Influence of playing rugby on long-term brain health following retirement: a systematic review

The severity and lifelong implications of rugby related head injuries has been central to press coverage this season. The same can be said for other contact sports such as American Football which has come under fire for allowing players to continue after sustaining head injuries. Further pressure for action was applied after postmortem examinations of former NFL pros raised concerns of increased prevalence of neurodegenerative diseases as a result of repeated head trauma.

As Cunningham et al suggest, rugby has a higher incidence of concussion than American Football, therefore more is needed to be done to understand the long-term impact on brain health of former players, so they can be protected. Therefore they decided to investigate this question by performing a systematic review.

They were specifically searching for research assessing the cognitive abilities of retired professional male or female players. What became clear during their search and analysis of the relevant research is that there is  a lack of an international standardized definition and criteria of concussion in rugby. This has therefore limited injury surveillance and means that there is a lack of comparable and robust long-term studies.

What the available evidence did suggest is that,  for most ex-professional players, neurocognitive ability and performance was largely normal apart from fine motor control which had diminished.

This loss in fine motor control could be explained in part by the increased alcohol intake associated with rugby culture at most levels of the game. The tendency for players to sustain chronic upper limb musculoskeletal injuries during their careers could also explain this finding.

The studies included within the review were inconsistent in their methodology and quality. An example of this was the selection in age inclusion/exclusion criteria; this could have added bias. Studies which only involve players up to the age of 40 or 50 would likely see no change in neurofunction or life changing impact in their players. This would miss the potential change in neurofunction as people age. You could argue that head injury impact could be more influential as people transition to age due to an increase in prevalence of mild cognitive impairments.

Another consideration of interpreting the results of this review is the fact that rugby has changed a lot in the past decade. It has a much faster physical style of play and, it could be argued, that the retired players within these studies had shorter careers (as not a professional game) and played a less intense form of the game.

Also there was often an absence of control groups within the studies and often they did not state whether they discounted TBI/HI occurring outside of the sport.

Clearly more evidence is needed to assess the true long term impact of the game on neurological abilities. What we do know is the impact of concussion in the short-term and this is a serious concern for players, particularly youth players. More and more is being done to reduce the impact of concussion on players and this can only be a good thing. Examples include the research performed at Bath University, a new pioneering exercise programme which has achieved staggering results including a 72% & 59% reduction in concussion and injury rates respectively. The programme is shown below.