On: The Effects Of Cumulative Blows To The Head

panorama

by Simon Jolly

To coincide with the start of the 2015 Rugby World Cup, the BBC screened a Panorama documentary entitled ‘Rugby and the Brain: Tackling the Truth’.  Presented by former Scotland and British Lions Number 8 John Beattie, the programme investigated the link between playing rugby and injuries to the brain.

Hot on the heels of the growing discussions surrounding Chronic Traumatic Encephalopathy (CTE) in former NFL players, the programme was a reminder that other sports are similarly concerned about the effects of repeated head trauma on its participants.  A number of rugby players have made the news as a result of being knocked unconscious during games, the most notable in recent times being the Wales wing George North.

North suffered three concussions in a five-month period, resulting in him having to miss the last 10 weeks of his domestic season for his club Northampton.  There was even speculation that North would have to retire should he suffer one more significant head trauma to ensure that he does not have to endure the effects of CTE once his playing career comes to an end.

As someone who has played both rugby union and American football, as well as suffering more than one significant concussion, I have personal reasons for following the ongoing research into CTE.  The irony in my case is that the most severe head traumas I received were not a result of playing either American football or rugby.

I knocked myself senseless toppling over the handlebars of my bike and landing on my head.  In my early 20s, when I went head first into a concrete outdoor basketball court having tripped over running at full speed, I didn’t lose consciousness but did lose my eyesight progressively over the course of an hour.  The eyesight returned, but as with the bicycle accident the intense nausea lasted for at least 24 hours afterwards, a sure sign of concussion.

Nor, for that matter, were my worst injuries from American football related to head trauma: it took me 6 months to regain a degree of mobility in my upper back after dipping my head going into a particularly ferocious tackle.  I still suffer back pain relating to that one, old injury.

However, what is more relevant is that, more often than I would like to admit, I would lead with my head going into tackles, whether I was carrying to ball or making the tackle.  It’s an easy habit to fall into, particularly as the middle of the forehead so often becomes the first point of contact in a tackle.

And that, in some ways, is what concerns me more.  For the evidence would suggest that it is not just the collisions that are severe enough to result in a diagnosable concussion that cause lasting damage, but also an accumulation of multiple sub-concussive impacts.

In particular, it is the frequency with which these sub-concussive impacts occur that seems to be one of the key factors in the development of CTE and may help explain why rugby has not seen quite so many ex-players suffering from the effects of impact-induced dementia.

For someone who makes their living in scientific research I am particularly keen to avoid anything that diminishes my sharpened mental faculties and feel a that the sport I once committed so much to in my youth may have left lasting damage beyond the back and joint pain.

One thing in my favour is that the level at which I played was nowhere near the standard of the NFL.  The highest standard I achieved was one rung below NFL Europe, the now-defunct feeder league that was itself inferior to the NFL itself.  As such, the players I faced were nowhere near as strong or as fast as those who play the game to earn their living.

My one saving grace may have been that I was not as good at the game as I would have liked to have been.  All along I knew that I would have to make my living elsewhere.

Partisan supporters of each sport have waged war since time immemorial on the thorny subject of which is the tougher sport.  Does the lack of padding in rugby win out over the higher collision speeds and larger athletes of American football?  That is a discussion best left for another time.

What is evident from watching both sports is how much more frequently one receives potentially sub-concussive blows to the head in American football.

While they may have a shared ancestor, the scrum in rugby is a very different beast to the line of scrimmage in American football.  Particularly with the introduction of the latest scrum engagement laws, successful scrummaging is more about effective technique and less about winning the “hit” — the point at which the two packs come together — meaning that the likelihood of severe, percussive injuries is reduced.

In any case, unless an opposing prop was being particularly malicious — or particularly daft (which some might say is the only reason for being a prop in the first place) — head-to-head contact at a scrum is highly unlikely.  As such, the biggest culprit for potential head injuries in rugby union is the tackle area.  Getting the head in the wrong place when tackling can result in a player knocking themselves senseless, as North discovered.

However, when compared with American football, rugby players are much less likely to receive repeated, sub-concussive impacts because there is no equivalent of the line of scrimmage, which is where most of these smaller head traumas are likely to occur.  When an offensive blocker and his defensive opponent come together it is almost inevitable that there will be some contact with the head of both players, whether that is a direct or glancing collision.

On average, an NFL team runs about 65 plays a game.  Assuming that just under half of these are running plays, that means that offensive linemen fire out of their stance with the express intention winning the initial collision with their defensive opponent about 30 times a game.

If a lineman comes out of his stance with the express intention of avoiding contact with his head, his torso immediately becomes upright.  While this is somewhat desirable in pass blocking, it significantly reduces the amount of force one can apply in drive blocking, whether one is attempting to make contact with the arms or the shoulder.

From such a position, with the back almost horizontal to the ground and firing out towards the opponent, it is virtually impossible to avoid contact with the head.  This results in either direct or glancing collisions between the helmets of opposing lineman, every single time a block is made.

This opens up the possibility that a player may be receiving a sub-concussive impact at least 30 times a game without any chance in between for the brain to recover.  Such a scenario is simply never repeated in rugby union.  The closest analogy is perhaps in boxing, wherein a boxer can take many blows to the head that do not actually result in a knockout throughout the course of a bout.

It may well be that these repeated sub-concussive impacts are what eventually leads to boxers becoming “punch drunk” and not the spectacular knockout blows that pepper the highlight reels.  And that’s a real concern for American football because of the frequency of these type of head impacts near to the line of scrimmage.

The difficulty, of course, is how to minimise such impacts for the health of the players.  The NFL has already introduced rules to try and limit the number of concussive head injuries through the protection of “defenceless” players, as well as introducing compulsory head injury assessments in the same way as rugby.  However, how one minimises the repeated sub-concussive impacts that form part of the battle at the line of scrimmage is an open question.

It’s difficult to see what small changes can be made that retain the essential character of the game but reduce the likelihood of head-to-head contact.  Perhaps one simply accepts that, as with boxing, there is an element of risk in playing as violent a collision sport as American football.

Fortunately in my case there appears to be no lasting effects of the concussive head injuries I suffered as a younger man: I even have the EEG’s to prove it.  However, I await the outcome of the ongoing research into CTE in sportsmen with more than a little personal interest, and the continued scientific investigations into the causes and effects of CTE can only be encouraged.

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