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Brain injury

Repeated concussions in rugby linked to mental health problems post-retirement

Former professionals more likely to have depression, anxiety and irritability compared to amateur rugby players and non-contact athletes




Former professional rugby players are more likely to show signs of mental health issues including depression, anxiety and irritability compared to amateur rugby players and non-contact athletes, a new study has revealed.

The retired elite rugby players in the study sustained more concussions during their playing days than those in other groups, which could be linked to their poor mental health later in life.

Players who had sustained five or more concussions were almost twice as likely to report signs of depression, anxiety and irritability compared with players with fewer concussions. 

These players were also more likely to struggle with feelings of covert anger, the Durham University-led study revealed. 

Signs of depression and irritability were also more common in rugby players who had sustained three or more concussions in their playing career. 

One in two players with three or more concussions experienced these signs of poor mental health compared to one in three players who had suffered less than three concussions.

The retired elite rugby union and league players, who all played in the UK, were compared to amateur rugby players and non-contact athletes, such as cricketers and runners.

The scientists say further research is needed to explore if there is a direct neurobiological connection between repeated concussions and longer term psychological health and to investigate any possible links with the development of neurodegenerative disease.

Lead author Dr Karen Hind, from the department of sport and exercise sciences, at Durham University, said: “Our study shows that elite level rugby players disclosed more adverse mental health issues following retirement from the sport, compared to those who had played amateur level rugby, or a non-contact sport. 

“This was particularly the case for those players who had experienced three or more concussions.

“These findings add to a growing body of evidence that can inform strategies to support player welfare and they shed further light on risks of repeated concussions.”

There were no differences in alcohol scores between the retired sports groups or in relation to concussion history.

However, the study did find that the former professional rugby players were more likely (1.8 to 2.9 times more likely) to suffer from sleep disruption compared to the amateur rugby players and non-contact athletes.

One in five former elite rugby players said they would not seek help from anyone if they had a problem or were upset.

The researchers acknowledge that forced retirement due to injury also played a part in players’ well-being post retirement. They also stress that while this study does not conclude cause and effect, the findings are important for player welfare and add to a growing body of evidence on the impact of repeated concussions.

In the study, 83 retired elite rugby players were compared with 106 age-matched amateur rugby players and 65 non-contact athletes. They were aged between 22 and 82 years, with an average age of 47.

The findings of the study come at a time when the issue of concussion in sport is very much in the spotlight, with questions surrounding pitch-side assessments, return to play, player after care and long-term neurodegenerative risks from repeated head impacts. 

World Rugby and International Rugby Players (IRP) have recently published new guidance to limit contact training aimed at preventing injuries and protect player welfare.

Co-author, Professor Patria Hume from Auckland University of Technology, who led the New Zealand Rugby Health study on which the UK Rugby Health Study is based, said: “Given the UK retired rugby players experienced worse outcomes for depression, anxiety, irritability and sleep disturbances but the New Zealand players did not, but that the New Zealand players showed more hazardous alcohol consumption whereas the UK players didn’t, we may need country specific strategies when addressing mental health and sleep disturbances, or alcohol consumption in rugby code athletes.”

Dr Judith Gates, chair and co-founder of Head for Change, said: “This paper adds further evidence as to the strong associative links between sports related traumatic brain injuries and subsequent neurodegenerative disease. The evidence is mounting.”

Alix Popham, who was not involved in the study, is a retired international rugby player, with 33 caps for Wales, played in World Cups in 2003 and 2007 and a 2008 Grand Slam winner.

Alix retired in 2011 and in April last year was diagnosed with probable chronic traumatic encephalopathy (CTE) and early onset dementia as a result of traumatic brain injury suffered in his rugby career.

He said: “The evidence from this research correlates with our lived experience from talking to and supporting members of the rugby family currently struggling following their professional careers. 

“Sadly, the scale of the problem is continuing to grow which is why we’re so passionate about Head for Change offering the much needed care and support to those affected.”

A study by the same research team has previously shown that rugby players continue to suffer from their high physical ‘injury load’ after retirement from the sport. 

In that study, concussion was the most common injury amongst rugby players which was most likely associated with reported longer term impact.

Brain injury

Expert panel to assess future of brain injury rehab

The webinar on Wednesday will examine the challenges and opportunities in neurorehab now and into the future



Experts from across the world of brain injury rehab are coming together to assess the future of the sector at an event this week. 

The webinar – What does the future of brain injury rehabilitation look like? – brings together leaders in their field of assess what challenges and opportunities lie ahead. 

Scores of people have already signed up for the hour-long live online event, on Wednesday at 4.30pm, with places still available and questions can be submitted in advance. 

The expert panel comprises:

The event marks the second webinar held by NRC Medical Experts, in association with NR Times, following a successful debate about the Rehabilitation Prescription earlier in the year. 

The upcoming webinar will focus on brain injury rehab, and the advances made in innovation to better meet the needs of people living with life-changing injuries. 

Through changes in technology, developments in medicine and the advances in neurorehabilitation, brain injury patients should face an outlook which is better than ever before. 

However, the lack of resource within health services, exacerbated by the ongoing impact of COVID-19 and mounting pressures on the NHS, mean that progress and change is not being seen at the rate many would hope for. 

“We are very much looking forward to addressing the very pertinent topic of brain injury rehabilitation with our stellar panel, all of whom have a vital role to play in supporting people living with brain injuries and their families,” says Deborah Johnson, editor of NR Times. 

“Innovation and technology is a hugely exciting area, but the impact of COVID on already stretched resources is of great concern. 

“Our webinar will look at the challenges and opportunities that lie ahead, and what more can be done to improve the lives of patients and their families.”

To attend the webinar, registration is required in advance. To sign up, visit here 

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Brain injury

ABI strategy confirmed by Government

Huge breakthrough in support for people with brain injuries comes after Chris Bryant MP introduced the ABI Bill



The Government has today committed to producing a strategy to deliver better support to people living with acquired brain injury (ABI), following efforts from MP Chris Bryant and an array of charities and leading figures to force them into action. 

In a statement, it was confirmed a strategy will be drafted with a call for evidence being launched early in the new year to help shape its development. 

Gillian Keegan MP, Minister for Care and Mental Health, said the development of the strategy would be co-chaired by herself and Mr Bryant, with senior officials in all relevant Government departments invited to join the board. 

“Following publication, the strategy will be kept under review and may be revised periodically to ensure that it continues to reflect the priority areas and actions needed to best support people living with ABI and their families,” the statement said. 

The move by the Government marks a huge step forward in ABI provision, following years of campaigning from charities and survivors for more support. Mr Bryant recently introduced a Private Members Bill with the aim of forcing the creation of such a strategy, which was due to have its second reading in Parliament tomorrow. 

Mr Bryant – chair of the All Party Parliamentary Group (APPG) on ABI and a tireless campaigner for the cause – had called on the Government to take action to ensure a more joined up approach from Government departments in supporting individuals and families affected by brain injury. 

Last month, he delivered a letter signed by over 200 MPs, charities, brain injury survivors and other providers to 10 Downing Street, calling on the Prime Minister to take action. Following that, Boris Johnson confirmed in Parliament that the Department for Health and Social Care would be looking at the development of such a strategy. 

It has also been supported widely by the public and via social media.

But today’s confirmation is a huge step forward and will ensure the development of an appropriate strategy, with input from families and professionals across the world of ABI. 

Announcing the development on Twitter, Mr Bryant said: “ The Government has just announced it will draft a strategy on Acquired Brain Injury, set up an ABI programme board which will be co-chaired by Gillian Keegan and me, and will call for evidence very soon. 

“So my ABI Bill won’t be needed. Many thanks to all who’ve helped!”

Charities who have been vocal in their support of Mr Bryant’s Bill were keen to celebrate the move, which comes after years of campaigning. 

UKABIF hailed the announcement as “a gift” and the Disabilities Trust said it was “just amazing”. 

The Child Brain Injury Trust added: “Fantastic news to hear. A strategy for ABI has been needed for so long. We are thrilled!”

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Brain injury

UEFA concussion charter urges protection and education

The importance of educating players, coaches, referees, doctors and the public about dangers of concussion in football is highlighted



A European-wide football concussion charter has been launched, stepping up efforts to safeguard players and urging the education of those involved in the game around the dangers of impacts to the head. 

UEFA has launched its concussion charter, which will apply to all teams taking part in men’s and women’s club and national team competitions across Europe. 

The charter aims to reinforce the importance of good practice in concussion management and highlights the concussion procedures that should be followed. 

It also promotes the education of players, coaches and staff about the concussion procedures in force at UEFA games. Team doctors are being asked to organise specific education sessions to brief players, coaches and staff about the concussion procedure to be followed at UEFA matches.

Furthermore, its 55 member associations are ‘strongly encouraged’ to deploy where possible, a medical video review system at their stadiums to enable immediate and informed injury assessments.

UEFA will facilitate the installation of the system with the host broadcaster. Home teams using a medical review system should offer the visiting team the same system.

Club and national teams are being urged to sign the charter to underline their commitment to safeguarding the health of their players.

In doing so, the signatories pledge their full support for UEFA’s guidance on how to recognise and manage a head injury from the time of injury through to the safe return to football.

“Everyone should know how to react and what to do,” said Tim Meyer, UEFA Medical Committee chairman. 

“Concussion is undoubtedly a serious injury which needs to be managed and treated properly. 

“The health and safety of any players taking part in Europe’s club and national team competitions is of paramount importance not only to UEFA, but also to national associations across the continent.

“Although research studies report a low incidence in football, everyone should know how to react and what to do in the event of a concussion on the pitch.

“By signing this charter, clubs and national teams will demonstrate their support for UEFA’s concussion awareness activities – and take a considerable step forward in helping to protect their players.”

The measure is the latest stage in efforts to safeguard players, following steps including UEFA’s implementation of a keynote concussion awareness campaign in 2019 and the Premier League becoming the first competitive league in the world to introduce concussion substitutes. 

UEFA’s head injury procedure is:

• In the event of a suspected concussion, the referee will stop the game to allow the injured player to be assessed by the team doctor. Players should remain calm during the situation and not interfere with the assessment.

• The assessment should in principle not take more than three minutes, unless a serious incident requires the player to be treated on the field of play or immobilised on the field for immediate transfer to hospital.

• If the assessment cannot be made after the three minutes and/or a suspicion for a concussion arises, the player should not be allowed to continue playing.

• A player suffering a head injury that requires assessment for a potential concussion will only be allowed to continue playing after the assessment, on specific confirmation by the team doctor to the referee of the players fitness to do so.

The decision remains entirely with the team doctor. Coaches, referees and players are not allowed to interfere in the assessment and decision of the doctor.

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