Don’t let repetitive brain injuries affect your life

The brain is overlooked in sport, with the focus instead below the neck, meaning the most vulnerable and important organ in the body is left unprotected, relatively unchecked, and typically only at best sometimes acknowledged after injury. It is the brain that determines performance in sport, and life. The brain defines who we each are; personality, moods, intelligence and memory, the ability to think, process information and make decisions.

The brain is at risk, not just to a single or high-force impact, but also to the multiple, relatively minor impacts which are invariably unnoticed and undetected in sport and life. Every single impact to the head has the potential to be career ending and life-changing. The effects of concussion or more correctly mild traumatic brain injury, and sub-concussive impacts are underestimated, with coaches, players and parents undereducated on the risks. Brain injury accelerates the progression to negative cognitive, psychiatric, mental health outcomes.

In a wider sporting context, research provides a significant association between a history of concussion and lower extremity injury, especially lateral ankle sprain, knee injuries and muscle strains. All athletes of all levels in sport have a greater risk of lower body injury issues for more than a year following a sport-related concussion. In some cases, this risk is as high as 67%.

The risk of brain injury is also a significant commercial issue for professional teams, given the billion-pound losses attributable to missed days due to injury. A clear relationship has been shown across professional sports between the number of days out due to injuries and the difference between a team’s final position against their expected position, adjusted for overall squad value.

Who is at risk?

Those with higher risks around brain injury include:

– Females

Females are at least three times more seriously impacted by concussion than males, have longer recovery time and post concussive symptoms are more pronounced. This is because of differences in the microstructure of the brain, the influence of hormones, coaching regimes and the management of injuries. In football, girls are more likely to get a concussion than boys. (Fuller, Junge et al., “A Six Year Prospective Study of the Incidence and Causes of Head and Neck Injuries in International Football,” British Journal of Sports Medicine (2005), 39(supp1): i3-i8).

Leeds vs Warrington Rugby - 2022 Challenge Cup

– Children & Youths

Between ages 8-12 is when peak development of the brain occurs, yet the brain is still developing through the refinement and rearrangement of pathways and connections between cells until early 20s. Younger players take longer to recover from a concussion than older players (Field, Collins et al., “Does Age Play a Role in Recovery from Sports-Related Concussion? A Comparison of High School and Collegiate Athletes,” Journal of Pediatrics (2003), 142(5):546-53).

Youth football header

– Those with a previous concussion/brain injury

Greater than 90% of concussions are not associated with a temporary loss of consciousness and more than 80% of concussions are diagnosed the next day, or several days later. Changes in white matter, brain connections and blood flow can persist a year or more after a concussion. Those who have a history of three or more concussions have a five-fold increased risk of developing mild cognitive impairment in later life (University of North Carolina at Chapel Hill, 2005).

Hockey players in-game wearing Rezon Halos

No brain, no gain

In the past twenty years there has been a greater interest in the long-term consequences of brain injury in contact sports, with an understanding and appreciation of brain trauma shifting from a singular acute injury, concussion, to the cumulative exposure of repetitive impacts over the course of a playing career.

What began initially with research into the effects of impacts to the head for American football (NFL) players has now opened a global discussion on the long-term consequences of brain trauma in sports. The medical and sports worlds now recognise the increasing number of contact sports players developing Chronic Traumatic Encephalopathy (CTE).


CTE is a progressive neurodegenerative disease caused by repetitive blows to the head and concussions. CTE can lead to dementia and related physical and cognitive symptoms such as memory problems, a decline in thinking ability, confusion, aggression, depression and changes in personality; is debilitating and life-changing for those affected, their families and friends.

Typically, CTE occurs with players in their 30s-50s. Initially, symptoms are of mild forgetfulness, low mood, easy to anger and slowing of thought process, which gradually progresses to loss of independence and dementia. Find out more about CTE.

The risk and severity of CTE is caused primarily by multiple smaller, sub-concussive impacts, and not by one hit concussions. Sub-concussive impacts are those which are of sufficient force to adversely effect the function of the brain cells, but do not cause symptoms of concussion. Players and those around them are not aware of these impacts. 20% of people with CTE diagnosed after life were recorded as never having sustained a single concussion.

In the UK, almost 300 former rugby internationals, some of whom have been diagnosed with early-onset dementia (The Guardian, 2022) and CTE are expected to take the sport’s governing body to court over the lack of care and failing to protect them from the risk of brain trauma whilst playing.

Increased research and the dialogue around CTE risk has increased the expectations on governing bodies to take greater steps to preserve brain health, and reduce the risk of repeated brain injury.

Brain scan showing CTE

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