New report indicates link between head impacts in sport and brain disease

It is "reasonable to consider" the link between head impacts in sport and brain disease, a report has found.

The potential association between the repetitive head impacts and the development of chronic traumatic encephalopathy (CTE) was highlighted in the latest report on concussion.

CTE is a progressive and fatal brain disease, with former Manchester United and England star Nobby Stiles, among the leading players who have been diagnosed with the condition.

Other sportsmen such as Jeff Astle, Rod Taylor and Billy McEwan have also been recognised as CTE cases.

Now, the latest Consensus Statement on Concussion in Sport states, "It is reasonable to consider extensive exposure to repetitive head impacts, such as that experienced by some professional athletes, as potentially associated with the development of the specific neuropathology described as CTE-NC (CTE neuropathologic change)."

The Statement has in the past played a key part in shaping how sports governing bodies set their concussion policies and protocols.

Players and staff at Manchester Rugby Club have welcomed the findings, but say their sport has been leading the way in addressing concerns.

Tim Holmes, Chairman of Rugby at the club says: "We recognise in our game its a contact sport, and concussion was something that we really wanted to get hold of.

"So about five or six years ago they brought in the Return To Play protocol, they brought in the remove the players immediately, so we've had the recommendations embedded in our sport for five to six years."

Now one of the report's authors, Dr Jon Patricios, has echoed calls made by head injury campaigners that swift removal of players suspected of suffering a head injury should be more widespread.

Dr Patricios says: "Three minutes is sufficient to suspect a concussion (but) if you're only allowing a three-minute period, your threshold for removing that player should be very low.

"If there is a suspicion (they have suffered a concussion) they should be taken off and not return to play if there isn't adequate time to do a proper evaluation."

There is also a recommendation to clinicians that they should advise a return to light physical activity that will not exacerbate symptoms within the first 24 to 48 hours of suffering a concussion.

The usual regime of strict rest until the complete resolution of concussion-related symptoms has been found to be "not beneficial".

And in an age where young players especially are rarely away from their phones for long, new medical evidence suggests that limited screen-time in the first 48 hours after injury can also aid recovery.

Players say any improvements to make the game safer are to be welcomed.

But the Statement says more work still needs to be done, and that studies conducted to date on the effects of concussion and repetitive head impacts on the health of athletes in later life have been "limited".

The 2019 FIELD Study found professional footballers were three and a half times more likely to die from neurodegenerative disease than members of the general population of the same age, raising concerns that their greater exposure to concussive and sub-concussive impacts was behind the heightened risk.

The new report states, "The studies, to date, are methodologically limited because most were not able to examine, or adjust for, many factors that can be associated with the neurological outcomes of interest.

"The studies examining cognitive impairment and neurological outcomes did not examine genetic factors and usually did not consider or control for factors known to be important for brain health in the general population, such as educational attainment, socio-economic status, smoking, hypertension and cardiovascular disease, diabetes, sleep apnea, white matter hyperintensities, social isolation, diet, physical activity or exercise.

"To establish a clear causal association between sports participation early in life and cognitive impairment or dementia late in life or to quantify that association, future well-designed case-control and cohort studies, that include as many individual risk-modifying and confounding factors as possible, are needed."

But while acknowledging the risks in sport, Manchester Rugby Club's Tim Holmes also stresses the benefits.