Lou Crawford, Brain Health Educator at Head Safe Football, explains how the non-profit association has been conducting awareness and education campaigns around CTE. CTE or Chronic Traumatic Encephalopathy is a neurodegenerative disease caused by repetitive head impacts, and is more likely to affect football players due to the prevalence of heading in the popular sport.
She rues that there is currently little research around the incidence of CTE in Africa but mentions that Head Safe Football is conducting campaigns in key economies such as Kenya and Uganda.
Edited excerpts from an exclusive interview:
1. With 23 years’ experience of coaching and teaching many different sports to a wide range of ages and abilities, what are the key observations you would like to share on Chronic Traumatic Encephalopathy (CTE)? Are there any estimates of its prevalence in Africa, based either on academic research or your own experience on the ground in key African countries?
Due to my background as a PE teacher and my love of sports I see CTE as a global multisport issue. Research shows that many contact sports such as American Football, Rugby, Football, Ice Hockey, Boxing, Australian Football all have cases of players who have experienced CTE. Chronic Traumatic Encephalopathy is a neurodegenerative disease caused by repetitive head impacts. Those impacts can be experienced in a variety of different ways over a player’s lifetime but Football is the only sport in the world where the head is used to control and advance the ball. Therefore our message at Head Safe football can be simple and effective – THINK HEADSAFE REDUCE HEADING IN TRAINING.
There is little research around the prevalence of CTE in Africa. The research is predominantly led by Western universities and scholars and focuses on Western players, this is likely due to the funding sources behind the research and the prevalence of players experiencing the signs and symptoms. The average life expectancy in Africa is 64.38 which naturally means that there are less people experiencing the signs and symptoms of CTE.
At Head Safe Football we are trying to raise awareness that head impacts do not only affect long term brain health. There is research to show that heading the ball can also be detrimental to short term brain function, such as memory and planning, concentration and mental health. One paper even suggests that repetitive head impacts can lead to an immediate decrease in athletes performance.
My experience in Africa showed me that coaches are open to learning and welcome new information that might improve their players health and well being. Head Safe Football are not campaigning to remove heading, simply reduce the cumulative forces that players experience over their lifetime by reducing the number of headers and the force of those headers.
2. As a Brain Health Educator at Head Safe Football, do you feel that organisations like yours are key to the conversations around CTE and the dangers it poses to football players – however, would you also agree that more such initiatives are needed to tackle ‘the elephant in the room’?
I think that step one to any form of change is to get people talking. ‘The elephant in the room’ refers to something that everyone is aware of but no one is confident to discuss, hence the reason we adopted the elephant as the logo for Head Safe Football. CTE has been known about for years but governing bodies are reluctant to discuss the issue.
Head Safe Football is trying to raise awareness of the link between repetitive head impacts and poor brain health. We do this in two ways. Education and Advocacy.
From the education perspective we create partnerships with clubs, associations, foundations, trusts and other community groups. We share the science that underpins our knowledge, we deliver classroom and on field sessions, and we provide resources. We aim to educate all stakeholders, coaches, parents, grass roots and professional players, medics and welfare officers so that everyone can come together collectively to change the culture around heading the ball.
From the advocacy side of things we tell the story of Bill Gates, former England and Middlesbrough Player who died in October of 2023 after battling with CTE for 14 years. Bill never drank alcohol, smoked cigarettes or suffered from concussion, yet a post mortem after his death showed stage 4 CTE. Head Safe Football uses our website, social media platforms and the traditional media of television, radio and newspapers to try and reach as large an audience as possible. There is currently traction on this issue, as this summer the first non-professional footballer Goff White’s brain showed CTE post mortem, highlighting that this is not just a problem for professionals. Bill’s inquest is also drawing media attention as the FA claimed the result was not in the public interest which sparked backlash and the government have intervened, raising the profile of the case and further amplifying our message.
3. As someone who has always loved football, and coaches two grassroots youth teams besides being an avid supporter of the England women’s football team, what key messaging have you shared around heading and how have you seen the impact of such messaging being felt?
Our key message is THINK HEADSAFE Reduce Heading in Training. 90% of heading happens at training and so if coaches are made aware of the risks and are given practical advice on how to reduce heading frequency and force, then this will positively impact their players brain health.
Every coach we have ever worked with has positively embraced this message. We often start by having to dispel some common misconceptions. The first being that the old leather ball was heavier than today’s ball and therefore impact forces are less. This is not the case. The FA states that the dry weight of the football must be 14oz, this has never changed. The old balls did retain water when wet and therefore get heavier but as a result they travelled slower. Today’s balls are made to be more aerodynamic and data shows us that they travel faster, they are the same weight and therefore the impact forces experienced today are greater than those in the past. This is a problem for today’s players and everyone who has ever headed a ball, young and old, male and female, professional and grassroots.
I feel that the impact of our work is a slow and gradual change working towards a safer sport.
4. In particular, have you seen a lot of confusion abound between concussion and CTE and how do you explain the differences in these conditions to laypersons without medical knowledge?
Concussion is a traumatic brain injury that contact sports athletes may experience. Concussion is an injury and most often the mechanism of that injury can be observed, as can the sign and symptoms. Concussion is usually immediate and medics are aware of it. Concussion has treatment protocols and everyday a person suffering from a concussion should see some improvements. You can recover from a concussion.
CTE is a disease and when we experience impacts from heading the ball we often have no pain or immediate signs and symptoms to help us recognise that we are causing ourselves damage. The onset of CTE can happen many years after the impacts have been experienced and doctors are not all knowledgeable about CTE. CTE is degenerative and there is no cure. CTE can only be diagnosed post mortem.
As you can see the distinction between Concussion and CTE is clear, however there is some overlap. If you suffer from a concussion it will add to the cumulative forces that you experience over your playing career, therefore concussions contribute to the risk of experiencing CTE.
5. What communication channels does Head Safe Football use to disseminate messaging around CTE? We note that the book No Brainer forms a major thrust of your efforts and the association also produced a movie that addresses this condition. Could you elaborate on these initiatives and others such as Trailblazers and community education programmes?
Head Safe Football looks to utilise as many platforms, outlets and mediums as possible to share our education and promote our work. We do this in an attempt to engage a wide-reaching audience. As mentioned in a previous question, we have our website, recently rebranded to appeal to a younger target audience, we have social media accounts on Facebook, Instagram, Twitter and LinkedIn. We have good relationships with the press, often appearing on national and local television and radio. We have had articles in the Telegraph, Daily Mail and Daily Mirror; Judith Gates, Founder and Trustee of Head Safe Football, has spoken on BBC breakfast news; and we’ve had events covered by Sky Sports News. We have had an article in GQ magazine, we have the No Brainer book which was number one best seller on Amazon in the category of football and we have our ‘Billion Pond game’, a short documentary, screened at the Tees Valley Film Festival in 2023. We speak on podcasts, at conferences and host webinars online.
‘Trailblazers’ is an initiative which encourages groups who have engaged with us to receive education and become leaders within their communities of HeadSAFE messages and principles. Trailblazers are recognised for sharing HeadSAFE content with all stakeholders and create a ripple effect that will permeate the footballing community.
6. How was your recent visit to Uganda? What would you say is the awareness level in the country around CTE and injuries from heading?
My recent trip to Uganda was fascinating. It is such a green country which makes it feel full of life as well as vegetative growth. It also has a growing economy which you can observe from buildings being erected and thriving businesses. 45% of Uganda’s population are under the age of 14 so the overall impression is one of growth and possibility. I loved the friendly and considerate people and the succulent fruits and organic food, the warm weather, and the beautiful landscape.
I delivered HeadSAFE to football coaches from the Kigezi Soccer Academy (KSA) in Kabale, a beautiful mountainous region in the south west. The founder of KSA had requested to learn about HeadSAFE after following Head Safe Football on social media. Coaches had no prior knowledge of the dangers of repetitive head impacts and the subsequent effects to brain health but they enjoyed playing the educational games and they felt confident that they can find simple solutions to reduce heading in training for the players that they work with. I will now follow up with online support, providing examples of scientific research and suggesting content for a social media campaign. I will support them in their quest to apply for funding so that they can lead HeadSAFE education across the 12 districts in their region.
7. We believe you also worked in Kenya with a football academy earlier this year. Could you share your insights from the ground?
I did not go to Kenya myself but HeadSAFE education was piloted via one of Head Safe Football’s partners Coaches Across Continents with a local group named Green Kenya. The coaches were all very receptive to the message that repetitive head impacts increases the risk of poor brain health. Coaches then explored HeadSAFE principles and discussed how best to implement HeadSAFE practices throughout their community outreach programmes.
8. Finally, what is the one key message you would like to impart to our readers about CTE and the repercussions that have been faced by football players over the years, including of course the late Bill Gates?
THINK HEAD SAFE – REDUCE HEADING IN TRAINING.We need to address the elephant in the room, openly discuss brain health, educate all stakeholders of the risk of repetitive head impacts and CTE, and support players to make informed choices and speak up if they have any concerns.
