Rugby and soccer players who suffer
multiple knocks to the head during their careers are at added risk of brain
damage that could lead to dementia and other neurodegenerative diseases, brain
scientists are warning.
Just as some American football players and
boxers have been found to have long-term cognitive deficits after suffering
repeated head blows or concussions during play, so soccer and rugby players
must be made aware of the same dangers.
"What happens is that when you have a
big impact, your skull twists one way but your brain stays in the same
place," said John Hardy, chair of Molecular Biology of Neurological
Disease at University College London's Institute of Neurology.
These injuries, he said, common among
boxers, American National Football League (NFL) and ice hockey players, as well
as soccer and rugby players, can cause damage to the brain, similar to
abnormalities found in people with Alzheimer's disease and other forms of
dementia. "We need to minimize the risks by coming down very heavily on
tackles and behaviours that are likely to cause rotational injury to the
brain," Hardy said.
Cavalier attitude to health
concerns have echoed across sport in recent days, particularly after English
soccer club Tottenham Hotspur controversially allowed goalkeeper Hugo Lloris to
play on even after he was knocked out in a collision with a striker.
Luke Griggs, a spokesman for the brain
injury charity Headway, said the decision displayed an "irresponsible and
cavalier attitude to a player's health." By playing on, he said, Lloris
may have caused greater damage to his brain. "He should have been removed
from the game immediately and taken to hospital for thorough tests and
observation." Brain scientists and medical experts agree.
At an international conference on
concussion in sport last year, specialist doctors working in sport drafted a
consensus saying that no player, regardless of the sport, should return to the
field of play on the day of a concussive injury.
Yet the problem there, says Willie Stewart,
a consultant neuropathologist at Glasgow's Southern General Hospital who is due
to speak at a professional rugby concussion forum in London this week, is that
diagnosing concussion is a far lengthier and more complex process than many
people assume. "People believe you have to be knocked unconscious to have
concussion, but there are many other symptoms of concussion too," Stewart
These include headaches, nausea, lack of
awareness and blurred or confused vision – but some, many, or all of these
symptoms may not appear straight away, he said, and often take hours or even
days to appear.
Which makes a five-minute pitch-side
assessment, be it in rugby, soccer, NFL or elsewhere, a fairly unhelpful
approach if an accurate diagnosis is to be made. "The rule should be 'if in
doubt, sit them out'," said Stewart. "And if you have enough
suspicion that a player is concussed to want to conduct a pitch-side
assessment, then there's enough doubt there already to take them out of
play."Stewart and Hardy both called for more education and awareness of
the symptoms of concussion, its risks, and the possible long-term damage it can
Chronic brain damage
While relatively few studies have been
conducted in rugby players, American footballers and boxers have been presented
with new and disturbing evidence in recent years, partly thanks to advances in
modern neuroscience that mean scientists know more than ever about chronic
It has various names including punch drunk
syndrome, dementia pugilistica and chronic traumatic encephalopathy (CTE) but
comes down to the same thing: The long-term trauma that can result from
frequent knocks to the head.
Hardy explains that within the soft mass of
the brain tissue, the blood vessels are more fibrous and strong – a bit like
wires. When the head is hit, especially in a rotational movement, one of two
things can happen – either the blood vessel can snap, leading to a haemorrhage,
or there can be microscopic tearing of the tissue around the vessel.
It is this microscopic damage, often not
picked up by doctors at pitch side, or even noticed by the players, that is the
most likely cause of long-term brain harm. A study published last month found
"profound abnormalities" in brain activity scans of former NFL
Such findings are not just in men. A small
study of female soccer players published earlier this year found evidence of
"mild traumatic brain injury of the frontal lobes" caused by
repeatedly bouncing a football off the head.
Hardy, whose main concern is about boxing, which
he describes as little more than "watching people inflict brain damage on
each other" says he was horrified to see women's boxing at the London 2012
Stewart says the key issue is the brain,
not the sport, the person, their age or their gender. "A brain injury is a
brain injury is a brain injury," he said. "When it gets injured, the
brain has no idea what sport it's playing or where it is."