashed him from pillar to post.

In later years Ali would identify that fight as a potential source of his Parkinson's. But in the years since his 1984 diagnosis there are still as many questions as answers surrounding sporting head injuries and degenerative brain disease. However, thanks to wise investment and innovative scientific analysis, the answers will soon outweigh the questions.

Muhammad Ali of the USA
Ali struggled with the effects of Parkinson’s.

The subject of Chronic Traumatic Encephalopathy is now one of the hottest topics in global sporting competition, and one of sport’s biggest taboos. Taboo because the ramifications of tackling this issue could potentially have a defining, transformative impact on sporting disciplines we all know and love. Quite literally human lives and billions upon billions of pounds are potentially at stake over this issue.

Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in people with a history of repetitive brain trauma (often athletes involved in contact sports), including symptomatic concussions as well as asymptomatic sub-concussive hits to the head that do not cause immediate symptoms but have lasting effects.

My old mate and former Sunderland keeper David Preece wrote a beautiful, melancholic and almost mournful piece about his experiences with the issue of concussions in football and how the scientific findings and breakthroughs of CTE research have left him reflecting on the possibilities of the long term effect of such brain trauma. I’ve known David since infant school and his old man David Sr, a quality amateur goalie in his day is still the best keeper I’ve seen perform in a lads vs dads game circa 1987. Preecey is a great lad and wears a beard much better than I, which irritates me profoundly. When I read his article regarding CTE it hit home at the personal nature of such injuries and the inner soul searching a sportsperson must experience after they’ve laced up for the last time.

It’s only now when I look at the symptoms across all four stages of CTE that it’s become a worry. They include attention deficit hyperactivity disorder, memory loss, social instability, impulsive behaviour, poor judgment, with the latter stages resulting in progressive dementia, depression and suicidality. And now the fear is real, you’re left without the justification to ignore the dangers. There are no training sessions to get through any more. No games left to excuse the idiocy of putting football before my long term health. Just the unwelcome thought that it might not be just age that’s stopping you from remembering things and there might be a reason why you aren’t feeling your usual self.

I don’t profess to be David’s best mate nor do I have some overtly brotherly connection to him, but he’s someone I’ve known for nearly 40 years. His words moved me.

But I’m just an old school pal. Imagine the emotional entanglement of an athlete’s child, partner, spouse or parent who could witness their loved one decrease in cognitive ability, slow down into a dwindling shadow of their former selves or in the worse-case scenario: suffer from a severe degenerative brain disease?

Wouldn’t that sportsperson and their most precious loved ones deserve some accountability for the lack of support and awareness surrounding an issue that can literally be the difference between life and death? If you haven’t read David’s article you should - it’s enlightening and brutal. He gives a modern, fascinating insight into the life of a professional footballer whose body, and head, are part of the physical toolkit required to compete.

For a fine example of an animated but-long suffering loved one moved by the tragic early death of her father, then look no further than the inspirational Dawn Astle. Daughter of former West Brom legend Jeff Astle, she now campaigns tirelessly for the Jeff Astle Foundation - a charitable organisation inspired by her father’s early demise caused via complications linked to degenerative brain disorder.

On the 19th January 2002, Astle died at his daughter's home aged only 59. The cause of death was a degenerative brain disease that had first become apparent almost five years earlier. Jeff, a former England international and known by West Brom supporters as ‘the King,’ had often been described as an outstanding header of the ball.

The coroner investigating Jeff’s death found that the repeated and consistent traumas to the brain had been the cause of his death. Sadly this is not the not the first case of a footballer's illness or death from Alzheimer's or dementia that has been directly connected to heading footballs. Another example is former Tottenham Hotspur captain, and footballing luminary, Danny Blanchflower who died of Alzheimer's disease in December 1993. Amazingly, a verdict of death by industrial injury was recorded.

In 2014, the Justice for Jeff campaign was launched, calling for an independent inquiry into a possible link between degenerative brain disease and heading footballs. Subsequently, West Brom’s King was confirmed as the first British footballer known to have died as a result of heading a football. In the same year it was claimed by a neurosurgeon that Astle had died as a result of chronic traumatic encephalopathy (CTE), a disease previously associated with boxers such as the most fabled of all professional athletes, the greatest - Mohammed Ali.

West Bromwich Albion v Swansea City - Premier League
The Jeff Astle gate.
Photo by Julian Finney/Getty Images

Earlier this year Jeff’s daughter Dawn walked out of a meeting with PFA chairman Gordon Taylor because of his refusal or inability to answer a simple question:

Do we have a problem with former players and dementia?

In her own words she continues:

He's the head of an organisation that's whole existence is player welfare yet he can't answer the simple question... This is killing their players yet he never gives you an answer.

In Mr. Taylor’s defence he has declared:

I can only assure her we are doing all we can on this issue. It's a serious issue and it's not just us who needs to find out the causes to this particular problem. It's an issue for the whole of society and an item very much high on our agenda.

Perhaps tragically and shockingly in equal measure is the fact that Dawn Astle and her family’s foundation has been approached by over 300 families of ex-players with head injuries and degenerative brain disease thought to be linked to their football careers. At first I found that a staggering number but research shows it could be the tip of the iceberg.

Across the pond, our American cousins in the NFL have spent millions of dollars in research as a consequence of billion dollar law suits filed by former players and their families who believe their lives have been indelibly blighted by the scourge of CTE as a consequence of sporting head injuries.

Currently 111 of these forlorn and desperate families have donated the brain of their deceased loved ones to this in-depth and pioneering exploration. The researchers at Boston University have made ground-breaking progress, and their research from July this year suggests the correlation between football and the disease is overwhelmingly strong.

Of the 111 brains of former NFL football players, 110 showed the presence of CTE. That’s 99.2%. So to put this in perspective 9 out of 10 former gridiron players tested were found to show clear evidence of CTE - compared to the general population where research shows that only 1 out of 16 over the age of 65 suffer from similar brain degenerative disorders.

Dr. Bennet Omalu, Who Discovered CTE In Ex-NFL Players, Holds Briefing On Capitol Hill
Dr. Bennet Omalu who discovered CTE in former NFL players.
Photo by Pete Marovich/Getty Images

I mention age because it’s significant. The findings suggest that the presence of CTE begins early for American football players. Researchers believe that according to the sequence of their research that 3 out 14 football players in High School will show signs of CTE.

Of course I don’t expect the findings in our version of football to be anywhere near as high as a sport that relies so spectacularly on huge and destructive contact. But as a sneaky, part-time NY Giants fan, I am alarmed at the sheer ferocity and scale of the findings this study has produced.

I also love my rugby which is just as impactful and forceful on the body as any contact sport in the world. Dr Willie Stewart, of World Rugby's Independent Concussion Advisory Group, says the governing body's attempts to tackle the issues around brain injuries have had little effect. He ventures, that the number of players suffering concussion at the top level is "unacceptably high" and warns the volume of injuries per match is making rugby "virtually unplayable".

This is a world renowned expert in brain dysfunction and concussion describing the sport he’s been asked to review as: "virtually unplayable".

And this is how significant this research is. This is how much studies, investigations and probes into CTE could ultimately change the landscape of contact sports forever. The traditionalists out there will reasonably claim that we’re a health and safety obsessed, politically correct controlled nation of liberal nit wits who’ve banned conkers and now want to ban sport altogether. That’s not what I’m suggesting or anywhere near what I want. But what I do know is that sports fans can’t make the call on how to protect their heroes, or when.

New Zealand v Australia - Final: Rugby World Cup 2015
Fans can’t decide how to protect the ones they idolise.
Photo by Phil Walter/Getty Images

Because when that sportsperson goes home, bloodied and broken, it’s not the fans who pick them up or wipes them down. We don’t have to worry about their mortgage or their kids, or how easily they can manipulate their tired bones to kiss their partners goodnight while they hold a permanent ice-pack against their skin to sooth whichever part of their body aches that day.

As much as we love them, we are not best placed to advise them when to hold back, when to complain of headaches or blurred vision, or when they should not compete at all. We’re too narcissistic for that!

Nor can our feted and gallant idols be relied upon to make the call themselves as their inner-selfishness to be the best and to carry on till the last drop of sweat has fallen is more intense than we could ever know. Many have played on with concussion putting their futures at risk. Likewise the coaches, owners and agents that all have a vested interest in maximum effort regardless of the cost. But accountability and duty of care must be crucial components to a competitor’s life- every bit as much as it is in ours.

They are not circus performing seal-lions happy to bend to the will of others for a fish. They’re human’s with families, with emotions, with responsibilities that can be directly impinged by head injuries long after the bang on the head was ever received. Science and medical advancements must act to preserve and safeguard these amazing men and women who serve up some of the best memories of our lifetimes and the sport’s governing bodies must be brave and take all necessary precautions to protect the players, the fighters, the jockeys or whoever it maybe who put their heads on the line for our enjoyment.

The FA have gladly taken action with their ‘If in doubt, Sit them out’ campaign, where Footballers who sustain a suspected concussion, either during training or in a game, should immediately be removed from the pitch and not allowed to return until the appropriate treatment has been administered. A genuine step on the right direction.

I know Bill Shankly famously proclaimed:

Some people think football is a matter of life and death. I assure you, it's much more serious than that.

I’m sorry Bill. But it just isn’t.

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