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Concussion in Rugby May Lead to Changes in Brain Structure, According to Study

Collisions and injuries in rugby are common. As many as one in five injuries involve blows to the head, which are classified as “mild traumatic brain injuries” in the professional rugby union in England. According to a new study, we now have evidence that sustaining head injuries or concussions in rugby may increase the risk of a change in brain structure.

The study was published in the journal Brain Communications and was funded by the non-profit Drake Foundation and led by Imperial College London. The study was also supported by the National Institute for Health, Imperial Biomedical Research Centre, the UK Dementia Research Institute, and the Rugby Football Union (RFU).

Researchers studied 44 elite rugby players. Nearly half of the group had recently sustained head injuries during professional rugby play. All of the players involved in the study submitted to an MRI brain scan. 21 of the players were then subjected to a second scan a year later after suffering a head injury or concussion in rugby. Scans were compared to previous scans as well as athletes in non-collision sports.

As part of the process, research scientists employed two different types of advanced magnetic resonance imaging. Diffusion tensor imaging and susceptibility-weighted imaging were used to assess the structure of blood vessels and potential change in white matter, the way brain cells communicate.

Here’s what researchers found:

  • 50% of the group sustaining head injuries or concussions in rugby matches had abnormal changes in the volume of the white matter in their brain.
  • These structural changes in the brain may be missed using conventional brain scans.
  • 23% of all rugby players scanned showed abnormalities in cell axons and/or small tears in blood vessels which cause small “microbleeds” in the brain — whether they had sustained head injuries or not.

One interesting side note is that researchers also had participants complete assessment testing, such as memory tests, to evaluate brain function. Participants with abnormalities performed no worse than those without abnormalities. Researchers say more long-term studies are necessary to probe deeper into this issue and the connection between concussions in rugby and potential adverse effects.

Based on the study results, the Foundation called for immediate changes to rugby protocols for elite players to reduce the number and ferocity of impacts both in training and match play. Researchers pointed out that today’s athletes are bigger and more powerful than ever, which can lead to bigger and more consequential impacts.

“The RFU is fully committed to advancing our understanding of the short, medium and long term consequences  of head impacts and concussions so that we can ensure we can make continued improvements in player welfare, “ said Dr Simon Kemp, RFU Medical Service Director. “While it is unclear from that research what the individual long-term implications are regarding the brain changes seen in these advanced imaging techniques, it is clearly a priority to investigate this further.”

In partnership with Premiership Rugby (PRL), the RFU has LAO announced specialist clinical services for retired elite players for male and female players between the ages of 30 and 55. The RFL, PRL, and the Rugby Players’ Association (RPA) have also instituted an action plan to reduce the exposure to head impacts and concussions in rugby for elite athletes.

In December 2021, the Digital, Culture, Media, and Sport (DCMS) select committee of MPs agreed to a UK protocol for concussions across all sports. The four nations are developing joint protocols based on the Scottish model, setting up a sports concussion forum to assess evolving science, and raising awareness of the dangers of concussions. The DCMS said it’s time to move past any concerns about how regulations may change sports and that real and effective action is necessary.

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