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SPECIAL REPORT HEAD INJURY IN SPORT
Head Injury in Sport Special Report
Sport being able to “mark its own homework” is a “dereliction of duty which must change”, the head of the committee which led Parliament’s recent inquiry into head injury in sport said.
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Julian Knight MP said the committee was left shocked by evidence from athletes whose future health was put on the line in the interests of achieving sporting success. In the committee’s report - which followed evidence from 27 clinicians, academics, campaigning organisations, sports people and representatives of sporting associations, alongside 51 further written submissions - the reality of the situation in sport was laid bare. Each sport is left to determine its own protocols for concussion and brain injury, it noted; those playing sport do not have enough information about head injury and its long-term consequences; there are no standardised procedures and data collection is poor; and there is a lack of transparency in published research funding and research evaluation. “We’ve been shocked by evidence from athletes who suffered head trauma, putting their future health on the line in the interests of achieving sporting success for the UK,” said Mr Knight. “What is astounding is that when it comes to reducing the risks of brain injury, sport has been allowed to mark its own homework. “The Health and Safety Executive (HSE) is responsible by law, however risk management appears to have been delegated to the National Governing Bodies, such as the Football Association (FA). “That is a dereliction of duty which must change.” The recommendations made by the report are: • The Government should establish UK-wide minimum standard definition for concussion that all sports must use and adapt for their sport • The Government should deliver a comprehensive communications campaign to ensure all those involved in sport can access best practice information. This should signpost people to advice on what action to take • HSE should work with National Governing Bodies of all sports to establish a national framework for the reporting of sporting injuries • UK Sport should take a governance role in assuring that all sports it funds raise awareness of the dangers of concussion effectively • UK Sport should pay for a medical officer at every major sporting event with responsibility to ensure the safety of participants and the power to prevent athletes at risk from competing • NHS England should review the way it collects data about concussion and concussion-related brain injury • NHS England and the Faculty of Exercise and Sports Medicine should prepare a learning module on best practice for treating and advising those with concussive trauma and ensure all GPs and A&E clinicians take this module within 2 years • The Government should convene a single research
fund to co-ordinate and fund research to ensure it is independent and excellence-driven as well as being accessible to all • The Government should convene a specialist group on concussion drawing on campaign groups and relevant scientific expertise. The report’s recommendations were welcomed by campaigners who have long fought for change in how head injury is dealt with in sport. Dr Michael Grey, reader in rehabilitation at the University of East Anglia and UKABIF Trustee, who gave evidence at the inquiry, said: “We are encouraged that the committee have accepted (repeated) our call for sport-related ABI research that is both independent and transparent; and for the need to upgrade health professionals’ knowledge in this area. We welcome the call for Government to take a leading role in this regard.” The report’s recommendations closely mirror those made in the All-Party Parliamentary Group for ABI’s Report, Acquired Brain Injury and Neurorehabilitation: Time for Change, which was published in 2018. Chris Bryant, MP and Chair of the APPG for ABI, said: “I’m delighted that the committee agrees with the argument we have been making for some time. The evidence grows ever stronger that we need to take concussion in sport far more seriously. I hope the government takes note and acts quickly on all the recommendations.” Peter McCabe, chief executive of Headway, which has run its Concussion Aware campaign for many years, added: “The committee’s criticism of governing bodies in sport is clear. This issue is not new and yet for years sport has been able to play down its significance, with little or no scrutiny from the Government. “For too long it has been left to charities such as Headway to hold sport to account and we agree with Julian Knight that this has to change. Sport has had long enough to get its house in order and the time has come for the Government to intervene. “It has been almost 20 years since a coroner recorded a verdict of industrial disease in the case of former England and West Brom footballer Jeff Astle. In any other industry, that would have led to greater scrutiny from the Health and Safety Executive, but sport has been allowed to govern itself and we have been seeing the consequences for some time. “The ball has been repeatedly dropped by sports authorities when it comes to concussion. It’s now been passed to the Government by means of the recommendations of the DCMS Committee and we will be watching carefully to see how seriously this report will be taken by the Government.”
Having played an instrumental role in initiating changes to player safety in NFL, Dr Chris Nowinski speaks to Deborah Johnson about the urgency to ensure that is replicated elsewhere in the world, from professional through to grassroots level, and how his creation of a UK Brain Bank is upping the ante on research in this area even further
Having experienced concussion during his career as a high-profile WWE wrestler, and been left shocked by the lack of awareness of the issue at all levels of sport, Dr Chris Nowinski is now leading the charge for change for head injury in sport around the world. Since 2007, Dr Nowinski has pushed the boundaries of what had become accepted as ‘the norm’ in sport - that there was ‘glory’ in players getting up and carrying on despite head injury; that there was no accepted correlation between multiple head impacts and longerterm neurological consequences; that sport was not taking more responsibility in protecting its players - and is helping to redefine the life-changing issue of player safety. And through the efforts of Dr Nowinski and his Concussion Legacy Foundation, significant change has taken effect in the United States, particularly in the National Football League (NFL), which was “embarrassed into action” through his 2006 book Head Games: Football's Concussion Crisis. The book, which also became a documentary, examined the long-term effects of head trauma among athletes, and was described by The Lancet as having "sent shockwaves through NFL”. The Foundation was also instrumental in the creation of the world’s first Brain Bank dedicated to the study of Chronic Traumatic Encephalopathy (CTE), which has led to the long-held understanding of brain trauma being revolutionised.
Through its pioneering research, the VA-BU-CLF Brain Bank remains the most significant CTE resource in the world, which has discovered the first cases of CTE in athletes whose primary exposure was soccer, rugby, baseball, ice hockey, and college and high school football. “In the US our understanding of concussion has changed completely. When I was injured, they were still putting people who had been knocked unconscious back into the game, saying they’re fine,” Dr Nowinski tells NR Times. “Through advocacy, we started to change the discussion and show how unethical it was to put someone back into the game. We focused on NFL because if we get them to change, then everyone would change. “There are now laws in every state which mean medical clearance must be given to players with concussion allowing them to return, we now tend to talk about concussion in the right way - in European soccer we see players being knocked unconscious, like we did in the recent UEFA tournament, but that doesn’t happen in the US anymore without a massive outcry.” And while such an ‘outcry’ has not been widespread in sport elsewhere in the world until more recently, happily change is starting to take effect, with the UK now seeing action like never before. Both football and rugby governing bodies are introducing new protocols, spurred into action by the many former players who have revealed devastating diagnoses of neurodegenerative illness. Dr Nowinski and his team have worked closely with the Astle family, who are campaigning for change in memory of footballer Jeff Astle, whose memory continues through the Jeff Astle Foundation which is dedicated to raising awareness of brain injury in all sports and offers support to those affected. The willingness of the many sports professionals and families who have played their part in lifting the lid on the reality of brain injury in sport is crucial in bringing about change in sport, even where there may be resistance, says Dr Nowinski. “I am amazed at the courage of families who are saying their loved one has dementia, without the steady drum beat of such stories this could be swept under the carpet
again,” says Dr Nowinski, a Harvard graduate who later gained a PhD in neuroscience. “People think this problem doesn’t exist because we don’t see it, but families previously chose to keep it private as nothing positive had ever happened before through going public. “If we continue to push the rock up the hill and continue to fight for change, it will happen. To change a culture, you have to know the culture. “I don’t recall any recent players being knocked unconscious and being put back in saying ‘I shouldn’t have been put back in the game’ and that needs to happen - but there is bad leadership within the football community and players feel without protection. “There are a lot of studies in the US linking head impacts to brain disease which are well-known, but people outside the US tend to ignore them. There is always a scientist who will say they’re not sure about the findings, or we don’t know if the changes we’re seeing are permanent.
“In the US, there are some very outspoken doctors who represent professional sports leagues and they focus on minor criticisms to justify inaction, rather than the clear solution of preventing the hits to head that cause brain injury. “While these doctors do their best to have their patients’ best interests in mind, even the most ethical doctors will be influenced by their professional position, this can lead to tremendous conflicts of interest. “I’ve had threatening letters from UK football teams. In the US, it took journalists outside of sport to be willing to offend, and very powerful newspapers who don’t care if their reporters have been threatened to lose access to the teams they cover. “Professional sports leagues are incentivised to minimise the the risks of concussions and CTE as they pose risks to profits, and that has unfortunately also played out in the UK.” While the recent findings of the Parliamentary inquiry into brain injury in sport - where it was noted that governing bodies are effectively ‘marking their own homework’ - are encouraging, says Dr Nowinski, action must be taken and lessons learned. “The Government has a huge role to play and the most recent hearings are a good start,” he says. “In 2009, things started to change in the US when the NFL were embarrassed into taking action through public Congressional hearings, and we realised if we continue in this direction, we can help to get the change we need. “One of the important things we did was to explore how the NFL’s Mild TBI Committee was doing terrible research and we got that committee to be retired. “This issue needs to be looked at independently - it’s a public health issue and we are still only scratching the surface.
“This isn’t just an issue of dementia, where people lose a few years off the end of their lives but they got to be a hero as a sports player - we’re not recognising the danger of this disease to people in early- and midlife, and that limits motivation for people to change.” A vital place to start is in protecting players from the very start of their experience of sport - from childhood. The Concussion Legacy Foundation adopts a stance in the US of encouraging parents not to expose their children to tackle football or any repetitive brain trauma, including heading in soccer, until the age of 14. “We need to stop hitting children in the head,” says Dr Nowinski. “We have young children playing sport by the same rules as adults and that’s insane. We should be focused on what is best for children, they need exercise, not hits to the head. “The odds of developing CTE are associated with how many years someone has been playing, and the correlation is extraordinary. We find it in boxing, we find it in American football, and we’re going to find it with soccer and rugby. “If we want to eliminate CTE in sports, then we need to reduce the number of years when they’re experiencing repeated head impacts as children. It is not the time when they’re an adult and they’re being paid to play. “If we reduce exposure among children, we can make it less likely they will get CTE. Right now, we assume we will only get better at dangerous activities by practicing those activities. That model, though well intended, is a mistake. “The faster we act, and it’s very urgent we do that, the less we will see what is happening today in the next generation of sports people.” Another important area is how concussion is portrayed in the forum where most people consume sport - via the media. The creation of the Concussion Legacy Foundation’s Media Project has helped to change the language used around head injury in sport, and in turn the perception of millions of viewers, particularly among the younger generation. “We have established the CLF Media Project in the US, which we’re now working on in the UK, we’ve done some work with professional journalists as well as students at university,” says Dr Nowinski.
“It’s very hard to reach a lot of people on this issue, and their understanding of concussion comes from watching sport on TV. “This is an important moment in time. A few years back, the US media were still glorifying players playing through concussion, they weren’t using the word ‘concussion’ and broadcasters were pretending nothing was happening. “We wanted to help them with the terminology that can describe what is happening without being seen to diagnose anything. In the UK and Europe, we see players playing through concussion, like in the recent UEFA tournament, and we don’t want these poor examples to parents and coaches to manifest into poor concussion care for children because the inappropriate medical care isn’t being criticised. “There can be a backlash against commentators because television is a business like football, but we hope to give broadcasters the tools they need to cover concussion right.” But underpinning the change is the research, which continues to be fundamental in greater understanding of, and action around, brain injury in sport. Following the huge advances effected by the creation of the VA-BU-CLF Brain Bank, collaborations have since followed with the University of Sydney, which has collected 30 donated brains in the past three years, and the University of Auckland has just received its first donation. And the pioneering impact is now coming to the UK with the creation of the Concussion Legacy Foundation UK led by Dr. Adam White of Oxford Brookes University, and a Brain Bank led by Dr. Gabriele DeLuca of Oxford University. Dr. White recently completed a research project into athletes and caregivers’ experiences of CTE, working alongside the Concussion Legacy Foundation and Boston University CTE Centre. The UK Brain Bank’s launch is accompanied by a 24-hour outreach hotline, education and peer support mentors and groups, with people also being connected with medics and clinics. “When we first started the Foundation, goal number one was to start a Brain Bank,” says Dr Nowinski. “Part of the reason concussion and brain trauma has been under the radar for so long is that there hasn’t been visual proof of damage. Without pathology, we can’t get this evidence. “We want to create undeniable proof and show this unique disease under the microscope and show how it is destroying the lives of athletes now. “We want the whole world to be working on this, the best scientists in the world, and we need this to be across the world if we want to have hope for treatment in our lifetime.”
The shocking impact of contact
The impact professional rugby can have on players’ brains in just one season has been revealed in a hugely-significant new study. Professor Damian Bailey, who led the project, discusses how further research is set to expose even more of the unseen effects of the sport on young and old players alike
Shocking new research laid bare the reality of the head trauma rugby players can face in just one season, with reduction in blood flow to the brain and decline in cognitive function seen among an entire team of professional players. The pioneering study has helped to widen the focus on player safety beyond concussion and into the cumulative effect of contacts, highlighting that it is not just blows to the head which can result in long-term neurological consequences. The research, by the University of South Wales (USW), found that cognition decreased across the season in both forwards and backs, although there was a greater degree of impairment seen in the forwards than in the backs players. Concussion incidence also appeared to be three times greater in the forwards compared to the backs. The research, which followed a team from the United Rugby Championship, examined the effects on the brain function and cognitive ability of the rugby players, which included the ability to reason, remember, carry out mental tasks and formulate ideas. The peer reviewed study, funded by the Royal Society Wolfson Research Fellowship, recorded six concussion incidents among all the players that took part over the course of the year - but other studies have suggested
professional rugby players could be exposed to 11,000 contacts each season. Every player who took part showed evidence of decline when comparing pre and post-season results. “There is a need to reduce contact in training or the game, not just to act on concussion and introduce reactive changes,” Professor Damian Bailey, head of the Neurovascular Research Laboratory at USW who led this research, tells NR Times. “The field has become polarised towards concussion but it’s the contact that really matters. It’s like in a road traffic accident where whiplash can cause brain damage - it doesn’t necessarily involve concussion. “It’s still in the early days but has highlighted the need for more research. It’s like an onion where you are peeling away the different layers, then you can attack the next layer then the next.” While the study focuses on professional rugby, many are drawing comparisons with the likely effects on amateur players - while research has not yet been carried out into this, Professor Bailey believes this is a great concern. “Much of the concussion surveillance focuses on the professional game, but we are looking beyond that,” he tells NR Times. “The arguments in the amateur game are ying and yang; amateur players are not as well trained, not as big, powerful or fast, so the impact of contact could be considered lower. “But against that, 52 per cent of concussion risk is during a tackle, and in amateur rugby, a lot of problems can occur through contact. Poorer technique could result in more damage. “For me, school children are a particular concern with young developing brains, whether male or female, being even hungrier for the fuel of oxygen and glucose, so they’re more vulnerable to mechanical damage.” Now, Professor Bailey is planning to uncover more evidence of the impact of head injury in sport with further research underway. This includes a study into the effect of contact and young people, and a pioneering project to look at the impact their rugby careers have had on retired players, which will be released in the near future. “We need to understand the later life changes in the mechanism of the brain as a result and have completed a study in retired players where we compared and contrasted against age-matched controls,” Professor Bailey reveals. “That will give us a snapshot into how does contact in the game over several years translate into later life brain function. It is another big piece of the puzzle we need to answer.”
VR - a viable alternative to heading
Pioneering VR technology is helping to provide a solution to the damaging impact of heading a football through recreating training via a headset.
Through the creation of professional-level training drills, Rezzil has devised a credible alternative to physically coming into contact with a ball outside of a match environment. In use from academy level upwards, with European League and World Cup winners being regular users, Rezzil’s range of training drills has seen it become the world’s leading platform for helping elite athletes to develop their skills, having started in football and now diversifying into basketball and American Football. But with its more recently-added programme specific to heading, Rezzil’s role has been widened from sharpening skills and building resilience to a vital and growing role in player safety. Recent data from a UEFA heading study highlighted that training was where the majority of heading incidents took place, with Rezzil able to recreate a training ground environment via headset and alleviate the many physical impacts a player would routinely take. The team has worked with some of the world’s top coaches to create drills to head the ball safely in a VR environment, by heading from the waist like an elite player would do, rather than with the neck or the top of the head. “We spent six months working on a really comprehensive piece of research into heading impact, which looks at heading the ball and how that impact could be mitigated through using technology,” reveals Andy Etches, co-founder of Manchester-based Rezzil. “Using a control method we have seen a reduction in heading a real ball from 20g to 5g in VR. When you think of a player’s brain rattling around in their skull, that is a massive saving in impact.” Research by Professor Willie Stewart has previously revealed that footballers were three-and-a-half times more likely to die of neurodegenerative diseases including dementia and had a five-fold risk of Alzheimer’s. This was supplemented by his more recent shocking findings which showed defenders had a fivefold risk, in comparison to goalkeepers, whose risk was the same as for the average person. The length of their playing career was also found to be crucial, with those playing for longer than 15 years being
five times more likely to develop neurological conditions. And with many now questioning whether heading should continue to play a role in football, given the significant concerns around safeguarding players, the Rezzil system is delivering benefits to a player’s entire game through its system, which operates via an Occulus Quest VR headset, and has recently been commercially launched to the mass market. The company is currently mid-way through further research, but indications are that it could even improve the standard of training. “It can be more effective, quicker, and a player can have multiple contacts with the ball,” says Andy. “In reality, a player can only head the ball a certain amount of times - but in VR, we are multiplying the contact with the ball by 100, but that’s because it’s in a virtual environment. We are reducing the amount of times you make contact with a physical ball, which will have a knock-on effect. “And through the use of VR, it’s about the heading, fitness, co-ordination, fun - that’s the whole idea of what we do.”
Gathering the real-time data to ensure player safety
The PROTECHT mouthguard has been hailed as having a vital role to play in player safety. Dr Chris Jones, Head of Science and Performance at SWA, discusses its growing presence in sports including top-level rugby and football
The PROTECHT system is a live load management tool that accurately measures the volume and intensity of contact events, by embedding sensors in mouthguards worn by players which transmits the head accelerations undertaken by the athletes in real time. This allows practitioners to objectively understand the demands of the competition and manage contact training for the first time. PROTECHT is so effective because it was developed by practitioners, for practitioners. Not only are we at the forefront of technology and research where we work with governing bodies and universities, but the biggest factor is that as practitioners looking after athletes, we understand the importance of measuring contact and its impact on recovery, fatigue, welfare and performance. Being able to measure, manage and manipulate contact in real time allows us to optimise athlete readiness and availability which will ultimately improve overall squad outcome. As a company we are very proud of what we have been able to achieve in a very short space of time. You look at the work we have been able to do in rugby, football and combat sports where we are paving the way in providing objective evidence to governing bodies and individual clubs and athletes that has already significantly impacted how these athletes are trained and managed. For example, in rugby, SWA were tasked by the RFU with a discovery research project to evaluate the level of head impact exposure in elite men’s and women’s rugby in England over a month. We were able to successfully conduct and complete this project and provide the first detailed description of head impact exposure during elite adult rugby training and matches. This not only demonstrated the feasibility of the instrumented mouthguards but helped identify future projects that need to be conducted. For example, the ruck provided the biggest risk of head impact exposure in both training and competition and this is now an area that will be the subject of further investigation from the RFU. This is in addition to the RFU expanding to a leaguewide project across both the male and female game. In football, we were commissioned by the Premier League to help understand the head acceleration involved in headers taking place during training sessions. We were able to measure not only the intensity of the forces experienced by the athletes performing a header, but we were also able to group headers based on their preceding event. For example, headers from crosses, long balls, passes, throw-ins; and headers from a standing position, running forward or backwards, etc. This information was provided to a cross-football working group, helping to shape the Heading in Training Guidance that all clubs now follow when undertaking headers during a training week. It is well documented that concussion has been an issue or a challenge that needs to be addressed for a long
period of time. It’s why we developed the system in the first place. We would say it is being taken seriously, but that until recently there had been no means of accurately measuring such an important factor in sport. In addition, the increased exposure in the media and greater amount of research being conducted in this area really helps to tackle and accelerate the understanding of these issues and potential future solutions. We have a number of success stories from the last few years. The biggest one is the work we have been able to do with Gallagher Premiership champions Harlequins, who have really pioneered and paved the way in how they manage the contact load for their players, through utilisation of the PROTECHT system. Not only were we able to collect and measure the demands placed upon them for a number of research projects, but they were also able to use the performance element of the system (contact management of the athletes). This enabled Harlequins to use the PROTECHT system to adjust and manage the amount of contact a player receives in training and has significantly reduced the amount of injuries in the squad, and significantly assisted towards their success. WE ARE PAVING THE WAY IN PROVIDING OBJECTIVE EVIDENCE TO GOVERNING BODIES AND INDIVIDUAL CLUBS AND ATHLETES THAT HAS ALREADY SIGNIFICANTLY IMPACTED HOW THESE ATHLETES ARE TRAINED AND MANAGED
The legal position around neurotrauma in sport
By Tracey Benson, Head of Serious Injury (South), Slater and Gordon
Traumatic brain injury in sport is becoming increasingly widespread in certain jurisdictions. The USA and Australia have seen extensive litigation instigated by former professionals against various institutional defendants. The most famous being against the US NFL by 4,500 former American Football players culminating in a settlement.
Claimants seeking recompense are typically suffering from neurocognitive injuries caused by repetitive exposure to mild traumatic brain injuries, commonly known as concussion. The long term effects are earlyonset dementia, or chronic traumatic encephalopathy. In December 2020 a letter of claim was delivered on behalf of a group of former professional rugby players against the RFU, the WRU and World Rugby. The 9 players concerned will proceed to a test case which will determine whether there is any liability on the part of the governing bodies to the Claimants in relation to the brain injuries they sustained during their professional careers. Essentially the allegations relate to failure by the Defendants to take reasonable care for their safety by establishing and implementing rules and regulations to tackle the issue including the assessment, diagnosis and treatment of concussive injuries during matches and training sessions. They allege that given the significance of the risk of serious and permanent brain damage it was negligent of the defendants to fail to take steps to reduce the risks which were known and foreseeable at the time. Obviously this is a highly physical contact sport and the issues to be considered are extremely complex. The basic principles of English Law will apply in relation to the tort of negligence. This tort allows a Claimant to bring a civil claim for compensation against one or more Defendants.The 3 hurdles in order to succeed are as follows:
• The players were owed a duty of care - without a duty of care there can be no claim It is difficult to see how the governing bodies and potentially clubs (who may become involved as employers) would not owe a duty of care to take reasonable care to protect the health and safety of rugby players. They create and enforce the mandatory regulations and have the knowledge in relation to all health risks including head injuries so it would seem entirely just to impose this duty.
• The Defendant(s) breached that duty of care - the onus is on the claimant to prove that the standard of care fell below that required by the law – the standard being that of a reasonable person in the particular circumstances So the Court will need to decide what a “reasonable governing body” should have done taking into account the knowledge available at the time and the severity of harm if they failed to take action and other important factors such as the overall impact on the sport generally for example. The key to this hurdle will be linked to the expert medical opinion and research and statistics which arguably date back to the early 1970s. The court will need to consider what actions could and should have been taken but linking into point 3 below.
• The breach of that duty caused the injuries and loss and were foreseeable - The expert evidence from the medical profession, coaches, players, officials will be key as to whether it can be proven that any “breaches” were responsible for the current position the ex-players now find themselves in given the physical nature of the sport. I suspect this will be the most complex part of the litigation and linked to a vast amount of medical and sport science research.
The first football match which involves no heading of the ball has a vital role in raising awareness and stimulating conversation about the impact of head injury in sport, its organisers have said.
The 11-a-side match, involving 25 former professional footballers, has been hailed as an experiment as researchers try to discover whether the game can function without heading, in light of evergrowing research which links football to neurodegenerative disease. Organised by Head for Change, the charity helping to drive forward calls for changes to player safety, the match allowed headers in the penalty box for the first half and then restricted all heading during the second half. The event forms part of the “legacy” for former Spennymoor Town and Middlesbrough defender Bill Gates, who has sports-related dementia, and whose wife Dr Judith Gates is co-founder and chair of Head for Change. “When Bill received his diagnosis in 2017, we made two promises to him,” Dr Gates tells NR Times. “One was to optimise his life and do all we could to make his life as good as we could as a dad, grandad and great grandad, and the second was for his legacy, to do everything we could to be part of the solution for future generations of footballers and their families not to have to face this. “The purpose of this match is to raise awareness of the dangers of heading the ball and to provide alternative discussion with purpose. It’s an experiment to see what the game will look like. “To be clear, Head for Change is not suggesting heading should be banned, that is a decision for football’s governing authorities, not for us. “But we want people to realise the impact. Bill was a Titan to me in his 20s, fit and indestructible, so if this disease can do this to him, it can happen to anyone.” The match has attracted widespread media attention and comes after an array of stark academic findings, including the research from Professor Willie Stewart that footballers are up to five times more likely to suffer from dementia than the general population. “Part of why I co-founded Head for Change was to be part of the solution,” says Dr Gates. “We’re extremely aware that there is a lot of bashing going on and everyone is saying it’s someone else’s fault, but lessons must be learnt from the past. “For too long we have been assured that our brain was safe in our skull, but we are increasingly understanding how the brain works and how it can be damaged through contact sports. Education will continue to play a very important role in what happens going forward.” The match itself – which will also be raising money for The Solan Connor Fawcett Cancer Trust – was held at Spennymoor Town’s stadium, The Brewery Field. The town is where Dr Gates grew up and met her husband, and in a quirk of fate, Spennymoor Town’s chief executive Brad Groves used to work for Bill as a warehouseman when Bill owned a chain of sports stores.
