Problem:

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, unchecked and typically only sometimes acknowledged after injury. The brain determines performance in sport, and life. Brain injury accelerates the progression to negative cognitive, psychiatric and mental health outcomes.

The brain is at risk, not just to a single or high-force concussive impact, but also to the multiple sub-concussive impacts which are unnoticed and undetected in training and playing. Every head impact 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, parents and fans undereducated on the risks.

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. Athletes at 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 a previous brain injury.

More 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).

Who is at Risk – 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).

Who is at Risk – Children and 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.

Research suggests a link between early life concussion and the subsequent risk for mental health disorders and dementia in later adulthood (Izzy S, Tahir Z, Grashow R, Cote DJ, Jarrah AA, Dhand A, Taylor H, Whalen M, Nathan DM, Miller KK, Speizer F, Baggish A, Weisskopf MG, Zafonte R. “Concussion and Risk of Chronic Medical and Behavioral Health Comorbidities.” J Neurotrauma. 2021 Jun 1;38(13):1834-1841).

Among children, 30% will experience persistent post-concussion symptoms including physical, emotional, cognitive and sleep issues (Davis GA, Anderson V, Babl FE, Gioia GA, Giza CC, Meehan W, Moser RS, Purcell L, Schatz P, Schneider KJ, Takagi M, Yeates KO, Zemek R. What is the difference in concussion management in children as compared with adults? A systematic review. Br J Sports Med. 2017 Jun;51(12):949-957).

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 and concussion, to the cumulative exposure of repetitive sub-concussive impacts over the course of a playing career.

What began 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 injury in sports. The medical and sporting worlds now recognise the increasing number of contact sports players developing Chronic Traumatic Encephalopathy (CTE).

CTE

CTE is a progressive neurodegenerative disease. CTE leads to dementia and related physical and cognitive symptoms such as memory problems, a decline in thinking ability, confusion, aggression, depression and changes in personality; debilitating and life-changing for those affected and their families and friends.

Typically, CTE occurs in players in their 30s-50s. Initially, symptoms are of mild forgetfulness, low mood, quick 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 sub-concussive impacts, and not by one-hit concussions. Sub-concussive impacts are those which are of sufficient force to adversely affect 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 failure to protect them from the risk of brain trauma whilst playing.

Increased research and dialogue around CTE risk have heightened the expectations on governing bodies, and those with a legal duty of care (sporting clubs, sports trainers, schools, sports teachers) to take greater steps to preserve brain health and reduce the risk of repeated brain injury.

Brain scan showing CTE

Brain Injury in Sport

The long and short-term effects of head impacts in sport are becoming bigger talking points by the day. Brain trauma is now beginning to be taken more seriously across sports in response to the increasing number of former players diagnosed with CTE.

Brain Injury in Football

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Brain Injury in Rugby

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Brain Injury in Hockey

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