FA ‘treating women’s footballers as second-class citizens’ over concussion risk

The Football Association has been accused of treating women’s footballers like “second-class citizens” because the female game has so few resources to help diagnose concussion.

Less than a month after MPs were told women are twice as likely to suffer a brain injury in collision sports such as football and rugby, Telegraph Sport has found the Women’s Super League mandates just one doctor at matches, versus the four doctors available at a men’s Premier League game.

The stark contrast in the level of medical support was described by Julian Knight, chair of the Department for Digital, Culture, Media and Sport select committee, who last month criticised the FA in its efforts to combat football’s dementia problem, as “deeply disturbing”.

While each WSL home side must provide a club doctor, there is no stipulation for away sides to do the same. Both home and away sides must provide a physio for each team.

In the men’s Premier League meanwhile, the rule book states that there must be four doctors for every match, including one doctor each for home and away teams, and a ‘medical coordinator’ – more commonly known as ‘tunnel doctors’. The latter is a third doctor who acts as an extra pair of eyes at Premier League matches to spot potential concussions through TV replays and Hawk-Eye footage.

They have been mandatory in the Premier League since the 2015/16 season and, while appointed and paid for by the home club, act as independent doctors. In the men’s Championship, away sides have been providing club doctors since the 2019/20 season. The Premier League also mandates that a ‘crowd doctor’ should be present as the fourth physician.

In the WSL medical staff also do not have access to replays in real time, which could help them in their assessment of head injuries.

“There is a major issue here and it’s certainly something we’ll take on board as part of our inquiry into concussion in sport,” Knight told Telegraph Sport. “My impression is that, whereas sports such as rugby seem to be taking a proactive approach to this, football seems to be doing almost the bare minimum and it’s particularly acute when it comes to the women’s game.

“This is treating women’s footballers as second-class citizens and regardless of what they say about the expense, if they’re serious about ensuring that there is a proper future for the women’s game it can’t be threadbare, particularly when it comes to safety. 

“Women’s football is almost worse than a poor relation. I think people could accept the fact that the economics of women’s football aren’t as lucrative as men’s football in terms of playing, in the same way that the championship isn’t as lucrative as the Premier League.”

Despite having recently secured a multi-million broadcast deal with Sky and the BBC from next season, which is set to increase revenue in the league dramatically, The FA told Telegraph Sport it currently has no plans to introduce tunnel doctors in the women’s top flight.

Responding to the news, Knight said: “I would call on the BBC and Sky to have urgent talks with the football authorities to make them think again about player safety. Now that we’re going to see more women’s football on television, I think people need to feel that it is equally safe as the men’s game.”

Alex Davies-Jones, an MP who sits on the parliamentary committee for the DCMS, said she was “hugely disappointed” by the FA’s lack of ambition. 

“I truly believe that having an independent doctor who is able to draw on video technology could be vital in combating concussion in sport and will be urging them to reconsider,” she said. 

Luke Griggs, the deputy chief executive of Headway, the brain injury association, argued that far greater transparency was needed regarding the role of ‘tunnel doctors’ in football.

“Who are they? What qualifications are needed to perform the role? What consultation goes on between tunnel doctors and the on-pitch medical teams? At the moment, we know too little about tunnel doctors to be able to judge their effectiveness,” he said.

“What is clear is that with studies showing female athletes to be at greater risk of sustaining concussions, it is vital that everything possible is done to improve concussion management in the women’s game.”

An FA spokesperson said player welfare was of “paramount importance” across the WSL and the Women’s Championship and it worked “closely with clubs to ensure that the appropriate level of medical support is provided to players”.

“This includes mandatory doctors and physios at every match and extensive emergency medical equipment at pitch side,” it added. 

“All doctors are highly trained to diagnose and manage serious injuries, including head injuries and concussions, to ensure players have the medical support required when they take to the field.

“We also work closely with clubs to monitor and record injuries and illness across both leagues in order to build a greater understanding and an accurate picture of the medical demands in the women’s game.

“We regularly review and adapt our medical protocols and processes to ensure the appropriate level of medical support is provided to the players.”

In February, the FA introduced concussion substitution trials in the WSL and the FA Women’s Championship, as well as the men’s Premier League in a bid to boost player welfare around head injuries. 

‘What if I get to 50 and I have to be put in a home?’

Towards the end of her career, Freya Holdaway, the former Crystal Palace captain, was unable to stare at a screen for more than a couple of hours at a time. One day, she woke up and burst into tears because her ears would not stop ringing.

Both were indicators of the three concussions she had suffered in the space of 18 months, which left her in a constant state of anguish.

“I’d ask myself ‘What if I get to 50 and I have to be put in a home?’ If I keep playing, that could happen,” Holdaway, who earned six caps for Northern Ireland, tells Telegraph Sport. “I had those moments of panic. I didn’t want to go through that sort of thing.”

The former centre-back wants to share the story of how concussion ended her career prematurely at 31 as a warning to the current crop of elite female players.

Freya Holdaway in action for Northern Ireland


Freya Holdaway in action for Northern Ireland


Credit: GETTY IMAGES

The first time Holdaway experienced concussion was during a pre-season friendly in July 2018, when her head “swelled up straight away”. The visible nature of the injury prompted her to leave the pitch immediately.

Nine months later, in a friendly, she took a knock to the temple and brushed it off as a minor incident. “I banged heads with another player and everyone explained it like two shin pads smashing together,” Holdaway recalls. “When the physio came on, she said ‘Come off for a few minutes and hang out by the goal just to get yourself together. They might put you on for the second half’.”

Holdaway walked around the pitch, trying to gather herself, but did not feel right. “The next minute, the floor came up to my face,” she says. “That was me obviously hitting the ground.”

What happened next was shocking for a player who, moments before, had been considering a return to the pitch. Holdaway experienced a concussive seizure, a fit of such severity that it is often confused with post-traumatic epilepsy, occurring in roughly one concussion case in 70.

It is chilling to consider what might have transpired had she returned to the field. “If I headed the ball again or banged somebody else’s head…what sort of damage could there have been?” she says.

Despite the incident, Holdaway made a full return to football. But in October 2019 she was concussed again as she headed away a goalkeeper’s kick. Research on women’s players in the United States has shown that the forces generated by heading the ball from goal-kicks can reach 100g, which is similar to NFL players crashing into each other.

“After that, I didn’t want to drive home. But I thought ‘Am I being a bit paranoid?’ Heading the ball from a goal-kick – a normal part of the game – is what made me feel awful again for months.”

Holdaway was later diagnosed with concussion. So persistent were her symptoms this time that she had to take a month off work. “I’ve never slept particularly well, but I was sleeping 12 hours solid,” says Holdaway, whose team-mates and staff at Palace, as she puts it, watched her “withdrawing from the game a bit”.

The pandemic-enforced break last year was a blessing in disguise. The suspension of all elite women’s football meant Holdaway did not head a ball. In the space of four months, her symptoms, including regular headaches and ringing in the ears, began to subside.

“I started to feel so much better than I’d been feeling in the past two years,” she says. “I always had the classic late-onset concussion symptoms. It wasn’t always straight away, they’d surface a week later. So if I played, I’d spend the next week worrying about how I’d felt.

“That’s when I was like ‘It’s time [to retire]’. I made that decision as a 30 plus year old. If I was in that position aged 23, I would still be playing, 100 per cent. That’s not the right thing.”

Holdaway is now an ambassador for the Scores Project, an ongoing study investigating the rate of cognitive decline in former professional footballers and other sportspeople in the UK compared with the average healthy person. The project has so far recruited 30 former female footballers, who must be over the age of 40 to take part.

“Once I hit a certain age, 100 per cent, I’ll be the first there,” says Holdaway. “I’m quite happy to leave my brain to research when it’s gone because again, it’s about what impact I can have on the game.”

She is also supportive of English football’s plans to implement new protocols for heading in the professional game this summer, but wonders how far the measures will go for women.

“As a centre-back, I can’t say footballers shouldn’t head the ball,” she says. “But I do think it should be massively restricted and I think there should be more emphasis on how to head the ball.”

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