Over recent years, several retired rugby players have received diagnoses of neurodegenerative brain conditions. New research is digging into this trend to uncover potential links between head impacts and long-term brain damage. One example of such a player is Dan Scarborough, who has been diagnosed with traumatic brain injury and early-onset dementia following his 15-year rugby career. Scarborough appeared on BBC’s Morning Live in summer 2021, where he explained how he felt when he received the devastating news and described the lack of medical attention players receive when they sustain head injuries.
The not-for-profit organisation The Drake Foundation has taken note of the increasing evidence that head injuries may lead to poor brain health outcomes and has funded various studies to raise awareness of any links between sports head impacts and brain injury. Here, we’ll delve into the recently published findings of two Drake Foundation studies that examine rugby-related head impacts and look at the change that these findings are driving in the rugby space.
The Drake Biomarker Study[CM1] commenced at Saracens Rugby Club in 2015. Since then, the longitudinal study has expanded to include players from several Premiership and Championship rugby unions and league teams, assessing a total of 41 male players and 3 female players over two years. The study involved the collection of participants’ blood, saliva, and urine samples to identify potential biomarkers of sports concussion injuries. The study also involved the application of advanced neuroimaging techniques and cognitive testing to identify brain changes associated with playing elite rugby.
Scientists and neurologists at Imperial College London and University College London (UCL) used two new advanced scan techniques to analyse structural brain changes in retired rugby players. Standard imaging approaches often miss the effects of head injuries, but the new types of imaging reveal damaged blood vessels and connections in the brain. These MRI scans can detect brain damage early, go into greater detail than ever before, and therefore could be life-changing.
The researchers compared the rugby players’ brain scans with scans of athletes who participate in non-collision sports. While the rugby players’ standard brain scans appeared normal, the advanced scans revealed bleeds and changes: 23% of the 44 study participants had developed abnormal changes in their brains’ white matter (wiring) or blood vessels, and 50% saw an unexpected decrease in white matter volume.
The study team is now collaborating with the Rugby Football Union (RFU) and Premiership Rugby to launch the ‘Advanced Brain Injury Clinic’, which involves widespread use of the new brain scan methods to provide a comprehensive assessment of player health for male and female players aged 30-55.
If this research had been available 10 or even 5 years ago, numerous players could have been protected. On a brighter note, the study will help the next generation of players understand the risk of concussions and head injuries that come with playing rugby and improve protocols to reduce and prevent these injuries.
Another study funded by The Drake Foundation, the BRAIN (Brain Health and Healthy Ageing in Retired Elite Rugby Players) Study[CM2] has demonstrated that retired rugby players aged 75+ who have a history of at least three rugby concussions are more likely to display poor cognitive function. These individuals may also be at a higher risk of memory loss. However, retired players aged 50+ tend to have no worse cognitive function than those who have experienced 0-2 concussions.
The London School of Hygiene and Tropical Medicine, Queen Mary University of London, and the Institute of Occupational Medicine conducted the study with researchers from UCL, the University of Oxford, and the RFU. The study examined just under 150 elite rugby players who played for England, Oxford University, or Cambridge University in the pre-professional era. The players participated in tests to capture their physical and cognitive abilities, like grip strength, memory, and reasoning. They also underwent face-to-face assessments and neurological clinical examinations to identify signs of disease and provided blood and urine samples for future analysis.
The researchers measured the players’ cognitive function using the Pre-Clinical Alzheimer Cognitive Composite (PACC) score, which combines tests that assess episodic memory, timed executive function, and global cognition. The researchers took factors like age, whether the players smoked, and player position into account and concluded that players aged 75+ who had sustained at least three concussions scored approximately 2 points lower on the PACC score. This score indicates a difference in cognitive function that could raise the risk of developing neurodegenerative diseases like Alzheimer’s.
80% of the participants reported at least 1 rugby-related concussion, although some had sustained as many as 25. The average number of concussions sustained was two. The cross-sectional study concluded that there was no link between the number of concussions sustained and player position or the length of a player’s rugby career.
The research team notes that the retired elite rugby players who took part in this study were generally highly educated and probably had higher than average cognitive function at the beginning of their rugby careers. This could be a reason why the study only identified lower cognitive function in participants who were over 75.
The BRAIN Study is the first to carry out detailed measurements of cognitive function in a large sample population and link these to individuals’ concussion and playing history. It is also the first study of its kind to examine large numbers of individuals who are over the age of 75. Previous studies have primarily focused on younger players and have revealed little to no association between sports concussions and reduced cognitive function.
The research findings from both studies add to the growing number of calls for changes to the game of rugby. And this change is starting to take shape. Rugby officials and other governing organisations have recently announced that they will be making new efforts to protect rugby players.
In 2021, the Digital, Culture, Media, and Sport select committee of MPs held an inquiry into sports concussions in several games. The committee collected evidence from retired athletes, players’ unions, doctors, scientists, and governing bodies. They concluded that governing bodies have failed to protect player well-being and address brain injury issues in sports. This inquiry should pave the way for change in the game of rugby, amongst others.
In line with this demand for change, the RFU has announced it will launch new measures, including a new tackle height, to reduce head injuries in training and matches. The RFU will also draw up a framework for contact training and off-field head impact assessments for women’s matches (such a framework already exists for men).
Philanthropist James Drake launched The Drake Foundation in 2014 because of the number and severity of head injuries that football and rugby players sustain. These hits — and the speed of these hits — are often bigger in professional rugby than they are in amateur rugby, and doubling the speed of a hit means quadrupling the energy, increasing the risk of brain damage.
While there is typically a high level of knowledge about sports medicine in the rugby and football space, neuroscience is less widely discussed. Drake aims to connect mainstream contact sports with neuroscience research in the UK. So far, the findings are worrying: The Drake Foundation’s studies raise significant questions about the brain health of rugby and football players. However, these studies will have a huge positive impact on the future of sports practice and open doors to future studies, too.