Former Wales defender Keith Pontin died from dementia caused by him heading the ball repeatedly during his career, an inquest has found.
Pontin, capped twice for Wales, played for Cardiff between 1976 and 1983 and made more than 200 league appearances.
He was diagnosed with early onset dementia in 2015 aged 59, and died at the Royal Glamorgan Hospital on August 2, 2020 aged 64.
His family, including his wife Janet – who has campaigned for a better understanding of dementia among players – and his two grown-up daughters, have always believed his condition was linked to years of sustaining multiple concussions during matches.
Pontypridd Coroner’s Court heard on Tuesday that a post-mortem examination, carried out by pathologist Dr Esther Youd, found the cause of death to be chronic traumatic encephalopathy (CTE).
What is Chronic Traumatic Encephalopathy?
CTE is a progressive brain condition believed to be caused by repeated blows to the head and episodes of concussion.
The symptoms of CTE affect the functioning of the brain and eventually lead to dementia.
During the hearing, a list of the injuries Mr Pontin suffered throughout his career, compiled by his wife, was read to the court – beginning with a concussion during a match against Wrexham when he was was playing for Cardiff aged 18.
Assistant coroner David Regan said a number of statements described Pontin as a “gentle giant off the field”, but was a “competitive” footballer with a “combative” style.
Paul Burrows, a former Swansea player and teammate of Pontin’s at Barry Town during the 1990s, said the role of a defender used to be more physical than in the modern game.
Burrows said: “He was what I would describe as an old-fashioned centre-half. I’m not sure of his height but I’d guess he was around 6ft 2ins and was expected to be dominant in the air and good at heading the ball.
“That central position is a big, strong, tough defender and people looked up to Keith for this attribute.
“There was a time when he came back on the field with his head bandaged up with blood everywhere. Everyone thought that was great at the time, he was a hero sort of thing.
“Now there’s a lot more emphasis on checking out the head injuries. But back then if the player said he was fine, he would go back on the field.”
William Stewart, consultant neuropathologist at Glasgow’s Queen Elizabeth University Hospital, who examined Pontin’s brain tissue, said he found a pattern of Tau protein in Pontin’s brain consistent with CTE, and that after collecting a history from Pontin’s wife believed it could only have been caused by his playing career.
“What comes through particularly strongly is the behavioural changes which were unlike him in terms of episodes of aggression and challenging behaviour,” he said.
“All of it fits quite strongly with the current understanding of CTE.
“Dementia is a very loose term for a degenerative brain process, it’s an imprecise term. The precise term in this case is CTE. That is the precise term for his dementia.”
He said around 75% of all former footballers and rugby players with dementia have CTE and former footballers are three-and-a-half times more likely to develop CTE later on in life, with the risk jumping to a five-fold chance for defenders.
“There is no evidence yet suggesting changes in the modern game have altered the risk,” he added.
Mark Evans, from the Football Association of Wales, was called to give evidence, but said the organisation no longer held records relating to Pontin.
A legal representative for Cardiff attended the inquest and questioned Stewart over his findings, claiming there was not enough evidence to prove Pontin’s career in football had caused CTE.
However, coroner Regan said he found Stewart “extremely persuasive” and concluded: “Keith Pontin died from chronic traumatic encephalopathy caused by repetitive head injury suffered as a professional footballer.”
A spokesperson for the Professional Footballers’ Association said: “Our immediate thoughts are with Keith’s family, his wife Janet and two daughters.
“The Industrial Injuries Advisory Council (IIAC) must act now to recognise dementia in former footballers as an industrial disease. The verdict of the coroner, along with expert testimony, adds to a mounting weight of evidence that can no longer be ignored by the IIAC.
“The evidence submitted during the inquiry also demonstrates the need for football’s law makers to increase the protection given to current players, particularly the urgent strengthening of head injury management and concussion protocols.”