Following the release of a report by the neuropathologist, Dr Wille Stewart, extending the link between brain injury, and in particular early onset dementia, to contact sports, most notably rugby, the press has been keen to highlight the dangers to rugby players, but what are the risks and how can they be prevented?
I must declare an interest here as a rugby player of too little talent and too many years, as a coach and as the dad of a 10 year old whose talent for the game is only matched by his father’s unrealistically high expectations…
“Dementia pugilistica” has been a common diagnosis in boxers for over a century and the punch drunk ex-fighter who “cudda been a contender” has long since taken his place in sporting legend however with some high profile head injuries and concussions being suffered by England players the rugby authorities have had cause to review the way that head injuries are dealt with, both with in the professional and community game.
It is beyond doubt that concussion is a complex area and should be taken seriously by players and parents of players alike. It is the exposure to repeated concussions that is the focus of the report.
The symptoms of being “punch drunk”, can include memory, speech and personality problems, tremors and a lack of coordination and until recently the condition had been thought to only affect boxers who suffered repeated concussive injuries through being punched in the face. However now a link is being made to other sports where athletes are exposed to head injury in high levels.
Whilst Dr Stewart has acknowledged the percentage of rugby players affected was likely to be far lower than sports such as boxing, American football and ice hockey, (where competitors are more likely to suffer repeated head trauma and concussions) he has stated that in fact all sports that carried the risk of head injury - including football, horse racing and show jumping - had a responsibility to ensure athletes did not return to action too soon after suffering a concussion or other brain trauma.
Dr Stewart is concerned that, "What we are really starting to worry about now is the long term problems, the things that might happen 10 or 15 or 20 years down the line. Has that injury to the brain perhaps led to longer term damage?”
The rugby authorities have revisited the issue and further to the last awareness programme dating back to 1996 (a programme in clubs and schools called “Use Your Head”) have now in January this year launched a new awareness and education programme called “HEADCASE”. This programme is based upon the most up to date guidance and is supported by Headway, one of the UK’s leading brain injury charities (www.headway.org.uk).
The programme has a dedicated website on RFU.com where information and videos can be found, together with downloadable content for coaches, players, officials, schools and parents alike as well as health care professionals.
There are fact sheets, pocket advice cards, player assessment forms, advice whistle wrist bands for referees and branded headgear. The site also has links to the International Rugby Board’s website for on-line concussion education courses.
Although the risk of brain injury is small it must be taken seriously, playing sport of any kind has wonderful benefits and it is important to remember that severe head injuries are extremely rare in rugby, (especially when compared to other activities such as cycling, and sports that involve high speed projectiles. For example, in UK, over 1,300 under 16 year olds are tragically killed or seriously injured each year through pedal cycling accidents and 70% of these are due to head injuries).
The general advice for a concussion is if in doubt, stop playing and sit it out. So at all levels, if you think there has been a concussion the player should be removed and not expose him or herself to further damage. There is a risk that a second head injury, coming within a short space of time and before the brain has properly recovered, can be much more severe and cause more problems and more symptoms.
It is in the nature of sportsmen and women that they will try to play on in spite of injury and it is the responsibility of everyone, their teammates, the referee and of course any parents to ensure they do not do so. Just as we would stop them from playing on with a damaged knee, it is even more important that we should not have them carry on with a damaged brain!