English soccer union wants fewer headers for pros, and none for kids, to protect players’ brains

BOSTON (AP) — The union representing English soccer players has created the first comprehensive protocol for preventing the brain disease CTE, expanding the heightened concern over concussions to include the damage that can be caused by the less forceful blows from heading the ball.

The guidelines from the Professional Footballers’ Association, which represents current and former players in the Premier League, the FA Women’s Super League and the English Football Leagues, recommend no more than 10 headers per week – including practice – for professionals. Children under 12 shouldn’t head the ball at all, the PFA said, part of a chronic traumatic encephalopathy prevention protocol designed to reduce head impacts across a player’s lifetime.

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“CTE is preventable. Period,” Dr. Adam White, Director of Brain Health at the PFA, said on Monday in describing the protocol at the first-ever Global CTE Summit, which was held in San Francisco while the NFL descended on the Bay Area for Sunday’s Super Bowl.

“It is the principles of less heading, less force, less often and later in life that matter,” White told The Associated Press. “These could apply to any sport and are the best hope we have of stopping current and future players from the same fate as former generations.”

Speakers at the summit included researchers, former athletes and lawmakers; those in the virtual and in-person audience also included family members who witnessed the dangers of CTE, which can cause memory loss, depression, violent mood swings and other cognitive and behavioral issues.

“This might be the most underreported public health challenge in the world right now,” former U.S. Surgeon General Richard Carmona said. “CTE prevention requires courage – the courage to change tradition, the courage to confront denial, and the courage to put long-term health ahead of short-term gains.”

The degenerative brain disease now known as CTE was studied in boxers more than a century ago as punch drunk syndrome and first diagnosed in American football players in 2005. It has since become a concern in ice hockey, soccer and other contact sports and among combat veterans and others who sustain repeated blows to the head.

A 2017 study found CTE in 110 of 111 brains donated by former NFL players. The disease can only be identified posthumously through an examination of the brain.

NFL Hall of Famer Warren Sapp, speaking about an hour away from Levi’s Stadium on the day of the Super Bowl’s much-ballyhooed Opening Night, said attention shouldn’t just be on professionals, who are at least compensated and able to make informed decisions about the risks of playing a dangerous sport.

“It’s our obligation to the game to make it better,” he said. “It’s how we apply it to our children and the age that we give it to them.”

The NFL, college football and many other sports have instituted protocols that guide teams and athletes on returning to play after sustaining a possible concussion.

But the English soccer protocol is the first comprehensive plan to combat CTE by addressing the less dramatic, subconcussive blows that can be common in practice, according to Chris Nowinski, the founder of the Concussion and CTE Foundation.

“For contact sports, CTE prevention protocols are equally important and possibly more important than concussion protocols,” he said.

Among the more recent concerns are the routine head hits sustained by football lineman, and those from soccer players heading the ball. Research funded by the union and the Football Association found that Scottish pros have a risk of dementia that is 3.5 times greater than the general population; studies of brains from British soccer players found the majority had CTE, including Jeff Astle, Gordon McQueen and Chris Nicholl.

“With what we know today about the disease, it would be a failure to our players to do nothing,” White said. “The science and solutions are clear, it just takes willingness from the sporting bodies to put athletes’ long-term health first and I am pleased that we have been able to do that in England. I encourage all sports to put as much, if not more, effort into CTE prevention protocols as they have concussion protocols.”

The protocol also includes annual education, support for research and care for ex-players who suspect they are living with CTE. It follows the publication of a CTE prevention framework published in 2023 by researchers assembled by the Concussion and CTE Foundation and Boston University’s CTE Center.

Nowinski called on sports leagues and their medical advisors to adopt CTE prevention protocols.

“There is now overwhelming evidence that more head impacts in sports will result in more athletes with CTE,” Nowinski said. “Sports administrators aren’t risking CTE themselves, but the policies they set are sentencing some athletes to a life with CTE, a burden that will primarily be carried by their spouses and children. Enough is enough.”