Rugby’s problems run much deeper than concussion from the odd ‘big hit

Rugby’s problems run a whole lot deeper. Two weeks ago an Imperial College-led study funded by the Drake Foundation was published, which found that 23% of a group of current elite rugby players were playing with axonal injury or diffuse vascular injury in their brains, while half had unexpected reductions in the white-matter volume, akin to the brain’s processor. Today On Friday a study by the University of South Wales is published that reveals a link between contact events in rugby and reduced blood flow to the brain, impairing cerebrovascular function.

 

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To date sports like rugby, and the furious debates therein, have focused almost exclusively on what has become known as “concussion”. The definition of this phenomenon is continually changing but, whatever it is, to address concussion feels manageable, since it remains occasional. We associate it with the odd “big hit” or “vicious blow to the head”, depending on how charitable the observer feels towards those poor stooges smashing into each other in the arena for our entertainment. The crippling hypothesis that firms up with each and every paper published in this area – and there are plenty more to come – is that rugby has been, if not wasting its time on this, completely missing the point.

It is not the concussions. They do play a part, as the outward manifestation of a distressed brain, but the damage to those brains is constant in a sport like rugby and correlates to the sheer number of blows each brain takes, directly or indirectly, over a prolonged period. “You cannot interpret it any other way,” says Professor Damian Bailey, lead author of the USW study. “You’ve got this noxious, cumulative, recurrent contact that doesn’t actually need to be anywhere near the head, so long as there’s some sort of torsional movement imparted to the brain. And it just builds up over time.” Bailey is the director of the neurovascular research laboratory at USW and works, among other projects, with the European Space Agency on blood flow to the brain of astronauts. He was also a handy scrum-half in his time.

His team are due to publish a string of papers on this, delving ever deeper, but this introductory study tracks a group of 23 elite players in the Pro14 and compares biomarkers and functionality across a season, as well as each player’s exposure to contact events. Forwards, of course, were subject to greater exposure – and they suffered a corresponding decline in their ability to regulate blood flow to the brain, compared with the backs. Further studies will compare these player groups with control groups not exposed to such contact.

None of which is to predict the worst for the players affected. Science is still a long way from joining all the dots from a career in rugby to a later life suffering from neurodegenerative conditions but these studies are beginning to unearth the clues of contributory factors, which will likely affect the individuals in a variety of ways. What remains ever clearer is the need to shift the dialogue away from terms like “concussion” and “that’s a red card!” and towards a conception of each contact event as sitting somewhere on the same sliding scale, some of which surpass the arbitrary threshold designated for concussion. But they all contribute to what the neuroscientists like to describe as “cumulative dose”. And that is what speaks to one’s risk (not certainty) of neurodegenerative conditions in later life.

“I don’t think we understand what concussion means,” says Bailey. “Sub-concussive blows, concussive blows, it doesn’t mean anything. They’re all contact events.” Worse, the diagnosis of those concussions is “blunt”, as Bailey describes it, because it relies currently on cognitive tests. Short-term cognitive deficits are symptoms some way down the chain of reaction triggered by each injury and may appear some time later or not at all. These players are supremely fit after all – and thus that neuroprotection conferred can inure them against the worst of any cognitive deficits.

The crippling news for rugby is that these threats are hardwired into the sport as currently played. If a way is to be plotted out of the crisis, it is to science the game must turn. The development of pitch-side biomarker tests through which each event might be anatomised at a molecular level is a priority – and creeping ever closer. The technology of accelerometers in gum shields, such as those to be deployed across the Premiership next season, grows ever more sophisticated. Chronic traumatic encephalopathy, the neurodegenerative condition most directly relevant to those in a contact sport, might soon be diagnosed in the living, rather than only post-mortem, as currently.

Through these developments those dots could start to be joined up, so that a clearer understanding emerges of the actual risks and what rugby can do about them. Alas, each successive study seems to be leading away from the current paradigm that the enemy for collision sports is simply concussion. The threat runs far deeper. Which means red cards and return-to-play protocols can only ever have a peripheral influence.