It’s estimated that 5% of all sports injuries are concussions, with the U.S. Centers for Disease Control and Prevention estimating that this results in approximately 300,000 sports-related concussions every year in the United States alone. What's more, this is likely to be a significant under-estimate as the figures only cover athletes who have lost consciousness. Since it's believed that such a loss of consciousness only occurs in fewer than 10% of concussion incidents, the scale of the problem is enormous.

The violent nature of boxing meant that it was the first sport in which concussion was a notable problem, with fighters appearing to be “punch drunk” after repeated blows to the head over the course of their careers. Of course, we now know that this form of brain damage from repeated head injuries is something that afflicts athletes from a wide range of sports, with the blows causing brain cells to die and ultimately the brain to shrink.

The Aging Brain

Research from the University of South Wales explores how concussions suffered by elite rugby union players impact the brain of athletes as they get older. The research shows that the brain function of a player with a history of concussion is generally on par with an adult in their 60s. In other words, the kind of repeated concussions often seen in physical sports, like rugby, considerably accelerate the biological aging of our brain by up to three decades.

The study found that this is due, in large part, because the rugby players appeared to have a lot more so-called “free radicals” in their blood. These inherently unstable molecules are known to damage cells and also have lower nitric oxide levels, which is crucial as nitric oxide supports oxygen and glucose in its journey to the brain. As a result, the players would react sluggishly because the blood vessels in their brain struggled to react to changes in blood flow, which is a phenomenon known as “cerebrovascular impairment”.

The impact of this on the lives of athletes is significant, with research strongly linking cerebrovascular impairment with significant cognitive dysfunction. This impacts how people think, their ability to formulate ideas, concentrate, and remember important facts. It can also increase the chances of developing dementia later in life. The Welsh research found that these cerebrovascular impairments were particularly present in the areas of the brain that were most vulnerable to violent contact during rugby matches.

A Universal Problem

The results reveal that both active and retired elite players were showing significant cognitive impairment compared to people of the same age and fitness levels who had not experienced previous concussions. The analysis also showed that not all players were at a similar risk of concussion, with one’s position a key risk factor. Perhaps unsurprisingly, forwards, who are typically involved in more violent collisions with opponents, were more prone to suffering from concussions and the subsequent cognitive problems that result from them.

Concussion has become a significant concern in contact sports, such as rugby, in recent years as the scale of the damage being done to players becomes apparent. Indeed, it’s only as recently as 2005 that a neuropathologist in Pittsburgh became the first person to connect the repetitive brain injuries suffered in American football with chronic traumatic encephalopathy (CTE), which is a particular form of neurodegeneration.

Despite this growing awareness, however, the problem has still been far from solved. Indeed, with the conditioning players undergo meaning that they are bigger and faster than ever, the impacts seen in sports such as rugby and football mean the risk is arguably greater than ever.

CHanging the Game

To try and better protect players, the games themselves have been tinkered with. For instance, shoulder charges have been fully outlawed, with tackles to the head also resulting in offenders being sent from the field. These changes don’t go far enough for some, however, who argue that tackling itself should be outlawed.

Others don’t wish to make such radical changes to the game and instead argue for better assessments of both molecules and cerebrovascular function during the games themselves to allow for more effective detection of concussion. The argument is that better detection allows for faster treatment and more effective recovery.

The research provides yet another reminder of the life-altering impact concussion can have, not least because the true impact can often emerge when it’s too late to do anything meaningful about it. The researchers state that there are around 10 million rugby players globally, and professional players are likely to suffer a concussion every 25 games on average. When the number of players of similar contact sports, from football to boxing, is taken into account, the scale of the risk cannot be overstated.  Awareness of the risks has also grown considerably, and with legal pressure also mounting we can at least be confident that it is an issue that is being taken seriously by all involved.

ADDITIONAL RESOURCES:

• Concussions: How They Can Affect You Now and Later
• Effects of Brain Injury