English Football Announces New Joint Brain Health Action Plan

The FA

December 6, 2021

The FA, Premier League, EFL and Professional Footballers Association (PFA) have today announced a new joint action plan on understanding, promoting and protecting brain health.

The plan focuses on research, education, awareness and support for players. It will bring together all workstreams and resources to more effectively manage head injuries, and to further understand the links between the game and neurodegenerative diseases.

The organisations have also announced a consultation with key stakeholders which will help shape future work in this important area. Interested parties will be invited to provide their views regarding ongoing research programmes, how to improve heading awareness, knowledge and education of concussion across the game, as well as any additional areas of support that could be given to current and ex-professional footballers.

A comprehensive list of all research supported by football to date has also been confirmed, demonstrating the cross-football commitment in this area.

Our Chief Executive, Mark Bullingham, said: “Understanding the risk factors of neuro-degenerative disease in football is an incredibly complex area of medical science which requires exploration of many different lines of research. Football is working together to try to build a more complete picture by supporting a variety of projects. Until we have a greater level of understanding, we are also reducing the potential risk factors. We have already done this for heading earlier this year by introducing the most comprehensive guidelines anywhere in the world, covering the youth and adult game at all levels. This new joint action plan will further help to build our understanding across English football of this complex area.”

Richard Masters, Premier League Chief Executive, said: “The safety of players is a priority for the Premier League and football’s joint action plan outlines our extensive work to better understand and manage the brain health of current and former players. It is important that football has come together to work collaboratively on this issue. With the help of experts, and alongside other sports with similar challenges, we want to ensure we have the right approach in place to protect the welfare of players.”

Trevor Birch, CEO of the EFL, said: “English football has a collective responsibility to understand and act upon the risk factors of neurodegenerative disease and therefore the EFL is pleased to support the game’s new joint action plan on brain health. By working together in this collaborative approach, we will acquire the information to be better equipped to improve safeguarding measures for those who play football at all levels of competition.

“The EFL and its clubs are committed to making improvements in this vital area and have signed up to the game’s new Heading Guidance and are also taking part in the trial of concussion substitutes throughout the current season in all our competitions which we hope will provide the insight to develop the processes needed to ensure appropriate safeguards are in place going forward.”

Maheta Molango, PFA Chief Executive, said: “The PFA is committed to advocating strongly on behalf of our members while working collaboratively with football’s stakeholders.

“A joined-up approach is essential to improve the health and safety of our current and future members. A coordinated response is also required to provide comprehensive and dedicated support to our former players, and their families, currently living with dementia and other neurodegenerative diseases.

“This is a vital and complex area. It has to be the top priority for all involved in football.”

Several research projects are currently ongoing to understand the links, risks and possible causes of degenerative brain injury in ex-footballers and ensuring the game today reduces the risk of injury.

Research

The FA is supporting a new study starting in 2022 from Glasgow University. The BrainHOPE study, part of the wider Prevent Dementia study, provides an analysis of deterioration of cognitive function in the mid-life of ex-professional footballers to understand potential early interventions which could help reduce risk or speed of developing dementia. This £1.2m investment will run until the 2024/25 season.

We are also partnering with the RFU and Premiership Rugby to expand the Advanced BRAIN Health Clinic, a new specialist clinical service and associated research programme for retired elite rugby players. The expansion to retired football players is due to start operating in 2022.

The clinic will be run by world-leading experts from Imperial College London (ICL), University College London (UCL) and the Institute of Sport, Exercise and Health (ISEH). It will establish a linked research programme that will provide insights into the risk, causes and management of brain problems occurring following participation in elite rugby and football. This £2.4m investment by English football is scheduled to run until at least 2028.

For a full list of research projects, please see below.

Education and Awareness

English football continues to pool its resources to educate the game from grassroots up to professional footballers.

In July 2021, Heading Guidance was introduced across all levels of the game, informed by research which will continue this season. The guidance, which is specifically focused on training sessions where the majority of heading occurs, has been designed to meet the requirements of each level of English football. It has been developed using a precautionary approach to protect player welfare where scientific evidence is limited and will be kept under review.

An initial study last season involving mouthguard technology with players from Liverpool and Manchester City informed the guidance and will now be expanded to include additional teams across the Premier League, EFL and The Barclays FA Women’s Super League (WSL).

In the professional game, the Premier League, The FA and EFL continue to work with clubs to ensure heading guidance is understood by players and appropriately monitored by club staff in real time. To further support players, an expert working group formed by the Premier League is devising Neck Strengthening Guidance. This will provide clubs with an introductory programme which is recommended to be implemented by strength and conditioning coaches.

In the grassroots game, we are working with brain injury charity Headway on a campaign that will seek to improve awareness of concussion and ensure existing guidance is understood and accepted as standard practice. The aim is to launch the campaign later in the 2021/22 season, and we are also looking to provide new support to referees in dealing with concussion.

The Premier League and The FA have also committed to working with Alzheimer’s Society on dementia-friendly stadia. This will include reviewing the Accessible Stadia Guide and ensuring that support for dementia contributes to clubs’ Premier League Equality, Diversity and Inclusion accreditation.

Supporting Players

The safety of and support for current and former players is a priority for English Football.

Currently, all professional leagues in England test players in order to understand their baseline neurocognitive function. This can be used to help evaluate players suspected of having concussion and aid their safe return to sport.

This season, the Premier League has implemented the use of video replays from the Hawkeye system to support the assessment of head injuries. A tablet device provides broadcast feeds to allow the club’s medical staff to view, clip and replay suspected head injury incidents from multiple viewing angles in real time.

Concussion substitute pilots continue across The FA, Premier League and EFL competitions. The organisations will review the results of this pilot at the end of this season and submit their recommendations to IFAB.

The PFA provides extensive support services for former players including individual assessments and triage for families of those living with dementia. The PFA support team provides courses for those families to inform and empower carers.

Grants are available from the PFA Charity towards respite care, care in the home and home adaptations.

The PFA is committed to exploring ways in which its members can be best supported. Designing a suitable support system, including a new Care Fund, will need increased understanding of the number of former players with dementia and other neurodegenerative diseases. The PFA will lead an engagement survey with former players, their families and charities with the football partners to design an appropriate support mechanism for former professional footballers.

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