tag:theconversation.com,2011:/id/topics/contact-sports-15540/articlesContact sports – The Conversation2022-10-03T21:49:17Ztag:theconversation.com,2011:article/1918302022-10-03T21:49:17Z2022-10-03T21:49:17ZNFL player Tua Tagovailoa’s concussion might have been prevented with rugby’s stricter protocols<figure><img src="https://images.theconversation.com/files/487863/original/file-20221003-20-2vmubv.jpg?ixlib=rb-1.1.0&rect=536%2C771%2C4114%2C2586&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Miami Dolphins quarterback Tua Tagovailoa runs onto the field before the team's NFL football game against the Cincinnati Bengals on Sept. 29, despite a head injury during a game a few days earlier. </span> <span class="attribution"><span class="source">(AP Photo/Joshua A. Bickel)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/nfl-player-tua-tagovailoa-s-concussion-might-have-been-prevented-with-rugby-s-stricter-protocols" width="100%" height="400"></iframe>
<p>Few moments in sport are more gut-wrenching than a player lying on the field, limp from the impact of a high-speed collision. The crowd’s visceral groans speak volumes, as they did during a game between the Miami Dolphins and the Cincinnati Bengals on Sept. 29.</p>
<p>Dolphins quarterback Tua Tagovailoa was stretchered off the field and hospitalized with a concussion.</p>
<p>In the days since his injury, questions have increasingly been raised about whether Tagovailoa should have been playing at all that night, and whether the NFL needs to revise its concussion protocols to prevent an episode like this occurring again.</p>
<h2>Concussion in sport</h2>
<p>If Tagovailoa had been playing rugby, the story of his injury would likely be very different. World Rugby, the governing body for one of the most physical contact sports, has a clear set of guidelines on concussions that map out a pathway for players’ recovery that diverge markedly from the NFL and most other professional sports. </p>
<p>There are <a href="https://passport.world.rugby/player-welfare-medical/concussion-management-for-match-day-medical-staff-using-the-hia-protocol/hia-protocol/hia-procedures/">12 symptoms</a> of possible concussion that require immediate removal from a rugby game with no return to the field of play. A further series of assessments, which take at least a week, and a gradual scaling up of activity ensue in order for players to safely resume participation in contact sport.</p>
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<a href="https://images.theconversation.com/files/487879/original/file-20221003-14-m6zuct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Officials with a stretcher are seen emerging from a cluster of men in teal football uniforms" src="https://images.theconversation.com/files/487879/original/file-20221003-14-m6zuct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/487879/original/file-20221003-14-m6zuct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487879/original/file-20221003-14-m6zuct.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487879/original/file-20221003-14-m6zuct.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487879/original/file-20221003-14-m6zuct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487879/original/file-20221003-14-m6zuct.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487879/original/file-20221003-14-m6zuct.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Miami Dolphins quarterback Tua Tagovailoa is taken off the field on a stretcher during the first half of an NFL football game against the Cincinnati Bengals on Sept. 29, in Cincinnati.</span>
<span class="attribution"><span class="source">(AP Photo/Jeff Dean)</span></span>
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<p>These measures are due in no small part to rugby’s high incidence of concussion (<a href="https://doi.org/10.1177/0363546515622389">conservatively more than two and a half times the rate of football</a> and <a href="https://doi.org/10.1177/2059700219860641">growing</a>) and the large number of players embroiled in <a href="https://www.theguardian.com/sport/2022/jul/25/case-against-rugby-union-governing-bodies-on-dementia-destined-for-courts">lawsuits related to after-effects of concussion</a>, such as early-onset dementia.</p>
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<a href="https://theconversation.com/concussion-is-more-than-sports-injuries-whos-at-risk-and-how-canadian-researchers-are-seeking-better-diagnostics-and-treatments-189899">Concussion is more than sports injuries: Who's at risk and how Canadian researchers are seeking better diagnostics and treatments</a>
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<p>The size of rugby players <a href="https://doi.org/10.1080/026404101750158312">has ballooned</a> over the past few decades. Since 1975, the average player’s body mass has increased by nearly four times the amount observed in the previous 70 years. That, together with rugby players’ sparse protective gear and the avalanche of lawsuits, has encouraged the game’s regulatory bodies to take a far more cautious view of head injuries than almost any other sport.</p>
<h2>An injury in an earlier game</h2>
<p>World Rugby’s criteria for concussion would undoubtedly have applied to Tagovailoa in a game on Sept. 25 — in other words, four days before he played against the Bengals. <a href="https://www.espn.com/nfl/story/_/id/34670980/miami-dolphins-qb-tua-tagovailoa-not-concussion-protocol-coach-mike-mcdaniel-says">He was tackled and his head struck the ground in the second quarter</a> of a Dolphins’ game against the Buffalo Bills. </p>
<p>After that play, he reached for his head with his hands, struggled to get to his feet and fell after a couple of steps, clear signs of concussion. He seemed to be propped up by his team mates. Yet, less than an hour later, he was cleared to play and returned in the game.</p>
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<img alt="Two men in peaked caps assist a man in a white football uniform and helmet, seen from behind" src="https://images.theconversation.com/files/487874/original/file-20221003-26-38yca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/487874/original/file-20221003-26-38yca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487874/original/file-20221003-26-38yca.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487874/original/file-20221003-26-38yca.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487874/original/file-20221003-26-38yca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487874/original/file-20221003-26-38yca.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487874/original/file-20221003-26-38yca.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Miami Dolphins quarterback Tua Tagovailoa (1) is assisted off the field during the first half of an NFL football game against the Buffalo Bills on Sept. 25 in Miami Gardens. He was later cleared to return to the game, despite indication of concussion.</span>
<span class="attribution"><span class="source">(AP Photo/Rebecca Blackwell)</span></span>
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<p>If Tagovailoa had been playing rugby, he would almost certainly have been barred from returning to that game and been kept on the sidelines on Sept. 29.</p>
<p>In the days following the Bills incident, Dolphins officials, including coach Mike McDaniel insisted that Tagovailoa was being evaluated daily and that his <a href="https://www.espn.com/nfl/story/_/id/34670980/miami-dolphins-qb-tua-tagovailoa-not-concussion-protocol-coach-mike-mcdaniel-says">instability after the hit was related to back and ankle injuries</a>.</p>
<p>He was cleared to start against the Bengals on Sept. 29, but hit his head on the ground again following a tackle in the second quarter. His symptoms pointed to indisputable neurological damage, including a potential brainstem injury. He was carried from the field on a stretcher and taken to hospital for evaluation.</p>
<p><a href="https://www.nfl.com/playerhealthandsafety/health-and-wellness/player-care/concussion-protocol-return-to-participation-protocol">NFL concussion guidelines</a> mandate that players suspected of concussion undergo an independent review by an unaffiliated neurotrauma consultant. </p>
<p>According to the NFL, the unidentified specialist who assessed Tagovailoa after the first impact <a href="https://www.sportsnet.ca/nfl/article/report-nflpa-fires-unaffiliated-neurotrauma-consultant-involved-in-tagovailoas-concussion-check/">has since been terminated as a result of investigations</a> into the decision to clear him for further play. The review is being conducted jointly by the NFL and the players’ association, with full results expected within a week or two.</p>
<p>Neuroscientist Chris Nowinski of the <a href="https://concussionfoundation.org/">Concussion Legacy Foundation</a>, a not-for-profit concussion advocacy organization based in Boston, tweeted after the second head injury: “Two concussions in five days can kill someone. This can end careers.”</p>
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<p>Tagovailoa was the fifth overall draft pick in 2020, touted as a possible successor to legendary Dolphins quarterback <a href="https://www.profootballhof.com/players/dan-marino/">Dan Marino</a>. While he may have an exciting future, it is hard to argue that a third-round game, even with the Dolphins’ unbeaten record on the line, was a strong enough reason to put his health at risk. So why was he cleared to play?</p>
<h2>Conflicting pressures and interests</h2>
<p>Coaches, players and medical providers are constantly under intense pressure to allow an injured teammate back on the field, given the millions of dollars on the line in salaries, TV rights, endorsements and advertising.</p>
<p>A central issue is that most concussion protocols in professional sports, including the NFL, are subject to an element of human interpretation and judgement. Precise <a href="https://theconversation.com/concussion-is-more-than-sports-injuries-whos-at-risk-and-how-canadian-researchers-are-seeking-better-diagnostics-and-treatments-189899">diagnostic tools do not exist and players often under-report symptoms</a>. This leaves doctors leaning heavily on their judgement to make quick assessments in the heat of the moment. </p>
<p>In the case of the NFL, the final decision of whether a player should return to the field lies not with the independent specialist, but with the team physician, adding pressure on the doctor to put the team’s interests above those of the injured player.</p>
<p>The more conservative approach favoured by professional rugby has strategic and financial consequences that may discourage its adoption by football and other sport authorities. For example, football’s <a href="https://www.nfl.com/news/ranking-each-position-s-importance-from-quarterback-to-returner-0ap3000000503855">highly specialized positional game</a> means that the removal of important players for concussion assessments at key times in play can have an immediate and dramatic effect on the outcome of the game. </p>
<p>Furthermore, far more money is involved in football than rugby.</p>
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<a href="https://images.theconversation.com/files/487877/original/file-20221003-24-gak47e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A football player in a teal uniform about to fall to the ground as a player in a white uniform tackles him, while another player in a white uniform runs towards them" src="https://images.theconversation.com/files/487877/original/file-20221003-24-gak47e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/487877/original/file-20221003-24-gak47e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487877/original/file-20221003-24-gak47e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487877/original/file-20221003-24-gak47e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487877/original/file-20221003-24-gak47e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487877/original/file-20221003-24-gak47e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487877/original/file-20221003-24-gak47e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Miami Dolphins quarterback Tua Tagovailoa (1) is sacked by Cincinnati Bengals’ Josh Tupou (68) during the first half of an NFL football game on Sept. 29, in Cincinnati.</span>
<span class="attribution"><span class="source">(AP Photo/Joshua A. Bickel)</span></span>
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<p>The advantage of rugby’s approach, however, is that it greatly improves the <a href="https://blogs.bmj.com/bjsm/2021/11/17/concussion-in-professional-mens-rugby-union-improvement-in-detection-or-increased-risk/">recognition and diagnosis of concussion among players</a>. Since 2011 the number of concussions reported in professional rugby games has quadrupled, an increase largely attributed to heightened awareness and changes to protocols.</p>
<p>There is little evidence that the incidence of long-term brain damage is different in the two sports, since the medical consequences of concussion take decades to become evident. However, recognition and removal from play are key to preventing further harm. According to an <a href="http://dx.doi.org/10.1136/bjsports-2017-097699">international consensus statement on sport-related concussion</a> issued by the Concussion in Sport Group in 2017: </p>
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<p><em>“Having a past sport-related concussion is a risk factor for having a future sport-related concussion, and having multiple past sport-related concussions is associated with having more physical, cognitive and emotional symptoms.”</em></p>
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<p>The NFL has signalled that Tua Tagovailoa’s case <a href="https://www.nfl.com/news/changes-coming-to-nfl-concussion-protocol-a-needed-step-for-player-safety">may lead to some far-reaching changes</a> to its rules for the evaluation and identification of concussion. Here’s hoping the changes come soon enough to help the next player who suffers a serious head injury on the field.</p><img src="https://counter.theconversation.com/content/191830/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Pyle has worked for Rugby Canada. </span></em></p>Miami Dolphins quarterback Tua Tagovailoa was carried off the field during a game on Sept. 29 after his second injury in only a few days, raising questions about NFL concussion protocols.Adam Pyle, Emergency Medicine Physician and Lecturer, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1672932021-09-03T13:48:30Z2021-09-03T13:48:30ZTokyo Paralympics: why para taekwondo is the most thrilling new sport<p>For fans of <a href="https://theconversation.com/five-brain-boosting-reasons-to-take-up-martial-arts-at-any-age-95263">martial arts</a>, Tokyo 2020 was always going to be something to look forward to. Along with para badminton, the <a href="https://www.paralympic.org/sports">programme</a> this year saw <a href="https://www.paralympic.org/news/sport-week-10-things-know-about-para-taekwondo">para taekwondo</a> make its debut.</p>
<p>The new discipline joins para judo and wheelchair fencing in the combat sports roster, but because of the way points are scored – by landing powerful kicks on the body – para taekwondo is <a href="https://www.paralympic.org/news/sport-week-10-things-know-about-para-taekwondo">the first full-contact para sport</a> in the history of the Olympic Games. And it has not disappointed. </p>
<p>For the sport’s first bout on Thursday September 2, Afghanistan’s <a href="https://www.nytimes.com/2021/08/30/world/asia/afghan-paralympians-kabul-tokyo.html">Zakia Khudadadi</a> emerged on the mat to spar with Ziyodakhon Isakova of Uzbekistan, <a href="https://www.france24.com/en/live-news/20210902-taekwondo-kicks-its-way-into-paralympics">AC/DC’s Thunderstruck</a> playing over the speakers. Khadadadi was one of only two Paralympians who made it out of Kabul in time to compete in Tokyo.</p>
<p>Isakova won and para taekwondo has continued making headlines. Leonor Espinoza Carranza took Peru’s <a href="https://www.paralympic.org/news/day-9-review-taekwondo-kicks-debut-upsets-zahra-nemati-amazes">first gold medal</a> in Tokyo, and the country’s first Paralympic gold since Sydney 2000, in the women’s up to 49kg category. </p>
<p>Chances are that even if you don’t know the rules, you’ll find para taekwondo exciting to watch. For many, the spectacular kicks that characterise the sport make it the new highlight on the Paralympic calendar. </p>
<h2>Developing a para sport</h2>
<p><a href="https://theconversation.com/martial-arts-can-improve-your-attention-span-and-alertness-long-term-new-study-91798">Taekwondo</a> was first showcased at the Seoul 1988 Games and, in 2000, made an official Olympic discipline <a href="https://olympics.com/ioc/wt">at the Sydney Games</a>. The <a href="http://www.worldtaekwondo.org/index.html">subsequent development</a> of the sport for para athletes by World Taekwondo, the official sports organisation, opened up the possibility that para taekwondo might follow suit in the future. </p>
<p>Starting in 2005, para taekwondo was developed from the kyorugi or free-form sparring discipline, one of several that make up taekwondo. The <a href="https://www.paralympic.org/taekwondo/classification">eligible impairments</a> include limb impairments, arm amputations and the loss of toes which impact the ability to lift the heel properly.</p>
<p>The first Para Taekwondo World Championships were held in Baku, Azerbaijan in 2009, with 40 athletes from 20 nations. Participation worldwide has been on the rise ever since. The Tokyo 2020 events comprise kyorugi in three weight categories per gender, with <a href="https://timesofindia.indiatimes.com/city/chandigarh/para-taekwondo-athlete-aruna-aims-for-tokyo-glory/articleshow/83902213.cms">72 athletes</a> competing in total. </p>
<p>Para athletes, like their Olympic peers, <a href="https://olympics.com/en/featured-news/know-your-sport-taekwondo-rules-scoring-equipment">wear</a> helmets and trunk protectors (padded vests around their chest). They compete on an octagonal padded mat, 8m wide. And bouts are organised in three two-minute rounds. </p>
<p>Points in taekwondo are scored by landing kicks to the body with sufficient power and accuracy. Minor adjustments have been made to the rules for para-athletes’ safety. Kicks to the head are strictly forbidden, contrary to taekwondo, and punches to the body do not score because para taekwondoins do not have the full ability to block.</p>
<p>Instead, athletes can score two points for a valid kick to the trunk protector. They can score additional points for more difficult kicks – one more for a turn kick; two more for a spinning kick; and three points for a kick involving a 180-degree turn. </p>
<h2>Spectacular potential</h2>
<p>Since 2017, athletes can score four points for 360-degree spinning kicks too. This has meant that entire matches can turn on <a href="https://olympics.com/tokyo-2020/en/paralympics/sports/taekwondo/">a single move</a>, making spectacular spin-kick combinations the essence of the sport. </p>
<p>Taekwondo allows for various attacks and counter-attacks with linear, spinning and circular types of kicks. Analysis of how the perfect kick is pulled off has shown that an initial so-called loading phase of the knee and hip extension <a href="http://link.springer.com/10.1007/s42600-019-00022-1">is essential</a> to the athlete being able to launch into the kicking phase. </p>
<p>Research shows that para athletes <a href="https://wnus.edu.pl/cejssm/en/issue/15/article/97/">frequently execute</a> dynamic moves, including turning kicks, fast kicks, cut kicks, jump back kicks, and tornado kicks, in both defence and offence. <a href="https://wnus.edu.pl/cejssm/en/issue/15/article/97/">To perform these</a>, they need <a href="https://jomh.org/articles/10.31083/jomh.2021.019">exceptional speed</a>, agility, explosive power and dynamic balance.</p>
<p>In addition, all elite taekwondo athletes are trained <a href="https://www.frontiersin.org/article/10.3389/fpsyg.2019.02708/full">to anticipate</a> the opponent’s moves. They pre-empt attacks by kicking the opponent directly and performing spinning kicks from short distances when they perceive an opponent’s cutting action. </p>
<p>To successfully perform the turning kicks, taekwondo athletes use their arms to control their rotation (angular momentum). What sets para taekwondoins apart is that they do not have the same use of their upper limbs. Instead they deploy other compensatory motions to <a href="https://commons.nmu.edu/isbs/vol35/iss1/11/">achieve</a> extraordinary attacks, counter-attacks, combinations and defensive movements. <a href="https://www.france24.com/en/live-news/20210902-taekwondo-kicks-its-way-into-paralympics">For many</a>, para taekwondo offers more thrills than its Olympic counterpart.</p><img src="https://counter.theconversation.com/content/167293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jožef Šimenko does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Para taekwondo isn’t just a new Olympic discipline - it’s a millennial sport, developed in 2005. Its explosive debut at the Tokyo 2020 Games means it’s here to stayJožef Šimenko, Lecturer in Anatomy and Physiology, Essex Pathways Department, University of EssexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1600972021-05-05T07:23:01Z2021-05-05T07:23:01ZSports concussions affect men and women differently. Female athletes need more attention in brain research<p>News emerged last week that AFLW player <a href="https://www.theguardian.com/sport/2021/apr/30/damage-found-after-late-aflw-player-jacinda-barclay-donates-brain-for-concussion-research">Jacinda Barclay</a>, who died last year at age 29 following a short period of mental illness, had abnormalities in her brain tissue.</p>
<p>Barclay was the first Australian contact sportswoman to have her brain donated to the Australian Sports Brain Bank, a medical laboratory that investigates changes in <a href="https://link.springer.com/article/10.1007/s00401-015-1502-4">complex nerve structures</a> after death, in order to understand brain conditions sustained by sportspeople.</p>
<p>Similar to findings seen in some male athletes internationally, the researchers found changes in Barclay’s white matter. </p>
<p>White matter has to do with neural connectivity in the brain. As white matter degrades, as is often seen in ageing and in diseases such as Alzheimer’s, <a href="https://pubmed.ncbi.nlm.nih.gov/23643484/">neural connectivity diminishes</a>, contributing to cognitive decline.</p>
<p>However, we don’t understand enough about this process in the brain — particularly in sportswomen. </p>
<h2>Women’s sport is becoming more popular</h2>
<p>Over the past decade, Australia’s elite women’s sports have experienced unprecedented growth. More than <a href="http://www.roymorgan.com/findings/7916-sports-women-in-football-aflw-december-2018-201903220415">550,000 Australian women</a> (aged 14 and over) now play a form of football, be it soccer, Australian rules, rugby league or rugby union.</p>
<p>This increase in participation in contact and collision sports has seen a concurrent rise in injuries <a href="https://www.smh.com.au/sport/greater-risk-of-concussion-for-women-experts-warn-as-codes-beckon-women-to-contact-sports-20180209-h0vuxe.html">such as concussions</a>. Concussion is <a href="https://pubmed.ncbi.nlm.nih.gov/29098981/">a transient injury to the brain</a>, caused by a jolt to the head or body. </p>
<p>Although specialised brain imaging can detect microscopic changes in the connections between brain regions, concussion is hard to detect on routine brain scans. Diagnosis typically relies on <a href="https://pubmed.ncbi.nlm.nih.gov/31133539/">people reporting symptoms</a> such as dizziness, confusion, unsteadiness, nausea and headaches after a collision.</p>
<p>Recognising when someone has suffered a concussion, removing them from the field and carefully assessing recovery <a href="https://bjsm.bmj.com/content/51/12/930">are all crucial steps</a> before they return to play.</p>
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Read more:
<a href="https://theconversation.com/is-the-nrl-legally-liable-for-the-long-term-impacts-of-concussions-119880">Is the NRL legally liable for the long-term impacts of concussions?</a>
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<h2>Risk factors for female athletes</h2>
<p>Female athletes are <a href="https://pubmed.ncbi.nlm.nih.gov/21074087/">more likely</a> to sustain a concussion than their male counterparts.</p>
<p>Like males, women report <a href="https://link.springer.com/article/10.1007/s40279-015-0335-6">a range of symptoms</a> after a concussion, such as headaches, mental fatigue, concentration difficulties and mood swings.</p>
<p>Although symptoms <a href="https://pubmed.ncbi.nlm.nih.gov/25383595/">can last longer</a> in some people, recovery from a concussion normally takes <a href="https://www.healthline.com/health/concussion-recovery#_noHeaderPrefixedContent">seven to ten days</a> for adults. Research on length of recovery is mixed but overall supports that women <a href="https://journals.sagepub.com/doi/10.1177/1941738116672184">take longer to recover</a> than men. </p>
<p>Women also perform worse on <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5203982/">neurocognitive testing</a> post-injury, which measures things like decision-making ability and processing.</p>
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<img alt="An illustration of a brain." src="https://images.theconversation.com/files/398831/original/file-20210505-13-1qf1i3t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398831/original/file-20210505-13-1qf1i3t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398831/original/file-20210505-13-1qf1i3t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398831/original/file-20210505-13-1qf1i3t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398831/original/file-20210505-13-1qf1i3t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398831/original/file-20210505-13-1qf1i3t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398831/original/file-20210505-13-1qf1i3t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Concussion is typically considered a functional neurological disturbance rather than a structural injury.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>These gender-based differences may be due to a combination of factors. </p>
<p>Women tend to be more aware of their symptoms and are <a href="https://pubmed.ncbi.nlm.nih.gov/25971368/">more likely to report them</a>, so this may account for some degree of the gap. However, under-reporting still exists.</p>
<p>Female athletes also generally have shorter and narrower necks, and lower head mass (their heads are smaller and less dense). These factors are associated with <a href="https://insights.ovid.com/medicine-science-sports-exercise/mespex/2005/02/000/gender-differences-head-neck-segment-dynamic/15/00005768">lower neck strength</a>. Neck strength is a <a href="https://pubmed.ncbi.nlm.nih.gov/24930131/">protective factor</a> against concussion, so women may be more susceptible for this reason.</p>
<p>Further, female brains metabolise glucose (sugar) and oxygen <a href="https://www.tandfonline.com/doi/abs/10.1080/02699052.2018.1542507?journalCode=ibij20">faster than male brains</a>. If a head injury temporarily disrupts blood supply to the brain, it could have a greater effect on the faster nutrient-burning female brain. </p>
<p>Meanwhile, sex hormones such as progesterone that <a href="https://pubmed.ncbi.nlm.nih.gov/24220566/">vary across a women’s menstrual cycle</a> could also affect outcomes after a concussion. Concussions sustained during the follicular phase (after menstruation, before ovulation) are less likely to lead to symptoms a month later, whereas injuries in the luteal phase (after ovulation, before menstruation) result in <a href="https://www.frontiersin.org/articles/10.3389/fneur.2019.00691/full">poorer outcomes</a>. </p>
<p>Although we don’t fully understand why, concussion outcomes appear to be worse when progesterone levels are high. However, these effects may be negated when women take the <a href="https://www.liebertpub.com/doi/10.1089/neu.2017.5453">contraceptive pill</a>. </p>
<p>Despite these differences, women are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366411/">an understudied population</a> when it comes to concussion, resulting in a lack of gender-specific treatment guidelines.</p>
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<strong>
Read more:
<a href="https://theconversation.com/what-does-concussion-do-to-the-brain-53224">What does concussion do to the brain?</a>
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<h2>Repeated concussions and long-term risk: a complex area</h2>
<p>In the context of long-term brain injury and sport, we’ve perhaps most often heard about a condition called chronic traumatic encephalopathy (CTE).</p>
<p>Male former AFL players <a href="https://www.theage.com.au/national/victoria/coroner-calls-for-brain-research-following-death-of-danny-frawley-20210223-p574yv.html">Danny Frawley</a> and <a href="https://www.theage.com.au/sport/afl/shane-tuck-had-severe-cte-brain-bank-reveals-20210122-p56w3n.html2021">Shane Tuck</a> were both diagnosed with CTE when their brains were examined after their deaths. </p>
<p>CTE is described as a delayed-onset and progressive neurodegenerative disease, with symptoms appearing in midlife or decades after exposure to head traumas. It’s believed these changes lead to <a href="https://theconversation.com/heres-what-we-know-about-cte-the-brain-condition-that-affected-danny-frawley-145395">an abnormal buildup</a> of a protein called “tau”, which can damage brain cells. </p>
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<img alt="A woman sits on a couch, appearing to have a headache." src="https://images.theconversation.com/files/398835/original/file-20210505-19-w15kwd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398835/original/file-20210505-19-w15kwd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398835/original/file-20210505-19-w15kwd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398835/original/file-20210505-19-w15kwd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398835/original/file-20210505-19-w15kwd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398835/original/file-20210505-19-w15kwd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398835/original/file-20210505-19-w15kwd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Women tend to take longer to recover from a concussion than men.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>But CTE is not the only way in which changes to the brain might present over time. To date, no sportswoman has been diagnosed with CTE (including Barclay).</p>
<p>An article in <a href="https://www.theguardian.com/sport/2021/apr/30/damage-found-after-late-aflw-player-jacinda-barclay-donates-brain-for-concussion-research">The Guardian</a> reported Barclay “did not have a substantial clinical history of concussion and her brain did not show evidence of her having sustained a concussion in the weeks before she died”.</p>
<p>Brain bank research can detect white or grey matter changes but may not be able to ascertain which of several possible factors (for example, concussions, substance use, undiagnosed mental illness, ageing) <a href="https://www.futuremedicine.com/doi/full/10.2217/cnc-2018-0004">led to the development</a> of brain pathology in a given case.</p>
<p>Brain changes seen in some deceased athletes have also been found in people with a variety of neurological and psychiatric disorders, but with <a href="https://pubmed.ncbi.nlm.nih.gov/31169877/">no known history</a> of head trauma or participation in risky activities such as contact sports or military combat. </p>
<p>So there’s a lot we don’t know, and more research we need to do, including involving people outside professional sport.</p>
<h2>Increased focus on women is important</h2>
<p>Women have <a href="https://pubmed.ncbi.nlm.nih.gov/23305823/">higher rates of Alzheimer’s disease</a> than men. Although a history of head trauma <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098841/">is a potential risk factor</a> for developing dementia and other neurodegenerative diseases like Parkinson’s, studies have not yet examined <a href="https://academic.oup.com/brain/article/136/1/43/433876">the interaction</a> between sport-related concussions and neurodegenerative diseases in women.</p>
<p>We need <a href="https://www.futuremedicine.com/doi/full/10.2217/cnc-2018-0004">studies in women</a> to assess the interaction between exposure to single or repeated head impacts and the <a href="https://pubmed.ncbi.nlm.nih.gov/33312682/">potential changes</a> in brain and behaviour across the lifespan.</p>
<p>These studies need to use precise tests of attention, response speed and other cognitive abilities, and include indices of genetic risk factors, mental health, and menstrual cycle function pre- and post-injury.</p>
<p>Barclay’s groundbreaking donation to the Australian Sports Brain Bank is an important step towards gender equity in concussion research.</p>
<p>But to further advance our understanding, brain donors should participate in long-term studies during their lives that consider multiple causal or protective factors.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-what-we-know-about-cte-the-brain-condition-that-affected-danny-frawley-145395">Here's what we know about CTE, the brain condition that affected Danny Frawley</a>
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<img src="https://counter.theconversation.com/content/160097/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shreya McLeod has previously been contracted to be the physiotherapist for female athletes from Cricket NSW, Cricket Australia, NSWIS, Singapore Sports Council and the WTA.</span></em></p><p class="fine-print"><em><span>James F. Donnelly provides private clinical and neuropsychology services to children and adults who have suffered concussions.</span></em></p>Jacinda Barclay, an AFLW player who died last year, has had her brain donated to concussion research. In general, women are understudied regards to their long-term brain health.Shreya Mcleod, PhD candidate in sport-related concussion, School of Medicine and Public Health, University of NewcastleJames F. Donnelly, Lecturer in Psychology, Faculty of Health; private practice psychologist, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1464952020-10-15T13:44:03Z2020-10-15T13:44:03ZConcussion can accelerate ageing of the brain – research from the rugby pitch<figure><img src="https://images.theconversation.com/files/362455/original/file-20201008-18-1a5c086.jpg?ixlib=rb-1.1.0&rect=287%2C197%2C11658%2C5730&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rugby-players-fight-ball-on-professional-1150451498">Shutterstock/Alex Kravtsov</a></span></figcaption></figure><p>The serious harm caused by concussion in sport first became apparent among the “<a href="https://link.springer.com/article/10.2165/00007256-200737060-00001#ref-CR1">punch-drunk</a>” boxers who suffered repetitive blows to the head over the course of their fighting careers. A related form of brain damage is known to affect a <a href="http://sites.bu.edu/mckeelab/files/2014/06/Chronic-traumatic-encephalopathy-neurodegeneration-following-repetitive-concussive-and-subconcussive-brain-trauma1.pdf">range of other sports and professions</a>, where repeated head injuries kill brain cells and gradually cause the brain to shrink.</p>
<p>By working closely with elite rugby union players, <a href="https://www.physoc.org/abstracts/elevated-systemic-oxidative-nitrosative-stress-and-cerebrovascular-function-in-professional-rugby-union-players-the-link-to-impaired-cognition/">our research</a> has now helped us to understand the impact of concussion on the brain as we get older. We have shown that brain function in a young player with a history of concussion is on a par with someone in their 60s. In simple terms, concussion seems to accelerate biological brain ageing by as much as three decades. </p>
<p>One important discovery was that concussed rugby union players have more “free radicals” – unstable, cell-damaging molecules – in their blood. They also have less nitric oxide, a beneficial molecule which allows more oxygen and glucose to get to the brain. As a result, blood vessels in the concussed brain react sluggishly to changes in blood flow, a condition known as “cerebrovascular impairment”.</p>
<p>Cerebrovascular impairment has been <a href="https://physoc.onlinelibrary.wiley.com/doi/full/10.1113/JP276898">linked to cognitive dysfunction</a>, and can have a negative effect on the way a person thinks, concentrates, formulates ideas and remembers. It can also make them more vulnerable to <a href="https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.117.027448">dementia</a> in later life. In our analysis, these impairments were mostly seen in the regions of the brain where head contact is most frequently made during play. </p>
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<p>Both active and retired elite rugby union players were found to be cognitively impaired compared with people of a similar age and fitness, who had not been concussed or participated in contact sports. The effects also appeared to be related to a player’s position in the rugby team. They were particularly prevalent among forwards, who usually experience more tackles and collisions in a game compared to the backs.</p>
<h2>Game changer?</h2>
<p>Positive steps have been taken in the world of rugby as awareness has grown from the negative effects that concussion has on the brain. Indeed, we have come a long way since 2005, when a neuropathologist working in a Pittsburgh coroner’s office became the <a href="https://pubmed.ncbi.nlm.nih.gov/20201914/">first to identify</a> a form of neurodegeneration called “chronic traumatic encephalopathy” (CTE) in an American Footballer who had suffered repetitive brain injuries. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/will-the-law-strike-a-knockout-blow-on-concussion-in-rugby-37863">Will the law strike a knockout blow on concussion in rugby?</a>
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<p>But the problem has not been solved. And the increasingly gladiatorial nature of the modern game, with <a href="https://bjsm.bmj.com/content/46/8/580">players whose physiques resemble</a> those of a bodybuilder, mean the risks could be worsening. So what can be done to reduce the potentially life-altering effects of concussion in rugby players? </p>
<p>One approach involves changing the rules of the game. While some adjustments have been proposed, such as <a href="https://www.rugbypass.com/news/super-controversial-waist-height-tackling-among-6-law-changes-endorsed/">waist height tackling</a> to reduce the number of head-to-head collisions, <a href="https://www.bbc.co.uk/sport/rugby-union/41398969">some argue</a> that the tackle should be banned altogether. Others, including ourselves, have focused on establishing effective molecular (blood, saliva, urine) and cerebrovascular (brain blood flow) assessments for pitchside detection of concussion to enable swifter treatment and recovery. </p>
<p>While these remain in development, there are methods that rugby players – and anyone else – can use to help our brains fight off the risk of dementia. These include high-intensity interval training (HIIT) and regular aerobic exercise. </p>
<p>This is because exercise helps maintain a healthy body weight and promotes the release of nitric oxide, which improves the way our blood vessels function and <a href="https://physoc.onlinelibrary.wiley.com/doi/pdf/10.1113/JP275021?casa_token=dGGWYrRmI3YAAAAA:edWmY49H0sNQ78ts1QZJvOsN-TkkkqgM4hvGVpw7iKYynxrpW2g-_KerXIoQ9JonSBzJNPgKBwLKrg">contributes to better brain health</a>. </p>
<p>For now, though, concussion across all sports remains a prominent and potentially life-altering injury, with the true consequences often only noticed when it is too late. There are almost <a href="https://resources.world.rugby/worldrugby/document/2020/07/28/212ed9cf-cd61-4fa3-b9d4-9f0d5fb61116/P56-57-Participation-Map_v3.pdf">10 million rugby players</a> around the world, and professional players are more likely than not to <a href="https://bjsm.bmj.com/content/bjsports/early/2018/03/12/bjsports-2017-098417.full.pdf">sustain a concussion within 25 games</a>. </p>
<p>And while modern treatments and management protocols for concussion have improved with increased monitoring and neurological testing, the mechanisms which increase an athlete’s susceptibility to CTE and other neurological complications remain poorly understood. </p>
<p>Meanwhile, rugby union’s governing bodies have faced <a href="https://www.espn.co.uk/espn/story/_/id/16029747/rugby-nfl-concussion-issue-figured-out">criticism</a> for the lack of concussion management. But perhaps this should come as little surprise given that not very long ago, in the amateur era of the game, the traditional treatment for a knock to the head was a “magic sponge” doused in cold water.</p><img src="https://counter.theconversation.com/content/146495/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Damian Bailey receives funding from the Royal Society, Japan Society for the Promotion of Science and the JPR Williams Foundation Trust</span></em></p><p class="fine-print"><em><span>Chris Marley and Tom Owens do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Thankfully treatment has moved on from the cold sponge of the amateur era. But brain damage continues to be a serious risk in many sports.Tom Owens, PhD Candidate, University of South WalesChris Marley, Senior Lecturer in Exercise Physiology, University of South WalesDamian Bailey, Professor of Physiology and Biochemistry, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/879862017-11-22T23:54:54Z2017-11-22T23:54:54ZGrey Cup haunted by brain injury risk — but doesn’t have to be<p>When the Toronto Argonauts and Calgary Stampeders square off in Ottawa for the 105th Grey Cup on Sunday, it will be under dark clouds — not necessarily of weather, but rather the risk of concussions and their devastating long-term effect on players’ brains.</p>
<p>A growing body of evidence — including groundbreaking research examining the brains of living former Canadian Football League football players — suggests that the way the sport is played and the subsequent health of athletes are grave and connected problems.</p>
<p>We have long been suspicious about what football injuries were doing to the brains of some players, but even we were shocked when we brought 22 former CFL players into <a href="http://www.humanities.mcmaster.ca/%7Elmblab/">our lab at McMaster University</a> and studied their brain activity and structure. </p>
<p>Some former players showed readings similar to those one would find in a coma patient. It was astounding to us that the most deeply affected men were still standing, let alone able to carry on everyday conversations. </p>
<p>We discovered this in a two-year research project — <a href="https://www.thespec.com/hamilton-topics/7521250-collision-course/">Collision Course</a> — conducted in collaboration with Hamilton Spectator reporter Steve Buist, comparing former players to other people in a control group.</p>
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<img alt="" src="https://images.theconversation.com/files/195962/original/file-20171122-6044-mp70sx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/195962/original/file-20171122-6044-mp70sx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=247&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195962/original/file-20171122-6044-mp70sx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=247&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195962/original/file-20171122-6044-mp70sx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=247&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195962/original/file-20171122-6044-mp70sx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=311&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195962/original/file-20171122-6044-mp70sx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=311&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195962/original/file-20171122-6044-mp70sx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=311&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The brain of a normal control subject, left, shows significant difference compared to the brain of a former CFL player.</span>
<span class="attribution"><span class="source">(Handout)</span>, <span class="license">Author provided</span></span>
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<h2>Brain shrinkage, memory problems</h2>
<p>The results and the stories of those players were stark, and often sad.</p>
<p>On average, the retired athletes, ranging from 44 to 66 years old, had lost 20 per cent of the mass of the cerebral cortex. This controls movement and cognitive functions including attention, speech and memory. </p>
<p>Of the 22 former players, 16 reported memory problems, compared to just two of the 20 healthy control subjects.</p>
<p>Brain images from some retired players in their 40s looked like images from men twice their age. </p>
<p>It’s not news that concussions from fast-moving, hard-hitting contact sports such as football and hockey have been coming under closer scrutiny. Before our project, there already had been plenty of evidence — most of it derived after athletes’ deaths — that <a href="https://thewalrus.ca/inside-the-controversial-concussion-lab-that-could-save-football/">head injuries from football had significantly damaged the brain structure of veteran players</a>. </p>
<p>Our goal was to take a comprehensive and non-invasive look at the brains of living former players, so we used the tools at our disposal, including magnetic resonance imaging (MRI) and electroencephalography (EEG). </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/195965/original/file-20171122-6061-1phv0sk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/195965/original/file-20171122-6061-1phv0sk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=235&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195965/original/file-20171122-6061-1phv0sk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=235&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195965/original/file-20171122-6061-1phv0sk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=235&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195965/original/file-20171122-6061-1phv0sk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=296&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195965/original/file-20171122-6061-1phv0sk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=296&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195965/original/file-20171122-6061-1phv0sk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=296&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Left and right images of the cerebral cortex show in blue areas where retired CFL players had significant thinning compared to people in the control group. Lighter areas represent more significant thinning. About two-thirds of the area was thinner in athletes.</span>
<span class="attribution"><span class="source">(Handout)</span>, <span class="license">Author provided</span></span>
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<p>We measured the physical structures of our subjects’ brains, and gauged the neurophysiological activity going on in those same brains. These are two very different methods — revealing physical brain structures and activity — yet the results were grimly consistent.</p>
<p>The damage was not universal, to be sure. There was one player who showed no damage on either test, for example. But on balance, it was clear there is a strong and disturbing correlation between football and permanent brain injury.
Brain EEG shows <a href="https://www.thespec.com/news-story/7525066-collision-course-a-spectator-report-on-the-science-of-hard-head-knocks/">a difference in automatic attention that does not involve conscious awareness</a>, and also difference in voluntary attention that is usually controlled by awareness.</p>
<h2>Sports, science and risk</h2>
<p>As Canada approaches the Grey Cup on Sunday, one might expect researchers who have seen what we have to be marching outside the game with placards, calling for a stop to the carnage.</p>
<p>Far from it. Both of us will be watching — and enjoying — the action.
Football and hockey are simply great sports, packed with action and surprises, making them tremendously entertaining. Between the two of us, we have played years of both sports — one of us on the field, the other on the ice.</p>
<p>But unlike some, we won’t be cheering on Grey Cup Sunday when players get dumped on their heads, or when they get slammed to the ground and their helmets bounce off the turf. When we watch a game, we can see when a head-injured player is having a seizure after a tough hit, or when a player has lost consciousness even before hitting the turf. </p>
<p>Still, collisions are part of football and hockey, and that’s not going to change, nor should it. <a href="https://theconversation.com/how-to-avoid-recognize-and-treat-concussion-in-sports-83204">Players nowadays are more aware of the risks</a>, and that those risks increase with the number of years they play and the blows they take.</p>
<p>But those risks can certainly be diminished, if there is a will among sports leagues, owners, players and fans to adopt some small changes that can make football and hockey much more sustainable. </p>
<h2>Technology to protect players’ heads</h2>
<p>Improved rules to end hockey fighting, to better protect quarterbacks in the pocket, and to crack down much harder on illegal, high-risk blows in both sports, together with much stricter enforcement, would make football and hockey safer.</p>
<p>More cautious protocols around possible head injuries would go a long way to reducing repetitive concussion damage that echoes through decades. Today, we do more to protect players’ knees than their heads, and that has to change.</p>
<p>One way to go at it might be to use objective, evidence-based standards for blows to the head. </p>
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<figcaption><span class="caption">Technology to detect a potential brain injury is used by Liberty Christian High School in Dallas-Fort Worth, Texas.</span></figcaption>
</figure>
<p><a href="http://www.cnn.com/2014/06/09/tech/innovation/smart-football-helmet-concussions/index.html">Technology exists today</a> that can slip easily into a <a href="https://www.sbnation.com/college-football/2017/5/12/15629572/texas-longhorns-helmet-technology-riddell-insite-monitor-hits">helmet to measure the force and torque of a blow to the head</a> and transmit it to coaches and medical staff on the sidelines. It could be made mandatory for someone who gets hit too hard to be pulled out of play for examination, regardless of the apparent symptoms.</p>
<h2>Surviving the game</h2>
<p>It’s clear that even without tougher rules, some players are ready for changes that will protect them from debilitating brain injuries. It’s already hard enough for a player to survive in a game where any play could be his last.</p>
<p>We understand that dialling back the extreme blows that lead to head injuries might make games slightly less exciting. On the other hand, they might also make them more exciting, as strategy and agility would become more important and integral to winning.</p>
<p>Owners may worry about losing money if the game is perceived as softer — but they will definitely lose money if <a href="http://ottawacitizen.com/sports/local-sports/legal-battle-over-cfl-players-benefits-moving-upfield-inch-by-inch">badly injured players sue</a> them for not taking better care of their brains and win.</p>
<p><a href="https://www.fastcodesign.com/1671752/why-nfl-helmets-will-never-be-concussion-proof">There will always be injuries, and there will always be risk</a>. Players accept that.
Surely, we don’t need to see their heads pounded so badly that their already short careers in professional sports leave them permanently and catastrophically injured.</p><img src="https://counter.theconversation.com/content/87986/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Connolly conducted the EEG/ERP research using equipment purchased with funds from the Canada Foundation for Innovation. He is also the CSO of a pre-revenue start-up called VoxNeuro, Inc. that is involved in neurocognitive assessment. His work in the CFL research did not involve VoxNeuro, however. The CFL research described in this article received support from The Hamilton Spectator. </span></em></p><p class="fine-print"><em><span>Michael Noseworthy receives funding from: Natural Sciences and Engineering Research Council (NSERC) of Canada. MRI scanning was done using equipment purchased with funds provided through the Canada Foundation for Innovation (CFI). The CFL work described received support from the Hamilton Spectator.</span></em></p>Concussions in football and other contact sports correlate with severe, long-term brain damage — but science shows it doesn’t have to be that way.John F. Connolly, Professor and Senator Wm. McMaster Chair; Director, ARiEAL Research Centre; and co-director of Language, Memory & Brain Laboratories, McMaster UniversityMichael D. Noseworthy, Professor, Electrical and Computer Engineering, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/555322016-03-07T12:54:11Z2016-03-07T12:54:11ZIs a ban on school rugby tackling more about moral guilt than health?<p>The call <a href="http://www.theguardian.com/education/2016/mar/02/uk-health-experts-call-for-ban-on-tackling-in-school-rugby">by more than 70 academics and doctors</a> for a ban on tackling in school rugby provoked inevitable debate. </p>
<p>As a lecturer in sports ethics, my curriculum for more than 15 years has focused on constructing careful and measured arguments to defend a particular position. In many arguments about the dangers of sport, the conversation tends to stop after evidence of injury proves a point one way or the other; there is little discussion as to what values will be lost in the rush to prevent any harm.</p>
<p>Risk and harm are an inevitable part of children’s lives, so why should some risks and harms be more morally important than the value that is brought by the activity or action?</p>
<p>Though tackling can be a brutal move, the physical nature of rugby and its rough state of play is often deemed to be character-building, helping children learn through team sports and physical tactics.</p>
<h2>Injury intervention</h2>
<p>If we decide that the concerns over potential harm in rugby are morally important – outweighing any potential benefit that the sport brings – and that we should do something about them, we then need to decide what form intervention should take. In the case of children playing rugby, this might include rule changes, education, prohibition and introducing safety equipment.</p>
<p>However, there is still more to weigh up. For example, the strategy used to control doping in sport, which requires players to undergo testing to determine if they have used banned substances and issuing a ban if they are found to have done so, raises a significant number of concerns about the privacy, surveillance and autonomy of players – but we decide that fairness is more important.</p>
<p>Likewise, the introduction of compulsory helmets for children in cricket makes the sport more expensive and potentially more exclusive. Each stage of the argument is complex and no amount of empirical data will settle any issue. </p>
<p>Even if medics and academics are able to provide evidence showing that there is risk of injury which might be severe and have long-term consequences, their stance on the issue means they are making a value judgement or taking a moral stance. They are advocating paternalism and/or prudence. Paternalism – or parentalism – involves making a decision on behalf of children in order to prevent harm, in the case of school rugby, by prohibiting tackling. </p>
<p>The principle is fairly uncontroversial –- we do this all the time. The issue isn’t that we shouldn’t look out for children’s well-being, but whether prohibiting tackling will deliver overall benefit. While it might reduce the risk of injury, supporters can argue that if we follow the advice of those academics and medics who signed the open letter to politicians, some important values such as building character will be lost.</p>
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<figcaption><span class="caption">Tackle at a Hornsby under 11s match in 2012.</span></figcaption>
</figure>
<p>It is far more difficult to offer evidence for the character-building potential of rugby than it is to prove harm, not least because we are not sure what character is or how indeed it’s built. This is not to dismiss the claim that rugby and tackling does build character, but to acknowledge that substantiating it is far more difficult than substantiating the claim that injuries occur in rugby. </p>
<p>Even if we could demonstrate clearly that rugby (tackling included) builds character in ways that rugby (non-tackling) doesn’t –- or for that matter in ways that no other less risky activity could –- we would still need to make the case that character building’s positive outcomes outweigh the negative harm and risk.</p>
<p>Given these are two very different elements –- physical harms versus social or psychological benefits – one might say that it’s like comparing apples with pears. </p>
<h2>Forward-thinking</h2>
<p>When it comes to prudence, in some respects the prudent thing to do is just as difficult to identify. Prudence requires us to think about how our actions today might impact our future. The prudent thing to do is not to close down one’s future options by our present actions. </p>
<p>Rugby with tackling might limit our children’s options in the future, because paralysis or cognitive dysfunction is a significant threat to well-being. On the other hand not giving our children the opportunity to challenge themselves, develop important character traits or experience the value of rugby (tackling included) might in itself compromise their future well-being. </p>
<p>As statistics won’t settle the issue, a prudent approach means that we must weigh up the evidence before us, then carefully and rationally come to a cautious decision. </p>
<p>In this particular case, I’m not sure that rugby with tackling builds character in ways that rugby (non-tackling) or other sports can’t. I am fairly sure, however – and despite suffering two collarbone breaks before the age of 15 in rugby – that playing sports like rugby are rewarding, enjoyable and challenging. </p>
<p>Whether the risks are worth it, I’m not sure; will I encourage my son to play rugby? Again I’m not sure. If he doesn’t then I don’t think his life will be impoverished, but neither will it be free of risk.</p><img src="https://counter.theconversation.com/content/55532/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carwyn Jones does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A sports ethics expert considers the concern over tackling in school rugby.Carwyn Jones, Professor in Sports Ethics, Cardiff Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/389072015-03-19T19:28:53Z2015-03-19T19:28:53ZShould boxing be banned?<figure><img src="https://images.theconversation.com/files/75314/original/image-20150319-1562-13adqmd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It may be that the seemingly inhumane aim of causing your opponent to lose consciousness by punching them separates boxing from other sports.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/ennuiislife/3415283249">Kate Gardiner/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>The <a href="http://www.theguardian.com/australiac-news/2015/mar/17/queensland-boxers-death-prompts-doctors-to-call-for-sport-to-be-banned">death of a 23-year-old boxer</a> has prompted a call by the Queensland branch of the Australian Medical Association for the sport to be banned in Australia. But before we decide whether this is the right response, we should consider what attracts people to participate in and watch high-risks spectacles such as boxing. </p>
<p>Braydon Smith died when <a href="http://www.theguardian.com/sport/2015/mar/16/boxer-dies-less-than-two-days-after-losing-10-round-featherweight-bout">his life support was turned off</a> around two days after he collapsed. He had lost a ten-round fight 90 minutes earlier but had not been knocked out and appeared all right after the fight.</p>
<h1>Not uniquely deadly</h1>
<p>Boxing is not the only sport associated with fatal injuries. But we seem more tolerant of fatalities in other sports; you don’t see calls for their abolition when someone dies. The recent <a href="https://theconversation.com/explainer-what-is-traumatic-brain-injury-and-how-is-it-treated-34697">death of cricketer Phillip Hughes</a> due to a traumatic brain injury led to calls for better helmets, for instance, but no one suggested banning the sport. </p>
<p>Similarly, the death of a young NSW rugby player, Jake Kedzlier, after being struck in the face by a player’s knee led to statements about having weight classes for leagues and it being a “<a href="http://www.foxsports.com.au/nrl/rugby-league-hard-man-tommy-raudonikis-devastated-by-grandsons-death-in-rugby-league-accident/story-e6frf3ou-1226614898982">freak accident</a>”, as though injuries were not inherent in that contact sport.</p>
<p>After controlling for the number of participants in each sport, a <a href="http://www.ncbi.nlm.nih.gov/pubmed/21345432">2012 study from Victoria</a> found motor sports, fishing, equestrian activities and swimming all led to more deaths in a year than boxing, which didn’t even make it into the top ten. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10688484">Another study found</a> motor vehicle accidents and falls were far more likely to kill people than boxing or any other sport. </p>
<p>It may be that the seemingly inhumane aim of causing your opponent to lose consciousness by punching them separates boxing from other sports. And, for some reason, the relatively rare fatalities seem to get far more press than the insidious long-term effects of a career in boxing or other contact or combat sports. </p>
<p>If you’re evaluating the safety of a sport, you have to consider the whole gamut of potential injuries they cause, not just death. Major traumatic injuries, frequently to the head and face, <a href="http://www.ncbi.nlm.nih.gov/pubmed/16076230">are also much more common</a> in motor sports, cycling, skiing, hockey and equestrian activities than in boxing. </p>
<p>Some sports put participants at risk of acute injuries that resolve with proper care (a fractured arm, for instance, or a simple single concussion), while others last for years or a lifetime (damaged knees, or moderate to severe brain injuries). And others still put the person at risk for degenerative illnesses, such as Alzheimer’s disease, which is what faces many boxers. </p>
<p>Some boxers who have suffered numerous blows to head or face that rattled their brain develop what’s called <a href="http://www.ncbi.nlm.nih.gov/pubmed/10949160">dementia pugilistica</a>. This leads to serious problems with memory, attention, speech, balance and emotion regulation. It can cause premature death.</p>
<h2>Responding well</h2>
<p>So why might someone become a professional boxer? Well, professional athletes earn some money, but they also get recognition and the satisfaction that comes from perfecting a physique and skills. And, of course, most people like winning. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/75315/original/image-20150319-1588-1q6dl5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/75315/original/image-20150319-1588-1q6dl5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/75315/original/image-20150319-1588-1q6dl5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/75315/original/image-20150319-1588-1q6dl5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/75315/original/image-20150319-1588-1q6dl5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/75315/original/image-20150319-1588-1q6dl5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/75315/original/image-20150319-1588-1q6dl5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Spectators get caught up in the emotion evoked by the spectacle of sports, such as boxing.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/ennuiislife/3458443298">Kate Gardiner/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>And why might someone pay to watch as two men or women bash each other? Perhaps the boxing crowd gets caught up in the emotion evoked by the spectacle, and any thoughts about civilised behaviour go out the window as they watch what is taboo in other settings. There is no reflection on what the spectacle might mean for those involved when it ends.</p>
<p>The positive emotional experience of the spectator, especially in a crowd, was aptly <a href="http://www.just%20or.org/stable/2763073?seq=1#page_scan_tab_contents">described by social psychologist George Elliot Howard</a> in 1912:</p>
<blockquote>
<p>In the spectator crowd … very undisciplined social instincts or desires … well up from the deep abyss of the unconscious or the subconscious … the elemental gaming instinct slips its leash … the social person (at the boxing match) … is a group of sentiments attached to a symbol. </p>
</blockquote>
<p>Boxing and other spectator sports are commercial enterprises designed to fuel these social psychological needs of the spectator. And some sporting spectacles (think rugby, AFL, for instance, or motor racing and horse racing) with significant financial implications are linked to symbols of national or local pride. These get a pass when it comes to moral or safety issues, even when eventual impairment may be so great that the ex-participants cannot even attend future spectacles.</p>
<p>Finally, is it the role of government to save adults from themselves or should we as a society allow spectacles that include the risk of death? We tend to tolerate the occasional tragedy in recreational activities, such as skydiving or hang-gliding, and even more common favoured sports, such as cricket, rugby or gridiron. </p>
<p>We also defend against thoughts about the true risks involved for all participants, possibly because our psychological or social needs met by the sport outweigh the loss of one combatant. </p>
<p>We might rationalise a tragic event as rare or atypical, blame the person who died for not having sufficient skill, conjure up examples of others in the same sport who never got hurt or focus on the heroic features of the athlete’s history to somehow make the loss meaningful. All these act as defences against accepting that our favourite sport, which symbolises something important for our own sense of self, may actually be brutal and dangerous.</p>
<p>Some people continue to cling to the myth that aggression in sport acts as catharsis for both the combatant and the spectators. And that this aggression would otherwise be expressed elsewhere. But this <a href="http://psycnet.apa.org/psycinfo/1999-13741-004">idea has been wholly refuted</a>.</p>
<p>Rather than banning boxing, a more sensible solution may be to better manage the physical and social environment risk factors posed by it. This may decrease the brutality that attracts some people to the sport, but it will increase the opportunities for life after it for those risking life and limb by participating.</p><img src="https://counter.theconversation.com/content/38907/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr James F. Donnelly has received funding in the past from the Sylvia and Charles Viertel Foundation to develop concussion management programs for schools..</span></em></p>The death of a 23-year-old boxer has prompted a call by the Queensland branch of the Australian Medical Association for the sport to be banned in Australia.James F. Donnelly, Lecturer in Psychology, School of Health and Human Sciences, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.