Category Archives: concussion

Heading for Injury?

Authored by the team ‘Three Degrees’: Tom Willett, Trevor Tiller, and Simon Ludford [E119 22J students].

This blog was written as part of a collaborative teamwork task by students studying E119. They had to select a topic and then decide on what roles each person would perform in the team, such as researcher, writer, editor, and leader. This blog was chosen as one of the best blogs from 27 blogs that were produced in January 2023.

man in blue and white jersey shirt playing soccer during daytime

There is nothing quite like a headed goal-line clearance; a player willing to put his head on any ball needed to keep a clean sheet and secure those three points. Following a game against Wolves, Neil Warnock famously said to his Sheffield United players ‘You’ve gotta die to get three points’, he did not mean it literally, but this is the unfortunate reality of heading in football. No job should be at the cost of a life, but sport seems to be the exception. We have had enough warnings and time.

In 1966, Football authorities were warned by doctors that frequently heading the ball could cause brain injuries. A club medic highlighted the issue as well as players complaining of headaches in a magazine (Seward, 2019). Research completed on the link between heading the ball and brain disease showed there is a fivefold increase in the risk of Alzheimer’s, a fourfold increase in motor neurone disease and a twofold in Parkinson’s (Seward, 2019). This shows that heading and brain Injury in football has been a long-term concern to medical staff.

A specific brain condition that footballers have suffered from is chronic traumatic encephalopathy (CTE); which is linked to repeated injuries or blows to the head and over time can lead to dementia (NHS, 2022). Former footballer Jeff Astle died in 2002 at 59 after suffering from CTE; an inquest following his death confirmed he died of dementia as a result of heading footballs; he was the first British footballer to have done so (Seward, 2019).

Given Astle’s death was 20 years ago, the time for action was long overdue. The repeated heading of the ball can lead to CTE and cause behavioural issues and death from dementia. National governing bodies have a responsibility and duty of care to protect their players. But what is actually been done?

A report from the Department of Digital, culture, media and sport (DCMS) does not make good reading. MP’s found a lack of engagement with the issue of concussion, despite the coroner’s verdict on Astle’s death (UK Parliament, 2021). The report also places blame on the HSE (Health and Safety Executive) and government for allowing unreliable sporting governing bodies to address the issue of brain injury within individual sports, referring to it as ‘marking your own homework’ (UK Parliament, 2021). The UK Government (2021) created an action plan to address the failings of player welfare, stating that the UK government, sporting governing bodies and medical professionals will work more closely together to educate and address any knowledge gaps as well as the usage of tech companies to monitor any impact and whilst this action plan is welcomed, is it 20 years too late?

These actions will take time to implement – time football players do not have. There is an urgent need to act, and act now. Technology is advanced enough to monitor ball size, pressure, weight, mass and water absorption and it is required by football governing bodies such as FIFA. Using this technology, Auger et al., (2020) studied the neurological impacts of heading a ball of different sizes, pressures, and how much water they had absorbed, this study was completed by kicking the balls at a force plate in a laboratory. The study concluded that lowering the pressure inside the balls could reduce potential head injury by 20% and balls that absorbed too much water could be swapped out. A combination of a ball holding too much water and high pressure is like heading a brick (Nauman, cited in Auger et al., 2020).

The International football association board (IFAB), introduced a protocol on February 6th 2021 which allowed teams to make two permanent substitutions if a player was suspected of having a concussion (Dawnay, 2021). The trial was a success, and the protocol was used during the FIFA world cup in 2022. Medical staff had more control over a player’s well-being, they can access video footage to check if an injury has likely resulted in a concussion or not. This protocol has also allowed the opposing team to make an additional substitution for fairness of competition (Johnson, 2022).

The Scottish FA has taken it one step further by banning any heading of the ball on the day before and after a game to try to reduce any potential cumulative effect by reducing the exposure to heading; following on from the heading ban that is already in place at U-12 and below age groups. Interestingly, Hibernian defender of the Scottish Women’s premier league Joelle Murray says that whilst she accepts and understands the latest information on the impacts of heading and brain injuries, it is about the balance and that she doesn’t hesitate to head any ball during a matchday (Mclaughlin, 2022). Perhaps there is a suggestion here for game day rules to be looked at?

What is clear is that world football has failed to protect football players for at least 50 years. Football governing bodies have been reactive rather than proactive for far too long. However, what is also clear is that the world of football is now doing more than what it ever has done to protect the players whilst also considering any changes in the game, but this is only the start. Football must continue to look at how the risk of brain injuries can be reduced; it must be accepted that to remove the risk completely means changing the game as we know it. Could you imagine an elite level of football where there was no heading, or only heading in the 12-yard box? A set piece would seem almost pointless. However, the reality is that football in its current format is still carrying a risk of CTE – although reduced – putting the lives of footballers at risk. Collaborative relationships between footballers, governing bodies and medical staff must be maintained with the protection and well-being of the players as the utmost priority whilst also considering the future format and integrity of the game.

 

Reference list

Auger, J. Markel, J. Pecoski, D. Leiva-Molano, N. Talavage, T. Leverenz, L. Shen F. Nauman, E. (2020) Soccer players’ head injury risk could be reduced with simple adjustments to the ball, study finds. Available at: https://www.purdue.edu/newsroom/releases/2020/Q4/soccer-players-head-injury-risk-could-be-reduced-with-simple-adjustments-to-the-ball,-study-finds.html (Accessed: 25 January 2023)

Dawnay, O. (2021) Concussion substitutes set to be introduced by Premier League on February 6 as Football Association set timetable for new protocol. Available at: https://talksport.com/football/826076/concussion-substitutes-introduced-premier-league-fa-confirmation/ (Accessed: 25 January 2023).
Johnson, J. (2022) What is the World Cup concussion protocol? Additional substitution allowed in Qatar. Available at: https://talksport.com/football/1237372/world-cup-concussion-protocol-additional-substitution-qatar-germany-argentinar/ (Accessed: 25 January 2023).

NHS (2022) Chronic traumatic encephalopathy. Available at: https://www.nhs.uk/conditions/chronic-traumatic-encephalopathy/ (Accessed: 25 January 2023)

Seward, J. (2019) Football chiefs were warned that frequently heading leather balls could cause serious brain injuries by medics in 1966… 53 years BEFORE landmark report reinforced the link. Available at: https://www.dailymail.co.uk/sport/sportsnews/article-7603657/Football-chiefs-warned-dangers-heading-leather-balls-medics-1966.html  (Accessed: 25 January 2023)
UK Government (2021) Government to develop new protocols around concussion in sport. Available at: https://www.gov.uk/government/news/government-to-develop-new-protocols-around-concussion-in-sport (Accessed: 25 January 2023)

UK Parliament (2021) Sport allowed to ‘mark its own homework’ on reducing concussion risks. Available at: https://committees.parliament.uk/work/977/concussion-in-sport/news/156748/sport-allowed-to-mark-its-own-homework-on-reducing-concussion-risks/

Concussion in rugby: how does this affect players and the rest of their lives?

Authored by the team ‘A-Team’: Padraig Amond, Courtney Barnes, John Cox, Pelin De-Vanney, Aimee Keast, John Knipe, Kian Middleton, Colby Wood, and Amelia Yates [E119 22J students].

This blog was written as part of a collaborative teamwork task by students studying E119. They had to select a topic and then decide on what roles each person would perform in the team, such as researcher, writer, editor, and leader. This blog was chosen as one of the best blogs from 27 blogs that were produced in January 2023.

children playing football

When playing most sports, participants are warned of the risks and potential minor injuries they could sustain, but there are limited discussions on the dangerous, long-term outcomes which could happen. Children are highly influenced between the ages of 8-14 years, yet these influences could be putting their future health in danger. It’s not only the children that need to be educated on these health risks but also the parents, coaches and support team who need to know the impacts of injuries, particularly concussions. So, how do we educate them?

A sport which has been researched into having significantly more severe concussion cases is Rugby. This is a contact, team sport played with two teams trying to score tries, penalty kicks and drop goals. Players can run with the ball and kick or pass it sideways or backwards to a teammate. According to HEADS UP (2019), a concussion happens when there is a traumatic brain injury, which could be induced by a jolt, blow, or bump to the skull or by the head and brain moving speedily back and forth due to a hit of the body. Therefore, how is it possible to get concussed in rugby? Many concussions are from tackles in which the abrupt movement causes the brain to twist or bounce around in the cranium. Throughout this blog, there will be many things which prove that long-term impact will cause concussions.

One player prone to injury was Shontayne Hape, a former England centre, who gave his point of view on concussion in rugby and said how ‘players are regularly pressured to return quickly from head injuries’ and claims they ‘routinely cheated cognitive tests designed to monitor their brain function throughout the season’ (Steven, 2018). The former England centre admitted he’d been concussed close to 20 times in his career and said his condition got so bad he could not remember his PIN number and was left with ‘depression, constant migraines, and memory loss’ (Steven, 2018). There are many players like Hape whose careers end abruptly from concussion.

Research conducted in England in the 2018-2019 season has shown that 20% of professional rugby players sustained at least one match concussion. This was a 16% increase from the previous season. The contact areas of tackling and scrummaging account for 75% of concussions (Rugby Union, 2020). The number of concussions may have increased due to a larger acknowledgement of the danger of concussions, meaning that the coaches and officials are looking out for them. However, not only has there been an increase in the number of players in rugby union, but also the physical build of players. An example of this is in 1962, the average height of an England player was 1.80 m and they weighed 85.7 kg, whereas in 2012 this rose to 1.88 m and a weight of 104 kg (Fordyce, 2012). The weight increase would mean that there is a greater force between players, adding to the chance of injury. Similarly, broader, and fitter players mean that on the pitch it is more compact, making it difficult to run past or around the opposing players and potentially hitting the head, shoulder, hip, or knee of an opponent with great force. This would mean that during the game, the number of collisions and contact time increase. The force that has increased from this rise in player build has led to this increase in concussions.

Concussions can lead to serious health conditions and illnesses that affect the brain, such as memory loss, depression, dementia, and Parkinson’s disease. A considerable amount of rugby players have experienced this, one being Nic Berry. Despite suffering numerous head injuries in multiple seasons, the 28-year-old was cleared to start the 2012 campaign for Wasps. However, a ‘concussive episode’ during the season opener against Harlequins forced him to quit the game which was a massive part of his life. The retirement age for a rugby player is 38 years old, meaning that players such as Nic have had their careers shortened by an incredible amount. Another player who has experienced this is Dominic Ryan. The Ireland international retired at 28 years old from ‘terrifying’ concussion-related health problems such as dementia. When he spoke in the Irish Times, Ryan said: ‘It’s a weight off my shoulders…with a bit of distance I can see it was a no-brainer to retire. I can see now I was literally putting myself in harm’s way’ (Peters, 2013).

Importantly, concussion isn’t just experienced within men’s rugby. ‘Women typically have less neck strength and experience a greater concussion risk as well as greater severity of symptoms with a longer duration of recovery compared to men,’ (Zielinski, 2019). Someone like Kat Merchant suffered from this and retired on medical advice aged 28 in 2014 after 11 confirmed concussions in 14 seasons and still suffers from symptoms. “I have a lower cognitive capacity…I can’t do a hundred things at once without getting a headache, getting flustered or without forgetting my words’ (Orchard, 2020).

This evidence provided shows that many more precautions should be introduced to protect rugby players. The effect that concussion has on their lives is huge; not being able to continue doing something they love. These blows to the head result in serious health issues. The fact that they must give up everything they know will negatively impact their mental health. However, it’s not just rugby that these precautions need to be seen being introduced into. Football is another sport which involves areas of high contact, e.g. headers, and repeated actions of this will also result in concussions. Will we see some important changes to these big sports anytime soon?

 

References

Centers for Disease Control and Prevention, National,  (2019), ‘What Is a Concussion?’, HEADS UP, CDC Injury Centre https://www.cdc.gov/headsup/basics/concussion_whatis.html (Accessed: 14 January 2023)

Fordyce, T. (2012) ‘Land of the rugby giants’, BBC Sport, 8 March. Available at: https://www.bbc.co.uk/blogs/tomfordyce/2012/03/land_of_the_rugby_giants.html  (Accessed: 20 January 2023)

Orchard, S. (2020), ‘Rugby and brain injuries: World Cup winner Kat Merchant has lower cognitive capacity’ BBC Sport, 16 December. Available at: https://www.bbc.co.uk/sport/rugby-union/55306949 (Accessed: 20 January 2023)

Rugby Union, (2020) ‘Concussion in rugby union affected 20% of professional players in England in 2018-19’, BBC Sport, 22 December. Available at: https://www.bbc.co.uk/sport/rugby-union/55360214 (Accessed: 14 January 2023)

Steven, (2018), ‘LIST: The shocking list of rugby concussions that have ended career’ Ruck, pp. 1-4, Available at: https://www.ruck.co.uk/list-the-shocking-list-of-rugby-concussions-that-have-ended-careers/4/ (Accessed: 20 January 2023)

Zielinski, P. (2019) ‘Can stronger necks prevent concussions?’ Futurity, 16 January. Available at: https://www.futurity.org/concussions-necks-athletes-1959052-2/ (Accessed: 16 January 2023)

 

Concussions in women’s rugby: A cause for concern?

Authored by the ‘Team Unity’: Keaton Ager, Leah Bass, Laura Beet, Ethan Greenway, Meghan Hobbs, Daniel Hutchins and Chris Seymour-Henwood [E119 21J students].


This blog was written as part of a collaborative teamwork task by students studying E119. They had to select a topic and then decide on what roles each person would perform in the team, such as researcher, writer, editor, and leader. This blog was chosen as one of the best blogs from around 70 blogs that were produced.


In 2018, the Telegraph (Ellis, 2018) documented that women’s rugby is soaring in popularity. Almost 30,000 women and girls play rugby at club level, double the amount seen 4 years prior, with women now making up a quarter of players globally.

Increasing popularity brings in revenue, allowing governing bodies to provide additional funding into various aspects of the game, including research. With the higher revenue, research into the men’s game could be considered ‘the norm’, but more researchers are now looking into the women’s game and its positives and negatives – with concussions being one of the negatives.

What is a concussion and what is the research saying?

Physical differences between men and women seem to have an impact on the likelihood of concussions occurring. It is well documented that males are generally physically stronger than females. This point is echoed by Rugbypass’ Jess Hayden (2020), who states that although lower body strength between men and women is quite comparable, male rugby player’s upper body strength can typically be observed as three or four times greater than female players. This includes neck strength, which is a defining factor in concussions.

Dr Elisabeth Williams at Swansea University is a lead researcher into concussion in men’s and women’s rugby. Dr Williams (cited in Hayden, 2020) has found that a ‘whiplash’ motion is a leading cause of concussion in women’s rugby. So, what is a concussion? According to the Concussion Foundation (n.d.)…

A concussion is a brain injury occurring when the brain moves rapidly within the skull usually due to a blow to the head or body.

Research suggests (Neuro-Optometric Rehabilitation Association™ & PINK Concussions, n.d.) that concussions affect women and men differently, with women not only being at a higher risk of sport-related concussions, but also increased severity of symptoms as a result of concussion.

Neuro-Optometric Rehabilitation Association™ & PINK Concussions (n.d.) report that women often experience more severe and prolonged symptoms relating to:

  • Greater cognitive decline
  • Poorer reaction times
  • More frequent headaches
  • Extended periods of depression

Male and female brains differ both anatomically and chemically with female brains containing more delicate axons, a thin ‘cable’ that allows electrical impulses to pass from one neuron to others (The University of Queensland Australia, 2021). Lasting damage to neurons from concussion can lead to multiple issues, such as dizziness, vertigo, slower processing, memory loss, difficulty driving, focusing, and reading. Due to their axons being more delicate, females are more likely to damage these neuron connectors than males. This is one biological aspect that differentiates how each gender’s brains are affected by concussions.

Is neck strengthening the answer?

With biological and chemical differences altering concussions short- and long-term symptoms, is there any way women can help prevent concussion occurring?

Elaborating on Dr Elisabeth Williams’ (cited in Hayden, 2020) earlier point, she believes that there is a disparity in neck strength between men and women, stating that neck strength is “unfathomably low compared to men” resulting in women having less control over their heads during contact. This is one reason why the whiplash motion is so prominent in women’s rugby. According to Dr Williams (cited in Hayden, 2020), women naturally have less muscles and soft tissue in their necks than men. Whiplash initiated by head to ground or head to knee contact causes the brain to violently bounce around inside the skull.

More control over the head during contact can limit the whiplash motion reducing the probability of concussions occurring. Jess Hayden states that a senior player in the England Women’s Team informed her that they have been practising neck exercises to increase stability since 2014. This training has also been implemented by clubs in the Allianz Premier 15s.

Whilst neck strengthening can reduce the probability of a concussion happening as a result of whiplash, it will not prevent concussions altogether. Concussions are still prominent in the male game, with this type of injury being amongst the most common diagnoses. If disparities between neck strength alone defined whether a concussion happened, then in theory concussions should be less frequent in the men’s game. This, however, is not the case.

Dr Williams (cited in Hayden, 2020) believes neck strength needs to be a necessary part of women’s rugby training. With women’s rugby still developing and becoming more popular, many women do not start playing rugby until they reach university. Due to a lack of clubs at lower levels compared to the men’s game, Dr Williams (cited in Hayden, 2020) says that women grow up playing netball or football, even giving up sport, believing there is “nothing for them”. This means adult women often did not have the same opportunity to develop their skills over the years as men, including body positioning during contact. This could also play a part in the whiplash motion of the head, without the developed instinct to safely take contact and land.

Conclusion

For now, concussions pose a serious threat to female rugby players. However, the increasing popularity of women’s rugby will provide additional funding, allowing more research to be carried out on female players such as that being done by Dr Elisabeth Williams (cited in Hayden, 2020). Hopefully more research like hers will highlight areas of concern and make the game safer for all participants, especially since women tend to be more adversely affected by concussions. Also, with the growing popularity of the women’s game, there is potential for additional grassroots clubs to be founded. As a result, women will be able to develop essential awareness skills at a younger age where impacts are less forceful.

 

References

Concussion Foundation (n.d.) What is a Concussion? [Online]. Available at https://concussionfoundation.org/concussion-resources/what-is-concussion (Accessed 24 January 2022).

Ellis, S (2018) ‘How rugby can put a spring in your step’, The Telegraph, 8 June 2018 [Online]. Available at https://www.telegraph.co.uk/property/home-improvement-tips/benefits-of-rugby/ (Accessed 25 January 2022).

Hayden, J (2020) ‘Long-term brain damage likely a significantly bigger issue in women’s rugby than men’s, says lead concussion doctor’, Rugbypass, 14 December 2020 [Online]. https://www.rugbypass.com/news/long-term-brain-damage-could-be-a-significantly-bigger-issue-in-womens-rugby-than-mens-says-lead-concussion-doctor/ (Accessed 25 January 2022).

Neuro-Optometric Rehabilitation Association™ & PINK Concussions (n.d.) Women & Concussions [Online]. Available at http://ecp-uploads.s3.amazonaws.com/wp-content/uploads/sites/2704/2020/12/WomenConcussions_info.pdf (Accessed 24 January 2022).

The University of Queensland Australia (2021) Axons: the cable transmission of neurons [Online]. Available at https://qbi.uq.edu.au/brain/brain-anatomy/axons-cable-transmission-neurons (Accessed 25 January 2022).

Rugby – A Blow to the Head, a blow to the sport?

Tonight on BBC Panorama “Rugby and The Brain – Tackling the Truth” the Chief Medical Officer of the World Rugby, Martin Raftery, will announce plans to alter the laws of the game to limit the risk of players suffering concussion. He will confirm that there will be a specific focus on tackling. Only a few days ago, The Telegraph reported that “Jonathan Thomas quits with epilepsy caused by multiple concussion”. Following mild seizures and memory loss that he believes was the result of sustaining multiple concussions, the Worcester forward and former player for Wales, announced that he was retiring from rugby on medical advice. He is not alone, in the media this year, it has been reported that a number of high profile rugby players such as Rory Watt-Jones (Cardiff Blues) and Declan Fitzpatrick (Ulster and Ireland) have had to retire from the sport due to concussion related injuries.

Rugby World Cup (Land Rover MENA) Creative commons license https://creativecommons.org/licenses/by/2.0/legalcode Downloaded from https://www.flickr.com

Now in light of those stories, with the Rugby World Cup underway and all the excitement that has already been ignited, the pragmatic and perhaps more curmudgeon-like souls amongst us may turn our attention to the dangers associated with a sport that kindles our national passions. Of all the injuries that can occur in rugby, concussion is now the number one cause of missing matches through injury at elite levels.

Concussion can occur in any situation where a blow to the head occurs, such as in road traffic accidents (RTA) or as a result of a work-related accident, however, its incidence is becoming increasingly common in athletes who are prone to knocks to the head as part of their sport. Certain sports are more susceptible than others such as: rugby, NFL football, boxing, ice-hockey, rugby, football (soccer), equestrian sports, cycling, and diving. It is so topical an issue that in December a Hollywood blockbuster featuring Will Smith will be released simply entitled “Concussion”. In the United States there has been a prolonged debate about the health dangers of NFL football following the mounting evidence that repeated concussions can lead to degenerative brain disease (Chronic traumatic encephalopathy [CTE]). CTE is a neurodegenerative disorder that is characterised by a diminished ability to think critically, slower motor skills, and can lead to volatile mood swings. Unfortunately, at the current time CTE can only be definitively diagnosed post-mortem. These risks alongside the large financial settlements that have been awarded to former NFL players who have suffered multiple concussions should make us ponder whether rugby may be the next sport in the concussion spot light and whether the risks associated with rugby comprises a price worth paying.

But it is not all doom and gloom, although researchers have found that concussions in rugby are common, it has been found that concussion accounts for 29% of all injuries associated with illegal play, but only 9% of injuries sustained in legal play (Gardner, Iverson, Levi, Schofield, Kay-Lambkin et al., 2015). Accordingly, Roberts, Trewartha, England, and Stokes (2015) investigated collapsed scrums and collision tackles, and found that injury prevention in the tackle should focus on technique with strict enforcement of existing laws for illegal collision tackles. Furthermore, World Rugby is taking a proactive stance on concussion identification and management heading towards “a cross-sport and society approach to concussion to ensure consistency of research, education, prevention and management strategies to further protect athletes and members of the public”.

Sports such as rugby carry risks, but through legal play and active pitch side management of suspected head injuries, we can but hope that this World Cup is remembered for exciting play and home nation success rather than media reports of players with serious head-related injuries.

Concussion in Sport will be covered in a new OU Sport and Fitness module coming soon.