WALKING FOOTBALL - THE HIDDEN MEDICAL DANGERS
Quinn M1, Stride M2
1 Society of Sports Therapists, Glasgow, Scotland.
2 Isokinetic - FIFA Medical Centre of Excellence, London
Background:
Walking Football as a structured game with rules was launched in 2013, initially as a way of encouraging older Men over Fifty years of age, back into regular, safe exercise by modifying the most popular game in the world, into a small sided recreational pastime. (Reddy et al. 2017)
It was not a new concept as many professional teams have used a similar training exercise, with a slowed down small-sided game kicking into empty small goalposts. There are newspaper documents of The first known game of walking football taking place in Derby at the old Baseball Ground on May 14th, 1932, between Derby Railway Veterans and Crewe Railway Veterans. (Daily Telegraph).
This new fledgling sport received a massive boost and an incredible rise in participants after it was chosen to promote a TV advertisement for Barclay Bank, featuring the “Cove Rapidly Ageing Pensioners” team in training.( You tube: https://youtu.be/k3Lt3tDUJZ4) The game quickly progressed and is now one of the fastest growing sports, played in most countries worldwide.
There have been a few studies showing the many health benefits to the participants, results of the studies demonstrate the utility of recreational football as a physical activity intervention in older adults to improve functional movement. (Duncan MJ et al. 2022) (Arnold JT et al. 2015) The health benefits are amazing with improved cardiovascular fitness and proprioception (balance) joint strength, mobility and reported reduced cholesterol and weight losses all being attributed to this regular aerobic activity. (GF Fletcher et al. 1992), (J. Bangsbo, P. Krustrup. 2014) .
The social interaction is also a very positive benefit. (Cholerton et al. 2019),
From a sports physician’s point of view, the game can be used to reintroduce late-stage rehabilitation patients of all ages into a pre-discharge return to Sport. Used for both physical and psychological confidence.
Problems:
Recent Growth of the sport has introduced Women players 40 years + to the game and increased the range of male participation to the ages of 50-80 years of age. Unfortunately, there has been no Recognised Medical input into the rules and structure of the sport, or consideration of the physical deterioration of older players, leaving many potential risks to the participants. Due to the lack of a recognised Governing body, many organisers of club sessions are making up their own rules and versions of the game without any thoughts of the safety aspects.
The English Football Association has been made aware as to the hidden medical dangers, but It seems the English Football Association is more concerned with political correctness and equality than safety and common sense, which is leaving the participants at risk.
The FA are interpreting the game as a non-contact sport which on paper sounds straight forward and have been advocating the game as a mixed sex participation sport. The game will always have accidental collisions due to the competitive nature of football, and this is where the hidden dangers lie.
There is clinical proof that post-menopausal females have less bone density which can lead to Osteoporotic fractures, these hip fractures result in death within 12 months in over 20% of the cases with many more leading to disability. (Ethel S. Siris, MD; Paul D. Miller, et al, (2001).( Salkeld G et al. 2000)
The female anatomy also increases the risk of Anterior Cruciate knee ligament damage with a six to tenfold more chance of injury than their male counterparts. This is due to the wider hips and smaller knee joints of women. (Carrie DeVries. 2015), (Gould S, et al. 2013), (Cheung EC et al. 2015)
No one is questioning the ability or skill of female players but there are physical differences that stop mixed sex sports, and this is even more evident in older people. The FA are encouraging untrained combatants who possibly have not played football for many years to return to competition which is seldom properly regulated.
The Equality Act 2010. States “In competitive sports the organisers can hold separate events for men and women because the differences in stamina, strength and physique would otherwise make the competition unfair”. This has to take into account, we are talking about a majority of untrained, overweight and clumsy, older men, who would be unable to change direction of movement to avoid collisions at speed.
The game must be allocated into age ranges and single sex sections.
The significant differences in ageing bodies and different sexes greatly increases the risks to health and injuries. The ultimate aim of this paper is to encourage safety controls to alleviate many of the risks and may require the intervention of FIFA to take ownership of this game and instruct the relevant Football associations worldwide to ensure safety is paramount at every match or training session.
Structure
The first set of published rules by Hampshire FA were aimed at making the game safer. The game was designed as a small sided 6 aside match on a playing area of around 28 meters by 38 metres. The games were played as short 7-minute halves and participants should play around an hour in total. The game was planned with limited touches of the ball, initially two touches, but that soon progressed to three touches per player uninterrupted, to encourage inclusivity amongst teams to involve the less skilled players in the play. The limited touches also evened the playing field for the differences in ages and less need for physical fitness levels. Studies show that there was up to 60% less tackling in limited touch football. There were to be no tackles from the side or behind and no over aggressive tackles from the front. Goalposts were 2x3 meters and over time a no heading and no over crossbar height rule was introduced. The goalkeeper has a semi-circle 4 metre protection area. The games were played on a synthetic pitch with rubber crumb surface (Astroturf) with open sides instead of a closed arena, to allow short breaks in play as the ball left the field. The main concept of the game was no running, which was defined by always having one foot on the ground during play.
The aim was to create a game that could be played by the less mobile, who could use their experience and skills to create space, see openings, control the ball, and make the correct pass, whilst moving slowly into position for a return pass. By using their experience to position themselves between the attackers and the goalposts they can reduce the scoring opportunities without need for tackling. It would be more inclusive and limit the fitter faster players influence and level the playing field.
As the number of participants increased and new clubs were being formed, age sections were introduced initially over 50s and over 65s. Unfortunately, as participants fitness levels improved, the speed of the game also improved along with various clubs introducing their own rules of play, which had no thoughts of integrated safety. We now see multi touch games of 40 minutes each half, played in arenas surrounded by wire fences, which keep the ball in play at all times, with aggressive tackling and collisions with the fences as players try to shield the ball. We are seeing 8, 9 and even 11 a side matches on larger pitches forgetting the capabilities of the players. Clubs are encouraging mixed sex matches and decided they would reinvent the game as “Non-Contact” punishing fouls and runs with a blue card. This led to players being sent to a three-minute sin bin for offenders who committed three offences. To the untrained eye this is a punishment aimed at teaching offenders not to reoffend and make the game safer in the long term.
First of all, the game is not and never will be non-contact. Referees are blowing for many, many contact fouls during the matches, which proves it is a contact sport. It is the level of contact that must be addressed, such as deliberate barging or over physicality. Brushing a finger on someone’s shirt as you pass them by, does not merit a punishment. The games should be refereed by fully trained qualified capable football referees. There is no kudos in playing a small, sided match against a team with reduced numbers and sending aged people to a sin bin, once again increases their risk of injury as does overexerting their bodies by too much playing time. There are studies showing that in young fit Handball players who are sent to a two-minute sin bin are three times more likely to sustain an injury on return to playing. Older players were at greater risk of match injury. One would have to assume the effects on people three times their age would be an even greater risk. (Montasser Tabben et al. 2018) One also must question the increased vascular output and strain of outfield players attempting to cover the work rate of their missing player. Again, there is no thought of the wide range of medical ailments or deteriorating physical capabilities. A more sensible punishment for the offending team would be to use the futsal rule of five team offences having a penalty award against them, with every single subsequent offence being an automatic penalty. There should be no sin bins in walking football.
There are too many stoppages in the modern game now. We have established there is a non-heading rule for safety purposes, and a crossbar height restriction of the ball in play. The height restriction should be enforced if someone kicks the ball above the crossbar height. Unfortunately, the game is being stopped if the ball accidently deflects off a player and rises above this height through no fault of the player. There is no need to stop the game as heading is not permitted, so therefore there is no risk of injury to anyone, play should continue without stoppage. The same thing applies to goalkeepers who save a shot which deflects above the crossbar height or back into play. There is no valid reason to stop the game, play should continue as there is no risk to anyone. In normal football the goalkeeper is not permitted to pick up from a pass back and can only use their feet. Walking football tries to complicate this by allowing the keeper to pick up but only after two defenders have touched it first.
The players should be penalised with a blue card for running offences, which is subjective to the referee’s interpretation of the running rule. Again, we have many poorly trained referees who are being told they are qualified, by groups unfit to award any qualifications. There is even one self-appointed group of experts who are basing their running interpretation on “Olympic race walking” and insisting they require a straight leg when it strikes the ground, which is an unacceptable risk in playing football due to leaving the leg susceptible to being broken if external forces were applied. (S Ounpuu. 1994)
The environment and surface are also paramount; matches should all be played on 3 or 4g Astroturf rubber crumb surfaces where possible. If the game is played on grass it adds other risks. If the grass is over dry the ground is uneven and solid, which could increase the injury from a fall. If it is soft and wet, then the participants will need to wear studded boots, which in turn increase the injury damage from bad tackles. It should also not be played indoors on concrete or wooden floors surrounded by brick walls or outside in wire cages. Falls are a common and often devastating problem among older people, causing a tremendous amount of morbidity, mortality, and use of health care services, including premature nursing home admissions. (Laurence Z. Rubenstein.2006)
Obviously not everyone will have access to Artificial surfaces, but the only endorsed form of the game must have all the safety aspects.
There should be medical screening to ensure the participants are physically able to play and this should be regulated by medical professionals. There should always be medically trained and properly equipped personnel at any sporting event to take care of emergencies. Defibrillators should be present at Pitch side and not situated far away from the playing surfaces as most are. An older person will take longer to run to a leisure centre or office and return promptly, losing valuable minutes at a crucial time
In November 2017, there were four myocardial infarctions reported with only one of the four surviving. The only survivor was the one who had a defibrillator at Pitch side. There has been reports of successful interventions from defibrillators. (Daily record March 24, 2015).
Other factors to be aware of include checking the players do not wear fit bits or watches and must wear shin guards in competitive matches. Using a lighter size 4 football is kinder to the goalkeepers and tends to bounce less high, helping avoid the over crossbar height rule. There should be regular water breaks and a period of warming up and cooling down at each session.
We need to ensure all possible risks are removed from the game.
If the game is controlled as suggested above, the health and psychological benefits are incredible and could even lead to social prescribing from medical doctors when returning patients to activity after medical interventions or mental issues. With a qualified medically trained, coach or supervisor, players could have clinically measurable improvements and data from wearing heart monitors during the controlled slower training sessions, hopefully leading to full fitness and return to competitive action. This treatment alternative would be enthusiastically received by older adults in comparison to gym sessions.
Making these adjustments could prevent many injuries or even deaths.
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