Dr. Ian Beasley – Ex-footballers Healthcare – Injury Rehab Network

The July Injury Rehab Network event with BASRaT featured a presentation from Dr Ian Beasley. The online event took place on the evening of Thursday 11th July with 90 sports rehabilitation practitioners in attendance.

Dr Beasley discussed healthcare for ex-footballers. The recording is available to watch here.

Dr. Ian Beasley

Dr Beasley qualified in 1982 from St Bartholomew’s Hospital, London, followed by General Practice training. He was awarded a Smith & Nephew scholarship to study Sports Medicine in London in 1986 and passed his diploma with merit a year later. Ian gained his MSc in 1997 and was a foundation fellow of the Faculty of Exercise Medicine at its advent. He holds a Certificate in Ultrasound Scanning from the School of Medical Ultrasound in Bournemouth.

Ian has worked in all four professional football divisions in England as the team physician at Leyton Orient, Chelsea, Watford, Fulham, Arsenal, West Ham, and Bournemouth. He was the national team doctor for the England men’s team and chief medical officer for the English FA from 2009 to 2016. In 2012, he was appointed by the BOA as a sports physician by Team GB for the London Olympics.

Ian was Chief Medical Officer for England and Great Britain Hockey for ten years and attended the Olympic Games, Commonwealth Games and World Cups with the national squads. He was recruited by the world-famous Aspetar Hospital in Qatar and worked there for two years. Ian was a Senior Lecturer in Sport and Exercise Medicine at Queen Mary College, London University, and clinical lead in SEM at Barts Health NHS Trust. He completed a certificate in Learning and Teaching whilst there.

He was a venue medical officer for FIFA at the U-17 women’s World Cup in India in 2022 and at the FIFA World Cup, Qatar 2022.

Ian was a medical adviser to the Royal Ballet Company London for 15 years until 2023.

Current posts:

• Medical Consultant to the global performance unit at Manchester City FC
• Board member of the International Concussion and Head Injury Research Foundation

Dr Beasley regularly lectures to domestic and international audiences on assorted topics in Football Medicine, Team Medicine, and other issues in Sport and Exercise Medicine.

He was ‘The Athletes Doctor of Choice’ in the Times Magazine in 2010.

Ex-footballers healthcare

It is clear now that professional footballers suffer significant morbidity as a result of their time in the beautiful game. Dr Beasley’s talk outlined those morbidities and asked how we might support those who have entertained us over the years.

Ian considered the question, “What happens to professional footballers after retirement as a consequence of their participation in the beautiful game?”

Background

Dr Beasley discussed his experience as a team/ sports physician, starting with Leyton Orient in 1987 and including work with Chelsea, Watford, Fulham, Arsenal, England, West Ham, City Football Group and AFC Bournemouth.

Ian has also worked as the Medical Officer for GB Hockey at the Olympic, Commonwealth, and World Cups and as the Medical Adviser to the Royal Ballet Company.

Dr Beasley described his time working at the Aspetar Orthopaedic and Sports Medicine Hospital in Doha, as a Senior Lecturer/ Consultant/ Clinical Lead at Queen Mary College (University of London), and as a FIFA Venue Medical Officer.

Ian considered research by Gouttebarge et al (2018), which examined the health of retired professional footballers, including the development of an after-career consultation focused on:

1. Detraining from professional football
2. Remission of osteoarthritis
3. Promotion of healthy lifestyle
4. Preventing mental and cognitive health problems
5. Employment and education

The research led to new guidance and resources from FIFPRO.

Issues Covered

Ian discussed the issues covered in his presentation, including:

1. Degenerative joint disease (knee and hip)
2. Cardiovascular effects
3. Mental health issues
4. Concussion +/- dementia
5. Neuro-degenerative disease

Degenerative Joint Disease

Dr Beasley described how ex-professional footballers have a prevalence of lower limb osteoarthritis of 33%. Retired players report earlier onset of joint pain and are 3 x more likely to need a knee replacement. Knee pain peaks 10-15 years earlier in ex-footballers compared with men in the general population.

Hip osteoarthritis is 2% in current and 8% in former professional footballers (0.3% to 8.3% in the general population).

Ian considered his firsthand experiences in professional football, with up to 40% of players reporting that they play with an injury or pain.

Cardiovascular Effects

In examining the cardiovascular effects of a career as a professional football player, Dr Beasley first considered the WHO Global Recommendations on Physical Activity for Health. Adults should do at least 150 minutes of moderate-intensity physical activity per week or 75 minutes of vigorous-intensity exercise. For additional benefits, it is recommended that adults double the amount of activity to 300 minutes of moderate-intensity exercise or 150 minutes of vigorous exercise and undertake muscle-strengthening exercises on two or more days per week.

Ian considered research into cardiovascular effects on elite athletes with considerable support for superior longevity outcomes for those in endurance and mixed sports (e.g. football). There is also a significant reduction in CVD (and cancer) for mixed sports athletes.

Dr Beasley discussed Lone Atrial Fibrillation, with research showing it may be more common in athletes who participate in a large volume of high-intensity exercise. Research highlights that the dose response relationship between exercise and lone atrial fibrillation is at lowest risk in individuals who participate in 1,000 hours of high-intensity exercise. Athletes who participate in 2,000 hours or more of high-intensity exercise are more likely to develop lone atrial fibrillation.

Mental Health

Dr Beasley considered the mental health effects on professional footballers and discussed the challenges and pressure that footballers face. Anxiety and depression are the most common problems with players affected by low self-esteem and adverse nutrition behaviour. Ian considered the effect on mental health in academies, where research shows a need to offer emotional and psychological support to players and provide counselling services to support players through the deselection process.

In summary, Ian considered that ex-professional footballers seem more prone to mental health problems, and there is a need for support systems to be set up.

Concussion, Dementia et al

Dr Beasley discussed research into concussions in football and dementia. Studies have been based on low numbers, but findings do postulate that repetitive heading was responsible for Chronic traumatic encephalopathy (CTE) and that further research is advised.

Ian considered research in Scotland, which shows that mortality from neurodegenerative disease was 1.7% in ex-footballers compared to 0.5% in a control population. Dementia-related medication is also more commonly prescribed to footballers.

Ian described another research project that focused on the number of times that players head. This research showed changes in MRI and memory scores associated with having headed the ball more than 1,800 times per year.

Dr Beasley discussed research into concussion in women’s football, with females more susceptible to concussion, have prolonged symptoms after a concussion, and are more likely to report a concussion than their male counterparts.

Sports bodies are learning from the effects of concussion, and Ian described how changes are now being implemented in English football to make football safer. Professional football now provides guidance for the recommended number of headers. From the 2024/25 season, deliberate heading will no longer be allowed in youth football for ages U7 – U9.

Neuro-Degenerative Disease

Dr Beasley discussed research into Amyotrophic lateral sclerosis (ALS) and motor neuron disease (MND). Research in Italy reviewed the deaths of 24,000 Italian professional footballers between 1960 and 1996. The findings showed an excess in mortality from ALS, with eight deaths observed versus 0.69 expected. Ian noted that it isn’t clear if these deaths were linked to head injuries/concussions or associated with nutrition or drugs. The research asked, “Is ALS an occupational disease?”

Ian considered research into the link between vigorous physical activity and early onset of ALS. Findings show that individuals with a history of vigorous physical activity are more likely to be diagnosed with ALS before the age of sixty. The study concluded that more research is needed.

In addition to vigorous activity, Dr Beasley also considered research into the links between repetitive concussion and cervical spine trauma in sport. This research shows that ALS is significantly and independently associated with professional sports prone to repetitive concussive head and cervical spine trauma. Research into ALS and Parkinsons in NFL players showed that 7 out of 3,439 players had ALS vs <2 out of 3,439 in the general population. The risk of dying was four times higher among players/ ex-players.

Dr Beasley concluded that there is some evidence that heading may present ‘sub-concussive’ episodes that can cause brain dysfunction or damage. Professional footballers may have an increased risk of contracting a neurodegenerative disease. ALS is more common in elite athletes and even more so in those taking part in contact sports with repetitive CNS trauma. Ian noted that scientists are still awaiting definitive connections.

So – The Beautiful Game?

Dr Beasley concluded his presentation by reflecting on the five areas covered:

1. Degenerative joint disease (knee and hip)
2. Cardiovascular effects
3. Mental health issues
4. Concussion +/- dementia
5. Neuro-degenerative disease

Ian noted that the days should be gone where doctors see ex-players as favours and try to help them. Administrators and governing bodies must start to support ex-players properly, and for the long term. Ian suggested the idea of a trust or vets’ system for players, certainly those at the lesser-funded end of the game.

Dr Beasley noted that transitioning out of professional football is a challenging time and that there are enough resources and research now to support players appropriately on retirement if needed. Ian commented that this applies to other sports and not just football.

Q&A

Dr Beasley kindly answered questions put forward by practitioners who attended the session. Please see the presentation recording for the insights from Ian to the questions.

Presentation Recording

The recording of Dr Beasley’s presentation is available to watch here.

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