Research has found that half of elite rugby players are showing an unexpected reduction in brain volume, and almost a quarter have abnormalities in their brain structure.
The study, which was led by Imperial College and is the first to examine the long-term impact of rugby union and league, used a pioneering method of imaging which allowed researchers to study blood vessels and white matter.
Results were compared with those who had not played contact sport and found a "significant proportion" of the rugby players, of which almost half were assessed shortly after a mild brain injury, were displaying abnormalities. Although the group of rugby players did not show any cognitive decline in memory tests, the report's authors concluded that their findings suggest "an association of participation in elite adult rugby with changes in brain structure".
James Drake, founder of the Drake Foundation which funded the research, called for urgent "common sense" rule changes in rugby that would significantly reduce the "number and ferocity of impacts, both in training and actual play".
Concussion has been the most widely reported injury in rugby union for the past nine years and the Rugby Football Union, which supported the research, on Wednesday announced an action plan that will include guidance this summer to limit head impacts.
Any player returning from a concussion in 10 days or under will also be reviewed by an independent concussion consultant, although it will still be possible to be back playing within the current six-stage window. Campaign groups such as Progressive Rugby have called for a mandatory three week break, citing how Luke Cowan-Dickie was cleared by one of the consultants to play for the British and Irish Lions a week after being knocked out in the Premiership final.
Publication of the Drake-funded research follows the emerging testimony of a series of recently retired former players suffering symptoms of early-onset dementia, as well as legal action that has been brought by a group of players against both World Rugby and the RFU.
"Since rugby was professionalised in the 1990s, the game has changed beyond all recognition," said Drake. "Players are now generally bigger and more powerful, so we have to be mindful of all the ramifications that increased impacts will have on their bodies. More must be done to protect players, and without delay."
The study compared 44 elite rugby players alongside a controlled sample. Using advanced magnetic resonance imaging, the study suggested that playing rugby "can be associated with structural changes in the brain that may be missed using conventional brain scans".
The examination of changes in white-matter brain volume involved 18 rugby players and, as well as indicating a brain volume loss in half of them, found a reduction in 25 per cent of what was an older control sample.
Lead author Prof David Sharp, whose work was also supported by University College London, said that the unexpected changes in white-matter volume could indicate a longer-term effect of these abnormalities to connections in the brain.
Karl Zimmerman, also from Imperial's Department of Brain Sciences, described the findings as "concerning" but stressed that the results related to professional rugby and highlighted the wider community health benefits of sport and physical exercise.
Dr Simon Kemp, the RFU medical services director, welcomed the research and announced, in partnership with Premiership rugby, a specialist brain clinic for the assessment and management of retired rugby players between the ages of 30 and 55. The RFU and Premiership Rugby have agreed to invest £2.5
The RFU will also invite all Premierships clubs to take part in a two-year mouthguard project designed to assess the incidence and severity of head impacts. The Allianz Premier 15s will become the first domestic women's league to introduce temporary head injury assessments.
The mouthguard development follows a trial with the Harlequins men's and Bristol Bears women's squad this year which found that forwards were exposed to greater contact than backs. It also reported that the ruck provided the biggest risk of head-impact exposure in both training and competition, while lower-body tackles resulted in lower intensity impacts.
The RFU intends to agree a standardised categorisation of training activities with all clubs and the England senior men's and women's national and age grade teams. "The goal must be to reduce player exposure to head impact by removing unnecessary impacts," said Damian Hopley, chief executive of the Rugby Players' Association.
Shocked MPs slam British sport for inaction over brain injuries
By Jeremy Wilson
A damning parliamentary report has accused British sport of "marking its own homework" over devastating brain injury and strongly condemned the Football Association for its failures to tackle the game's dementia crisis.
An inquiry by the Digital, Culture, Media and Sport committee also rounded on the Health and Safety Executive, a government body, for leaving unaccountable governing bodies to oversee player welfare and expressed shock at the testimony of witnesses who had sustained neurological injuries.
"The protections afforded by the state to workers apply as much to footballers and jockeys as they do to miners and construction workers," said the MPs. "We are astounded that sport should be left … to mark its own homework."
The committee is now calling on the Government to mandate sports to report all head impacts that could impair clear thinking or contribute to a brain injury to a new national framework that would be established by the HSE. It has also urged the Government to establish a specialist concussion group with protocols based on a "precautionary principle" rather than absolute scientific proof.
Witnesses to the inquiry included Dawn Astle , the daughter of former England player Jeff, Chris Sutton, whose father Mike was also a professional footballer who died of dementia, and Kyran Bracken, the England rugby union World Cup winner, who admitted that he had been suffering memory lapses. Steve Thompson, Bracken's England team-mate in 2003, revealed last year he had been diagnosed with early-onset dementia.
"We've been shocked by evidence from athletes who suffered head trauma, putting their future health on the line in the interests of achieving sporting success for the UK," said Julian Knight, the chair of the DCMS committee.
"The HSE is responsible by law, however risk management appears to have been delegated to the national governing bodies, such as the FA. That is a dereliction of duty which must change. The failure by these sporting organisations to address the issue of acquired brain injury is compounded by a lack of action by Government."
The MPs highlighted football's "lack of engagement … despite a coroner's court verdict nearly 20 years ago that dementia suffered by Jeff Astle was 'entirely consistent with heading a ball'," and also condemned the players' union, the Professional Footballers' Association.
"Football's engagement with the issue of concussion, both in England and internationally, has taken too long and its current prominence is due to the campaigning of organisations like the Jeff Astle Foundation and prominent spokespersons like Chris Sutton," said the report.
"We would have expected the FA, as the national governing body, to have taken a stronger, sustained interest in the issue after the coroner's verdict of Jeff Astle's death.
"We would also have expected the FA to have been publicly hounded by the PFA, whose key concern should be player welfare. Over the past 20 years, neither the FA nor the PFA have fought hard enough, or publicly enough, to address this issue within the broader football community."
Both organisations have defended their record and specifically highlighted how they funded research, which conclusively did prove the link in October 2019 between football and dementia. They have also promised further research and are in the process of drafting new heading restrictions in training.
The report recommends a UK-wide standard definition for concussion in sport after finding that individual governing bodies were being left to design their own protocols. They also recommend that UK Sport should pay for a medical officer at every major sporting event with the power to prevent athletes at risk from competing.
The Government, say the MPs, should also use its power to establish a single research fund to ensure that funded projects are independent of governing bodies and excellence driven. Dawn Astle was especially encouraged by the call for government intervention.
"For almost 20 years now, football has failed to act and failed to protect its players – men, women, children, all at risk, potentially, with no restrictions, unprotected, uninformed," she said. "If the sport is left to its own devices as it is, it will just do what it wants to do."
The campaigning group Head for Change said that it was "gratifying, despite being somewhat overdue, that this necessity for urgent action is now recognised at the highest level and documented in the DCMS report".
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