The disease that could be about to transform football – and cost the sport hundreds of millions

The former Scotland international footballer Gordon McQueen used to tell a story about his time at Manchester United that, in retrospect, takes on a more than poignant edge. He would recall how he once became exasperated by his then manager Dave Sexton, a coach, he reckoned, who was rather inclined to overthink.

Sexton was going through his plan for a corner and after about 10 minutes of complex, choreographed instruction, McQueen stuck his hand up and said: “Dave, it’s a simple game, football. All you need to do is get someone to cross the ball into the box and I’ll put my big stupid bonce on it and there’s every chance it will go into the net.”

Last week, at the age of 70, McQueen died from complications of vascular dementia. And there is little doubt his condition was exacerbated by spending his working life putting his “big stupid bonce” in the way of a football. In the immediate aftermath of McQueen’s death, the former United manager Sir Alex Ferguson added his substantial voice to a campaign calling for dementia among ex-professional players to be reclassified as an industrial injury. 

Ferguson was one of 20 Scottish football figures who issued a plea to the Scottish Parliament to acknowledge that players had been irrevocably damaged by their job, meaning, in the same manner as those found to have been afflicted by dangerous conditions in mining, manufacturing or the chemical industry, they would be entitled to additional state benefits.

“We, the undersigned, are calling for brain injuries experienced by ex-footballers to be classified as an industrial injury,” reads the statement put out by Ferguson and his colleagues. “We have a generational chance to support those who entertained us in our national game to be given the support they desperately need.”

The really sad news is that McQueen was by no means alone. Of the 11 players who won the World Cup for England in 1966, for instance, six have died of dementia. And Sir Bobby Charlton, one of the two men still alive, is now reduced by the condition.

Indeed, the statistics are brutal. Research has uncovered that professional footballers are three-and-a-half times more likely to develop a neurological disorder than the rest of the population; worse, they are five times more likely to develop dementia. Yet, so far no governing body, no football league, not a single club has acknowledged the link between the game and its devastating aftermath. And no player has yet received any financial compensation or anything by way of apology for being laid low by their profession.

“It is urgently needed,” says Richard Boardman of the specialist injury lawyers Rylands Garth. “It is not just players going through hell. It is their families as well.”

The conventional insistence, however, is that things have changed, that footballers of Charlton’s vintage were brought down by heading heavy, old-school leather balls, which, when soaked in mud and rain, delivered the equivalent of being thumped in the temples by a heavyweight boxer. Except McQueen was playing in the 1970s and 80s, when balls were lighter and made of smarter material.

But research published in 2015 by Eric Nauman, a professor of biomedical engineering at Purdue University, Indiana, found the modern lightweight ball of the kind McQueen got his bonce to, particularly when over-inflated to make it travel quicker through the air, can still deliver a devastating force on the brain.

“If the ball has too high of a pressure, gets too waterlogged, or both, it actually turns into a weapon,” Nauman explains. “Heading that ball is like heading a brick.”

Some players, particularly central defenders such as McQueen, can head the ball up to 80 times in a match. And it is not so much the occasional interaction with a flying missile that is reckoned to cause lasting brain damage. It is the insistent thump-thump-thump of persistent heading practice in training.

When World Cup winner Nobby Stiles died of dementia in 2020, his family donated his brain to the Glasgow Brain Injury Research Group. On opening it up, Dr Willie Stewart, the consultant neurologist leading the group’s research, discovered that Stiles’s brain was irrevocably compromised by chronic traumatic encephalopathy (CTE).

“CTE is a progressive degenerative disease only found in people with a history of repetitive brain trauma,” points out Dr Stewart. “Brain injury and head impacts are the only recognised risk factors. We don’t find CTE in patients with dementia unless there is a story of brain injury or head impacts.”

And Stiles was subject to regular impact doing his job. His son John calculates that, in training and in matches across an 18-year top-flight career, his father headed a football more than 70,000 times. “Dr Stewart told us the damage to my dad’s brain could only be explained by him heading the ball over the sustained period of his career,” he says.

Slowly, incrementally, some of those in charge of the game are coming to recognise the connection between repeated heading and the risk of brain damage. The Football Association has issued instructions to professional clubs to restrict players to 10 “high force” headers per week in training, has advised amateurs not to head the ball more than 10 times per week and, last season, trialled a complete heading ban for players under the age of 12.

But what is most likely to accelerate change is if, as Ferguson would like, dementia was recognised as an industrial injury. “It would be a game-changer,” says Dawn Astle, whose father Jeff died of dementia in 2013 and who is now the Professional Footballers’ Association’s project lead for neurodegenerative diseases in football.

“It would mean that the support available would be properly formalised and centralised,” she continues. “We know it’s a high bar they set [for such classification], so that’s only going to happen if the data and the science is in place to ensure the link can’t be disputed.”

If the condition is deemed to be the result of an industrial injury, those suffering would be entitled to an additional state benefit of £160 per week. So far, the Industrial Injuries Advisory Council – the body that rules on the issue – has not passed judgment, despite having the issue under constant review for the past eight years. It claims it needs more scientific evidence. The council’s usual requirement when making the link between illness and industry is that the workplace delivers double the likelihood of contracting a condition.

“Certain figures in football accept there is a link, that the science is straightforward and inarguable,” says Boardman. “But, as with tobacco interests in the past, there is a widespread fear that full, formal acknowledgement would be a spur to litigation.”

In the US the connection between CTE and the helmet-to-helmet collisions that had long been part of American Football was recognised by science as long ago as 2003. But it took a further 10 years before the National Football League finally reached a settlement of a class action lawsuit brought by brain-damaged former players said to be worth $765 million (£600 million). And it was not until 2018 that the governing body altered its rules to limit helmet-to-helmet hits.

None of that would have happened without relentless legal action. Boardman’s company (that also offers help to rugby players who have been similarly compromised by their profession) is already advising 30 former footballers on a class action case in this country. The football group – which includes the family of Nobby Stiles – is seeking compensation from several organisations, including the International Football Association Board, the body that sets the worldwide rules of the game.

Some would like things to go beyond compensation for past injuries and see the rules of the game significantly modernised to mitigate the dangers. Head for Change, a lobbying body established by Judith Gates, whose husband Bill played for Middlesbrough in the 1970s and is now diagnosed with dementia, held a no-heading trial match at Spennymoor FC in September 2021. Those who watched said the lack of heading was barely noticed.

“We are not looking to snowflake the game away,” says Boardman. “Yes, the science suggests footballers would be at far lesser risk should heading be banned completely. But the risk is hugely lowered by having reduced amounts of heading in training, by ensuring balls are not over-inflated, by adopting proper concussion protocols. That is what we are seeking. And that should be the minimum.”

One thing is for sure, this is an issue which is not going away. Gary Pallister, one of McQueen’s successors at Manchester United, who won several league titles under Ferguson’s direction, was talking recently about his own fear for the future. Although not yet diagnosed with any brain damage, the concern was starkly evident in his voice.

“Most of the time,” he said, “my head feels like it is filled with broken glass.”