Fitness assessments ranging from strength and flexibility to endurance and aerobic threshold are part and parcel of training for professional footballers. But players at Chelsea Football Club are now put through tests of an altogether different nature - those measuring their intelligence.
According to Dr Bryan English, the club's doctor, IQ analysis is set to become a tool that is widely used by professional clubs across the UK. Not that the measures of cerebral functioning will determine team selection. Rather, Dr English says, the results are to be used as base markers should players suffer serious head injury. “Players completed the tests set by an independent company, which also tests top high-flyers in the City,” he says. “Only we are getting them done for different reasons.”
Chelsea staff are not the only ones to be concerned about the issue. Sports medicine experts are holding a conference on sports and brain injury - the first of its kind - at Edge Hill University, in Lancashire, on February 19. “There are different types of head injury in football that can contribute to problems,” says Professor Adrian Lees, deputy director of the Research Institute for Sport and Exercise Sciences at Liverpool John Moores University, one of the speakers. “Acute injuries such as clashing of heads can cause immediate pain and damage but can also add to chronic head or brain problems. Mild knocks or heading the ball all contribute to a great deal of impact over the course of a player's career that might leave them vulnerable to dementia.”
Certainly, Chelsea has particular reason for concern as its players have suffered more than their share of serious head injuries in recent seasons. Two years ago the club's goalkeeper Petr Cech lost consciousness after colliding with the knee of Stephen Hunt, a Reading player. Cech suffered a depressed fracture of the skull and underwent surgery at the Radcliffe Infirmary's specialist neuro-surgical unit in Oxford.
His replacement in that match, Carlo Cudicini, was also taken to hospital after being knocked unconscious. In 2007, John Terry, now Chelsea, and England, captain, swallowed his tongue and temporarily stopped breathing after being knocked unconscious by a kick in the head during the Cup Final against Arsenal.
It is the cumulative effect of such injuries, combined with the repetitive heading of footballs, that has long been thought to increase the risk of dementia in players. According to the Alzheimer's Society about 700,000 people in the UK suffer from dementia, but the vast majority of cases are not caused by genetic faults. By far the biggest risk factor is age, but there is evidence that repetitive head trauma raises the risks. “People who suffer severe or repeated head injuries are at a three to fourfold increased risk of developing dementia,” says Dr Susanne Sorensen, the charity's head of research. “One possible reason for this is that the inflammation that occurs in the brain as a result of the injury may cause damage to the tissue and be a factor in the onset of the condition.”
Findings released by the Royal College of Psychiatry (RCoP) from a small study a few years ago confirmed that “mild head trauma over the course of an amateur or professional footballer's career may increase the risk of developing Alzheimer's in later life”. One player told the RCoP researcher that after executing “a good header” he was often left feeling dazed.
Dementia “link” to older footballers
Those thought to be at particular risk are footballers who played in the 1970s and earlier. Until then, a football's skin was made of leather that could absorb moisture as the game progressed and on wet days it was not unusual for a ball to become heavier. “Players from that era appear to exhibit symptoms of dementia more readily than those in some other sports,” says Lees. “It certainly suggests a link.”
Among them are Danny Blanchflower, the former Northern Ireland captain, who died from Alzheimer's disease in 1993 aged 67, while in 1998 the former Celtic player Billy McPhail lost his legal case for disablement benefit over a claim that he developed the first stages of senile dementia as a result of heading the old-fashioned footballs.
However, in 2002 a groundbreaking inquest into the death of former West Bromwich Albion and England striker Jeff Astle ruled that he died from a degenerative brain disease caused by repetitive heading of leather balls.
Modern footballs are not significantly lighter but are manufactured to be watertight and to weigh no more than about 450g throughout a game. But do they pose fewer dangers?
In a 2004 study, ballistic engineers at Glasgow University's department of mechanical engineering showed that a modern football can reach speeds of 80mph immediately before hitting a player's head.
“We weighed an old-style leather ball when it was dry and weighed the modern ball, and there was only a gram or two of a difference,” says Alan Birbeck, who led the study. “We then soaked the leather ball in water and this added only another gram of weight making the difference only a scale of two or three grams.” The peak force a player's head would need to absorb from an old-style leather ball travelling at top speed would be half a ton and although this would be reduced to half that amount with a modern ball, the force is still considerable.
Birbeck likened it to being struck by ten bags of coal for 3/100ths of a second and concluded that changes in ball materials have made “negligible” difference to the potential effect on a footballer's brain.
Even youngsters are at risk. A recent study in the British Journal of Sports Medicine looked at the risks of head injury among 268 adolescent football players. Dr Scott Delaney, research director of emergency medicine at the McGill University Health Centre in America, found that the risk of concussion was 2.65 times higher for players who did not wear protective headgear.
Although Fifa, football's international governing body, authorised the wearing of soft headgear in matches, it has not made them mandatory and McGill said that he hoped that his study would “help to convince parents” that head protection may be important for football-playing youngsters. Lees says that using appropriately sized junior balls and teaching children to head the ball in a straight line are also important preventive measures.
At a professional level, Lees concedes that players are more likely to take risks when it comes to gaining possession of the ball. However, measures such as tensing the muscles of the neck as they reach to head a ball can be helpful.
Rugby has strict rules on head injuries
ark Leather, a lecturer in sport and physical activity at Edge Hill University, Lancashire, who has also worked as a physiotherapist in professional football for 20 years, believes that professional football needs to follow the lead of rugby, which has introduced strict rules regarding head injury.
The Football Association's (FA) current medical recommendations state: “Since all head injuries are different in terms of the effects on the brain, no fixed time periods are applicable in professional football as to when the player should return to training and playing.”
Leather says: “In rugby union, a player with concussion cannot take part in a match or training for at least three weeks. Both rugby codes also use a testing system called CogSport, computer-based cognitive assessments that are done at the start of every season and after any head injury incident when the results are compared to the original baseline score.”
He says that the tests are not foolproof and should be used as an extra insurance policy for players' health alongside clinical and neurological judgment. “It's not surprising that Chelsea are introducing them and the hope is that other football clubs will follow suit,” he says.
Of course, among professional sportspeople, even intelligence tests can become competitive. So who came out top at Chelsea? “John Terry was in the top three,” says Dr English. “But Frank Lampard scored one of the highest set of marks ever recorded by the company doing the tests, and higher than me.”
Risk assessment
Horseriding
The British Horse Society is made aware of eight accidents a day involving horses and more than one third of them may result in head injuries. Christopher Reeve, the former Superman star, was paralysed from the neck down after landing on his head in a riding accident.
Cycling
About 70 per cent of cyclists killed on the road have suffered head injuries. Debates about whether helmets reduce the risk continue, although the Royal Society for the Prevention of Accidents recommends them as a means of protection.
Boxing
The majority of injuries in the ring are caused by a blow to the head. About 20 per cent of professional boxers develop chronic traumatic brain injury, according to research in the Archives of Neurology in 2006. The study of amateur boxers revealed that many of them had higher levels of certain chemicals in their cerebrospinal fluid in the days after a bout, indicating injuries to neurons and other cells important to brain function.