Credit: AFP

The world-leading expert on dementia in football has called on the authorities to explore removing heading completely from the game and suggested that footballs should be sold with a health warning after major new research into the national game’s risks.

Professor Willie Stewart, whose landmark research previously proved football’s dementia link, has delivered a series of hugely significant new findings, which include no reduction in the risk of brain disease among former professionals who played with new synthetic balls in the 1990s but dramatically increased dangers for outfield players compared to goalkeepers.

The research, which studied the health records of around 8,000 former players and directly followed The Telegraph’s campaign for answers, found that outfield players were almost four times more likely to be diagnosed with neurodegenerative disease.

There was virtually no added risk for goalkeepers but defenders were specifically at a five-fold greater risk, again suggesting that repeated heading and head impacts is the cause of the dementia risk. The studied players were all born between 1910 and 1969 – and played in the period between 1930 and the 1990s – but there were no significant changes in dementia risk according to the era. The leather and synthetic balls are an almost identical weight and, while the old balls did absorb water and then become heavier, this also meant that they were slower through the air.

“We are at a point in this current data to suggest that footballs should be sold with a health warning saying, ‘Repeated heading of a football may lead to an increased risk of dementia’,” said Prof Stewart.

“I would not fall into the comfort zone of thinking modern balls are somehow changing the risks – the risks could actually be higher. Unlike other dementia and other degenerative diseases, we know what the risk factor is here. It is entirely preventable.”

The key findings from Professor Willie Stewart's new research

The University of Glasgow’s research also found that the dementia risk rose according to the length of the professional careers and Prof Stewart believes that it is now time for football’s leaders to consider radical change. “This paper is the missing link,” he said. “If you are in a field position with high exposure to heading the ball and head impact, or you play the game longer, the risk is higher. We can really simply address this and prevent the disease.

“Is heading absolutely necessary for football to continue? That is the question we need to ask ourselves. It is called football, not head ball.”

Prof Stewart cited how rugby has developed different codes, from the full contact 15-a-side game to sevens and touch rugby, and asked why football, especially among children, could not consider its own evolution. “Maybe professionals, with full support from neurologists and medics, and with full knowledge of the risks they are taking can continue to play full contact, heading football,” he said. “But at community and certainly at youth level, we start to talk about a game with no heading. Do we wait 30 to 40 years, or say the evidence now is sufficiently strong to consider a sport without unnecessary head impact? I think we are at that point.”

The Football Association has issued new guidance which limits ‘higher force’ heading in professional football training to 10 a week and only 10 training headers of any type for amateur players. A higher-force header has been defined as those from a pass of more than 35 metres as well as crosses, corners and free-kicks.

Prof Stewart sits on the FA’s Research Taskforce but, despite his expertise, was not consulted before the FA’s new guidelines were drawn up. Of the 10 ‘high force’ header guidance, Prof Stewart said: “To be quite frank this is unscientific guess work. There is no basis on which to say 10 headers of a certain level will somehow produce no risk or even make a great difference to risk.

“It is a best guesstimate and we would have to wait 30 or 40 years to see the impact. In essence football would have to say, ‘we accept a risk of dementia for the next 30 or 40 years to be proven right or wrong’ as opposed to saying, ‘football does not accept the risk of dementia and we have to take more aggressive measures than that’.”

Timeline of football's brain injury scandal

A damning parliamentary report recently accused the football authorities of “marking its own homework” on the issue and called for urgent government intervention.

The Telegraph’s ‘Tackle Football’s Dementia Scandal’ campaign was launched in 2016 and, having initially called for research which established football’s dementia risk, has advocated a series of changes, including heading limits.

In parallel work led by Prof Stewart, a specific disease linked to head impact, known as chronic traumatic encephalopathy (CTE), has been found in a high proportion of former footballers, including 1966 World Cup winner Nobby Stiles and former England international Jeff Astle.

Charlotte Cowie, the chief medical officer of the FA, who part-funded the study, welcomed findings which have “enabled us to make changes in the game”. The Premier League had commissioned a series of studies on which to base the new FA guidance, including mouthguard technology to measure head impacts, an analysis of past matches and a review of existing research by the University of Central Lancashire.

Prof Stewart said that the research was “the equivalent of standing on the side of a motorway to estimate car speeds and then heading into town to talk about road traffic measures in the centre of a city”. He added: “It’s not entirely relevant to what is there.”