Concussion Cases From Rugby 'Could Be Underestimated'

Peter Russell

July 22, 2021

New evidence has emerged that contact sports such as rugby could be associated with changes in brain structure among players.

A study involving a small number of players, published in the journal Brain Communications,  found a significant proportion of rugby players had signs of abnormalities to brain white matter, in addition to abnormal changes in white matter volume over time.

A research team led by Imperial College London said that further investigation was needed to establish the impact of rugby on brain health.

Sport 'Marks Its Own Homework': MPs

The study was published as MPs said it was wrong that sporting governing bodies were allowed to 'mark their own homework' when it came to dealing with concussion.

Mild traumatic brain injuries are the most common reported match injury in rugby union in the UK, accounting for around 20% of injuries among professional players.

"Our research using advanced magnetic resonance imaging suggests that professional rugby participation can be associated with structural changes in the brain that may be missed using conventional brain scans," commented Prof David Sharp, from Imperial’s Department of Brain Sciences, who led the study.

The investigators said that previous work involving retired players had found limited evidence of mild cognitive impairment and depression but that the findings were limited by the symptoms being self-reported.
 

Neuroimaging

The study involved 41 males and three females in 2017 to 2019 of whom 21 were assessed after a head injury, compared to 32 people not involved in a sport.

Neuroimaging evidence of either axonal injury or diffuse vascular injury was seen in 23% of rugby players.

The study used two types of MRI called susceptibility weighted imaging and diffusion tensor imaging.

"Examination of longitudinal imaging revealed unexpected reductions in white matter volume in the elite rugby players studied," the study concluded. "These changes were not related to self-reported head injury history or neuropsychological test scores and might indicate excess neurodegeneration in white matter tracts affected by injury."

Experts commended the researchers for the study. Dr Virginia Newcombe a clinician scientist fellow from the University of Cambridge said: "Over the past few years there has been a growing concern that contact sports which are prone to repeated blows to the head, like rugby, have the potential to lead to long-term problems. These may range from problems with mood and thinking, including in the most severe cases a type of dementia commonly known as Chronic Traumatic Encephalopathy (CTE).

"So far the diagnosis of CTE has largely been made post-mortem. However, being able to detect injury while a player is still playing is key to be able to offer earlier advice and treatment, [and] manage symptoms appropriately."

However, Derek Hill, professor of medical imaging science at University College London, cautioned that the results were preliminary. He told the Science Media Centre that "the long term implications of this damage are not clear" and that "a longer study would be needed to determine if the brain changes lead to harmful long term effects".

Call for Government Action

A report published today by the House of Commons Digital, Media and Sport Committee criticised the Government and sporting authorities for failing to reduce the risk of brain injury in sport. That could have led to under-reporting of cases, it said.

Committee chair Julian Knight (Con) said: the committee had found "negligible effort to track brain injuries and monitor long-term impacts".

MPs said they were "astounded" that sport should be left to the Health and Safety Executive for an assessment of risk from participation. It said that the Government "should establish UK-wide minimum standard definition for concussion that all sports must use and adapt for their sport".

Reacting to the report, Peter McCabe, chief executive of Headway, described the Committee's report as "an important step forward in the campaign to better protect people from the short and long-term risks of concussion" and called for government funding into research on the issue.

"The committee's criticism of governing bodies in sport is clear," he said. "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."

Brain Communications, Volume 3, Issue 3, 2021, fcab133, https://doi.org/10.1093/braincomms/fcab133

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