Leading medical adviser echoes the PFA in calling for a reduction of heading in training

One of the FA and Premier League’s own medical advisers on Saturday night followed the PFA in saying it would be sensible to reduce heading in training.

The intervention of Professor Tony Belli – a world-leading expert on traumatic brain injury who runs the Birmingham Sport Concussion Clinic – is significant as he acts as an independent adviser on concussion to the football organisations who must now decide whether to implement the PFA’s recommendation.

Belli said: ‘I am not a football coach, but from a medical point of view you need to ask yourself whether long heading sessions are absolutely necessary.

‘It still needs to be established conclusively, but it is possible that heading the ball might be responsible for at least part of this increase (in risk of dementia among footballers). 

‘If there is a suggestion that heading the ball can cause permanent damage to the brain, you ask yourself whether limiting the number of headers will be sensible.

‘There is common sense. If 20 headers is just about right for a professional footballer, there is no need to go beyond that. Anything on top of that is not going to help.’

Belli describes the findings from Dr Willie Stewart’s landmark study last year – which showed ex-players are five times more likely to die from dementia – as ‘alarming’.

He was also interested to learn this week of the results of a study by Liverpool Hope University which found how only 20 headers could have a detrimental effect on brain function.

In his own treatment of players, Belli has noticed that if someone heads the ball soon after suffering a concussion it can ‘trigger a relapse’ and make them unwell.

‘It is critical we continue research into this,’ he continued. ‘I have been involved for many years and it seems to be getting worse and worse.

‘It is a concern, particularly in the light of evidence that keeps being added to what we know already.

‘There is a lot we are discovering but there is so much we still need to unravel. It is really important to really find out what is responsible for increased rates of dementia in football.’

Belli is himself currently leading a study into concussion using Premier League stars as participants. Saliva and urine samples are being collected from players who sustain a head injury, as well as non-injured control players.

These samples are then being tested for molecules which may act as biomarkers to indicate brain injury, with the hope that the test could one day assist pitchside return-to-play decisions.

While that research is ongoing, Sportsmail wants to see the immediate introduction of concussion substitutes, which would allow teams to make an extra change if a player suffers an injury.

Belli said: ‘I am in favour of bringing in concussion substitutes. It would help manage concussion better in the game and make everyone focus on the issue, which at the moment is a bit hit and miss.

‘We are not going to get it right from the start. A bit like VAR, there will be a lot of fine tuning. But I see this evolving season after season.’

Belli treats up to 18 sportspeople a week at his clinic at the Queen Elizabeth Hospital Birmingham. One of his patients is ex-York defender Daniel Parslow, who this week told Sportsmail how he was forced to retire aged 33 last year because of the long-term impact of a concussion.

‘There are extreme cases that can go on for months,’ added Belli. ‘One of the most common symptoms is headaches that can be very disabling.

‘Once they become chronic they are very difficult to treat. Often I get players who have suffered from headaches for months and they find no remedy.

‘Another symptom is fatigue. Their battery seems to get drained very quickly. There can also be visual problems, where focusing on something can be problematic.

‘We know that concussion is detrimental to the brain, so to reduce the number of concussions would be hugely beneficial. If there is a way to make things safer, then that is exactly what we should do.’