‘Knock-On’ Effects: New research examines the long-term impact of concussion in rugby players

Tackling concussion continues to be a major priority for rugby union as evidence emerges of the lifelong repercussions of the sport’s most common injury

With sunsets creeping in earlier and temperatures beginning to dip, the harbingers of the rugby season are well and truly upon us. A fresh bout of rugby fever is on the horizon as we enter the autumn months, and this year, it’s likely to be more infectious than ever before. All eyes are on the Irish squad as they embark on their Rugby World Cup campaign, riding the high of March’s Six Nations Grand Slam victory. Following Ireland’s stellar performance in the under-20s World Cup this summer, expectations are high for the world number one side as they seek to become the first Irish team to progress beyond the quarter-final stage. On campus, pre-season buzz has hit College Park as DU Rugby’s men’s and women’s squads resume training and gear up for their return to competitive play with a number of warm-up matches. However, the growing anticipation for what will surely be an exciting season of sport for rugby fans comes against a backdrop of rising concern for one of rugby union’s greatest challenges: concussion. Pre-season efforts have coincided with new revelations in the long-term effects of head injury in the sport, prompting concern from medical researchers and calls for greater intervention by governing bodies.

Diagnosing concussion can prove a unique challenge, particularly during gameplay, due to the broad range of associated symptoms”

Concussion is the most common injury obtained by rugby union players, accounting for 13% of injuries acquired by men and 10% of injuries acquired by women observed in the 2021/22 Irish Rugby Injury Surveillance Project. It is defined as a traumatic brain injury caused by a force applied to the brain. Diagnosing concussion can prove a unique challenge, particularly during gameplay, due to the broad range of associated symptoms. Depending on where the force has been applied to the brain, players may showcase one or more symptoms that can vary in severity, such as headache, nausea, impaired balance, amnesia, or loss of consciousness. Symptoms of concussion can also develop over time; some symptoms may not be observed until 12-24 hours after the initial trauma, further exacerbating the challenge of identifying the condition during play and ensuring effective treatment.

The importance of protecting against and effectively treating concussion has been highlighted by new findings from the Neurovascular Research Laboratory at the University of South Wales (USW) on the impact of recurrent concussion on rugby players beyond active playing years. The peer-reviewed study, published last month by the Physiological Society, marks one of the most extensive examinations of the effect of brain injury on rugby union players, and assessed the repercussions of repeated concussions obtained over two decades of play for retired athletes. A group of 20 former rugby players were matched with controls with no prior history of concussions of a similar age, education, and fitness, and they were assessed for “concussion-related symptoms, blood-borne biomarkers, brain blood flow measurements, and cognitive function tests.”

The study found evidence of permanent consequences in athletes retired beyond their active career, with long-term effects including accelerated cognitive decline, impaired fine-motor coordination and increased susceptibility to dementia. A decrease in nitric oxide availability in the brain resulting in a reduced blood flow was identified as a leading cause for the cognitive impairments observed. Nitric oxide is a key chemical that is integral to regulating cerebral blood flow and ensuring a necessary supply of oxygen and glucose to support brain function. A study carried out by USW in 2021 had previously linked low nitric oxide levels to rugby union, with a fall in levels detected in players following as little as one season of play. Crucially, this marks the first time these consequences have been observed beyond active play on a long-term basis. Common side effects associated with low levels of nitric oxide include memory loss, difficulty concentrating, and a decline in cognitive function.

Lead investigator Professor Damian Bailey of USW praised the new study as the first “to determine why contact events caused by the sheer physicality of playing rugby union is bad for the brain in the long-term.” He stressed the importance of such research in protecting the health of players over time: “By understanding the underlying mechanisms and biomarkers of brain health, we can better protect players throughout their careers and develop targeted interventions to improve brain blood flow and cognitive function.” While the results of the study have ramifications for other physically intensive sports where head injuries are prevalent, Professor Bailey stressed the poor consideration of concussion during the active careers of rugby players as a major concern: “One of the most striking observations from our research was the lack of concussion awareness during the active careers of these retired athletes. Players often continued playing despite experiencing classic concussion symptoms.”

Although further research is required to clarify the impact of recurrent concussion injuries over time in players, it is not the first time concerns have been raised regarding the treatment of concussion in rugby union. In 2022, former Irish rugby players David Cockery, Declan Fitzpatrick and Ben Marshall (followed later in March 2023 by Munster’s Tony Buckley) lodged High Court proceedings against the Irish Rugby Football Union (IRFU), World Rugby, and their respective provincial clubs over treatment of concussion. This came off the back of a number of similar cases taken in the southern hemisphere and UK, with many high-profile claimants such as former Welsh captain Ryan Jones and England’s Steve Thompson alleging that governing bodies failed to take sufficient action to protect players from long-term injury or cognitive effects. More recently, the IRFU came under fire for a “misleading” statement featured in match day programmes distributed during Ireland’s warm-up victory over Italy. Players’ welfare group Progressive Rugby condemned their dismissal in the programme that “amateur players are not at risk of mental health or neurological disorders later in life after exposure to repeated head trauma”, with Professor Bill Ribbans blasting the presentation of “information lacking accuracy and credibility” as “hugely disappointing” by the IRFU. 

Moreover, continued research efforts will help bolster demands for reform of treatment of concussion in the sport and inspire effective change”

As rugby governing bodies continue to grapple with the challenge of concussion, further research will prove imperative to ensuring players, staff, and regulators can make responsible decisions to protect the long-term health of athletes. Moreover, continued research efforts will help bolster demands for reform of treatment of concussion in the sport and inspire effective change. With an ongoing study by the IRFU currently examining the effectiveness of rugby headgear in preventing concussion, and World Rugby trialling lower tackle height laws for community rugby to avoid head injury, it is hoped that the coming months and years will see effective change by regulatory bodies that will improve health outcomes for players. However, it is highly unlikely that considerable change will be implemented before the end of the season, nevermind before the close of its biggest tournament this autumn. Rather, while research is ongoing, it is crucial that rugby governing bodies address the issue of concussion head-on with a greater level of transparency than seen previously. Open discourse and engagement with researchers will ensure that the looming spectre of concussion is tackled effectively, and prevent it from casting a shadow over the buzz of rugby fever for many seasons to come.

Sadbh Boylan

Sadbh Boylan is the Deputy Scitech Editor for Trinity News and is currently in her Senior Sophister Year studying Management Science and Information System Studies