“Many specialists mix heading game and concussion”, specifies the medical director of the FFF

“Many specialists mix heading game and concussion”, explains to AFP Dr. Emmanuel Orhant, medical director of the FFF, author of a study on the causes of death of ex-footballers (1968-2015) in France, the first in a major championship.

What are the main statistical lessons of your study?

Firstly, there is a lower mortality of professional footballers in France, whatever the age of death. This goes in the same direction as the previous studies of the International Olympic Committee or of (Daniel) Mackay in the Scottish Championship. Second, it protects against cancer and cardiovascular disease. Third — and this is the least positive thing — there are more neurodegenerative diseases. By comparing with the population of the same age and same sex, the risk of having dementia is multiplied by three (3.38, editor’s note) and by four the risk of having Alzheimer’s dementia (4.08, editor’s note) especially.

Have you been able to identify the causes of this excess mortality linked to dementia?

This has been observed in contact sports such as boxing, ice hockey or American football. Concussions and violent trauma may be the cause. Many specialists, mixing heading and concussion, will say that it is because of the heads. But based on our study, it’s believed to be a violent contact problem and not a head game. The longer the career, the lower the risk of dementia. (…) If it was the head games, gradually it would increase according to the duration.

What is the position of the French Federation regarding heading game?

Three groups of federations oppose each other. The English, Scottish and Irish have banned heading the game in training for the under-12s in 2020. In matches, on the other hand, they hit when they want… Two years later, what has changed? We do not know. We do not know if the rule is followed in small clubs, we just know that the approach was welcomed by British public opinion. The second group is Germany with this discourse, which is true: ‘no scientific demonstration says that head games are dangerous’. Their approach is to reduce the size of the balls, their swelling, the size of the field and the goals and above all to strengthen the muscles of the neck and learn to make heads, authorized without restriction. Playing the head causes small instant scars — you see it on neurocognitive tests or MRIs — but doing the same test a week later, it’s back to normal. At a general scientific level, there is no evidence of a direct or indirect link between head game and neurodegenerative diseases. France belongs to the third group: we don’t know, we continue to work. Lots of work is being done at the DTN level to find out the involvement of the heads in children, for example.

Concussions seem to worry you more than head games…

Since 2015 at the FFF, we have implemented a sixth replacement in the event of a concussion. Every time a player has a concussion, he has to pass an expert twice. We are the only ones in Europe to have implemented this protocol. We are protecting ourselves against hard play and concussions because, in this case, we are 100% sure that it is the cause of neurodegenerative diseases.

Can the conclusions of your study lead to changes in protocols and practices?

Over the period 1968-2015 examined, there were many more violent contacts, the balls were not the same, the training sessions and the intensities either, the players also had a second job from time to time. We are talking about another football, the rules of the game have changed. Since 2016, going into contact with the elbows to protect yourself is sanctioned with a red card. In Germany, a study showed that there were 20% less concussions in the three years that followed. The ideal would be to do the same study in 25 years, we will see that football has changed a lot.

Mathieu Idiart with AFP RMC Sport journalist

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