Sports Injuries as a Public Health Crisis

By Dr R Neerunjun Gopee

I am not the sporting type, although I did enjoy my share of sporting activities such as football, racing etc in the family setting and at school when growing up, later as a Boy Scout, and in secondary school till my attention then shifted completely to my studies which were becoming more demanding. But that does not mean that I don’t love to watch say, a good football match, as I used to do with my son who is a Man U fan. And for whom, on a visit to the UK in 1992, I walked up and down the length of Oxford Street in London to buy a Man U T-shirt, at 34 pounds sterling. I had already bought all the other Man-U paraphernalia according to the long list that he had given me, most of them from Argos which during my earlier stay in the UK for specialization had been a frequent shopping outlet.

Football and dementia: heading must be banned until the age of 18. Photo – expressandstar.com


Other than that, my only interest in sports is from the health and medical point of view, and given my speciality of Orthopaedics, it has been part of routine practice to have to deal with sports injuries pertaining to my field, knee injuries in particular when it comes to football. I am not crazy about so-called legends in sports, about whom there is a lot of hype – but there is also the obverse of the coin in their lives.

Footballer George Best for example, who succumbed to alcoholism and had to undergo a liver transplant (2002), dying of complications at the age of 59. Argentinian football icon Maradona died Wednesday, similarly at the relatively young age of 60 from a heart attack, when one would have thought that being such a top-notch sportsman he would have been in a good enough state of physical health that he could have lived much longer. But he had been treated in the past for drug addiction and heart ailment, an indication that perhaps his lifestyle overall didn’t match his level of excellence in sport.

Maradona died Wednesday at the relatively young age of 60 from a heart attack, when one would have thought that being such an excellent sportsman he would have been in a good enough state of physical health. Photo – images-na.ssl-images-amazon.com


In fact this is part of a commentary that I heard yesterday morning on BBC radio, which was interviewing a compatriot of Maradona. But lifestyle of sportspersons apart, there are health issues associated with sports, resulting from specific types of injuries depending on the type of sports.

What a coincidence that a few days before the death of Maradona, on November 23, there was an article in The Conversation that caught my interest. It was titled ‘Football and dementia: heading must be banned until the age of 18’, whose opening lines read as follows:

‘Alarm bells are ringing in sport about the risk of a group of chronic, neuro-degenerative diseases, commonly understood as dementia. There is an increasingly large body of evidence which has identified that small, repetitive collisions of the brain inside the skull cause this disease. More high-profile players from England’s 1966 World Cup-winning squad are getting dementia and heading the football is to blame. It is now time for a blanket ban on heading until the age of 18, and from then on it should be closely monitored and reduced.’

The article goes on to elaborate on how it is not only the ‘big collisions that end with players being carried off the pitch or taken to hospital’ but it is the ‘small, daily collisions’ which are responsible for the ‘particular form of dementia (known as chronic traumatic encephalopathy or CTE) seems to only exist among those who, as part of routine activities, incur these regular assaults to the brain’.

It cites the case of Jeff Astle, a member of England’s 1970 World Cup squad, who ‘became the first British footballer confirmed to have died from CTE’, whose ‘family had long claimed it was heading the ball that was to blame. But it was only when England’s 1966 World Cup-winning heroes began to be diagnosed with dementia that the football world really took notice’.

However, other sports too have been found in recent studies to be associated with ‘immediate and measurable alterations to brain functioning.’ This damage to the brain has been confirmed in other ‘heading studies’, notably ‘research on repetitive impacts that occur from other sports such as downhill mountain biking, resulting from riding over rough terrain’.

Furthermore, ‘more worryingly, in a large study of former professional footballers in Scotland, when compared to matched controls, players were significantly more likely to both be prescribed dementia medications and to die from dementia – with a 500% increase in Alzheimer’s’.

The stark warning is that ‘brain trauma in sport is not a medical question, it is a public health crisis’.

This has led to football associations changing the rules about ‘heading’ in football, and a demand that it should be banned before the age of 18 years. However, commenting on this, a reader has drawn attention to the fact that ‘we should be banning heading on medical grounds for under-25s… We do not just need to protect football-playing children; we need to protect football-playing young adults as well’.

No doubt this age demarcation will invite more debate and probably more research will have to be carried out to settle the matter, but as is usual when it concerns health, recommendations are not set in stone and have to be changed as new findings emerge over time. But meanwhile, decisions must be taken based on current knowledge.

This said, there is no doubt – and growing research evidence – that physical activity is beneficial in many ways for both physical and mental health, but there are so many other factors that come into play in the course of one’s life. Thus, two of my college friends, both of whom had achieved peak levels and bagged numerous coveted prizes – one in boxing and the other in gymnastics – sadly had tragic ends too early, through suicide, alcoholism and depression.

Sports may be good – but it is not the be-all and end-all of life: there are many other things besides.


* Published in print edition on 27 November 2020

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