When not discussing global health news, NH21 Weekly is partial to a bit of sport chat. Imagine the satisfaction then, of having the opportunity to discuss both in one go!

Albeit, today’s installment begins with the sad story of former England and West Bromwich Albion striker Jeff Astle, who died in 2002 at the early age of 59, after suffering from early onset dementia.

The inquest into his death found that repeatedly heading heavy leather footballs had contributed to trauma to his brain; and there is concern now that more players might be at risk of developing neurological disorders brought on by a type of brain injury called chronic traumatic encephalopathy (CTE), or, prolonged-shock-brain-injury in common tongue. (1)

CTE, which is linked to memory loss, depression and dementia; has been seen in other contact sports such as American football (gridiron), rugby and boxing.

There have been several high-profile cases in recent times, including the hospitalization of 25-year-old boxer Nick Blackwell; who in March 2016 was placed into an induced coma after suffering bleeding in the brain following a title fight defeat by Chris Eubank Jr.

Football is not so overtly a contact sport as boxing; where the British Boxing Board of Control (BBBC) general secretary, Robert Smith, rather alarmingly described Blackwell’s hospital visit as, A very normal procedure. They put you in a coma to get the swelling to go down. There’s no timescale. Now it’s just a matter of waiting and seeing.” (2)

Without professional training, a right-hook from Chris Eubank Jr would instantly kill most people. Yet, it is the slower, insidious nature of progressive and repeated trauma that has led to calls for more public awareness of the dangers involved in competitive sport.

Professional players can kick a football as fast as 70 miles per hour; which according to ‘Law 2’ of the codified ‘Laws of the Game’ (as prescribed by the sport’s governing body FIFA) is, “an air-filled sphere with a circumference of 68–70cm, a weight of 410–450g, inflated to a pressure of 111kPa (kilopascals), and covered in leather.” (3)

Additionally, the weight specified for a ball is the dry weight only; older balls became significantly heavier, especially during the course of a match played in wet weather.

Heading this watermelon-sized, heavy object as it speeds directly towards your face, requires placing the center of the forehead, directly between the eyes, flush in the way of this missile; whilst bracing the entire body against an impact that reverberates down the delicate bones of the neck and spinal column.

Further, in the machismo-world of football, only 100% commitment to the task is accepted; with those found guilty of flinching or avoiding the direct trajectory of the ball considered a liability and dropped from the team.

INFLAMMATION OF THE BRAIN

The nervous system is a network of fibres which permeate the body, coordinating both voluntary and involuntary actions via rapidly conducted nerve impulses. It transmits signals between different parts of the body, responding to changes within the internal and external environment.

The entire body is covered with a dense net of nerves that reach into the deepest aspects of the physical form. The system is arguably the most complex bodily structure; much of which is still largely unknown to medical science today.

The brain receives and processes sensory information, initiates responses, stores memories, generates thoughts and emotions.

The spinal cord conducts signals to and from the brain; and also controls reflex actions when the brains expertise is not required e.g. pulling fingers away from hot objects; or instinctively placing your head in the path of a ball after years of regular practice.

Nerve cells are known medically as ‘permanent cells’ which lose their ability to multiply at around the time of birth and so cannot regenerate once they have been injured or damaged.

Because nerves cannot regenerate, the body goes to great lengths to protect them. The brain has four layers of defence including;

  • Cranium: flat skulls bones encase the brain.
  • Meninges: layers of connective tissue envelop the brain.
  • Cerebro-spinal fluid: acts as shock absorber, also regulates pressure around brain.
  • Blood brain barrier: filters blood of harmful substances.

In any normal situation these mechanisms are sufficient to protect the brain and guarantee its long-term function. Yet there are myriad ‘lifestyle’ factors that can overwhelm these innate defences leading to repeated/chronic inflammation and subsequent loss of function (see NH21 Weekly “New Thinking” from February 3rd, 2017).

The report into chronic traumatic encephalopathy notes that for recreational footballers, injuries are unlikely to cause long-term problems; and as Dr David Reynolds of the charity Alzheimer’s Research UK points out, “the benefits of exercise are likely to outweigh the risks.” (4)

Yet for professional players, and for children with under-developed physical bodies, there are calls for increased education around the risks involved in the sport so many people love; as well as a greater focus of restorative practices after matches and training sessions.

The recovery period after a training session is part of the preparation phase for the next, especially if two or more are planned in a short space of time. Dietary modifications, lymphatic drainage massage and practices such as cryotherapy (short periods in extremely cold chambers) are all known to offset inflammation, and encourage the body to recalibrate after intense exertion.

Physical activity promotes good health, yet over-exertion compromises immunity and damages body tissues. Learning how to balance the two is critical for long term health to occur.

Jeff Astle is a legend of Midlands football, having played more than 400 games for Notts County and WBA, scoring over 200 goals in the process.

Yet his achievements in the game mean little to the family he left behind at such a young age. The hope now is that his story, and those of many other professional athletes, will inspire the next generation of players and coaches to protect their most valuable asset, mental health, as they strive for ‘success’ in the sporting arena.

References:

(1&4)http://www.bbc.com/news/health-38971750

(2)https://www.theguardian.com/sport/2016/mar/27/nick-blackwell-in-coma-title-fight-defeat-chris-eubank-jr

(3)http://www.fifa.com/mm/Document/FootballDevelopment/Refereeing/02/79/92/44/Laws.of.the.Game.2016.2017_Neutral.pdf