The long and short-term effects of head impacts in rugby league and union are becoming bigger talking points by the day. Brain injury is now beginning to be taken more seriously.
Red cards are on the rise as governing bodies try to reduce head-high tackles. This is in response to the increasing number of former players diagnosed with Chronic Traumatic Encephalopathy (CTE). Carl Hayman, Alix Popham, Michael Lipman, Steve Thompson, Neil Clarke, Tim Cowley, Jason Hobson, Neil Spence, Adam Hughes and Bobbie Goulding have all been diagnosed with CTE.
For a man in his 30s or early 40s, the odds of getting this diagnosis is around one in 10,000. And yet 75 former union players in England or Wales during the first 15 years of the professional era have now been diagnosed with CTE. This is roughly one in 20. And it is believed that up to one in two professional players will end up with some kind of neurological impairment.
Worryingly, the women’s players are beginning to echo the early years of men’s professionalism – bulking up and becoming fitter, faster and stronger. What does the future hold around brain injury in rugby?
This has all meant that contact load training, head injury assessment, concussion education, management and prevention are now key talking points across rugby. Is brain trauma in rugby a recent problem or has it simply been overlooked? It’s a combination of both.
In rugby, brain trauma has become overly focused on bigger impacts, concussion and contact load. However, it is the cumulative effect of smaller, sub-concussive impacts over time that contributes to neurogenerative disease.
These sub-concussions are caused by rotational force. So, there is a need to reduce rotational forces to the brain, as opposed to measuring and managing after an impact is received. Rotational forces occur from angled hits to the head, be it head-to-head, head-to-ball, or head-to-ground impacts. All of these cause the brain to rotate inside the skull, brain cells to shear, and tiny blood vessels around the brain cells to be torn in a twist-like movement. This sets up abnormal inflammatory processes, which become harmful and triggers CTE.
Another confusion in the debate around brain trauma in rugby is that former players have CTE with young-onset dementia, and not dementia as is understood in the context of ageing. Dementia is an umbrella term, not a specific condition, and refers to a number of cognitive symptoms. A lack of understanding between CTE and dementia by the media, governing bodies, coaches, players and fans means that CTE is not being properly understood, nor the risk factors appreciated.
The most significant mitigation to reduce brain injury in rugby is reducing the transmission of rotational forces to the brain from concussion and sub-concussive impacts. Halos® headbands for concussions and sub-concussions are uniquely designed to lessen the risk of rotational forces to the brain.
Headguards (scrum caps) protect against surface-level wounds. They are “not intended nor expected to protect against any form of mild traumatic brain injury or skull fractures”. However, given that sub-concussions are 500 times more likely than concussions and are symptomless, players need headgear that will protect from sub-concussions and neurological damage.