Contact sports and public health.

Hugh McCloskey

Imagine our society lauding people of all ages for activities that were potentially harming their long-term mental and physical health. But how? our society has come on leaps and bounds in health promotion, education surrounding alcohol consumption, numerous initiatives to help people stop smoking. All these things clearly demonstrate our conscious commitment to public health as a nation.

But what if I told you we as a society were actively promoting activities in our young people that could lead to conditions with symptoms similar to those caused by the long-term abuse of tobacco and alcohol in their later lives. And that we were promoting these activities as beneficial.

The activities I am talking about are of course contact sports, anything that involves players sustaining direct impacts to their head, examples include; rugby, boxing, MMA, kickboxing etc. There is a growing body of evidence to suggest that impacts to the head sustained by sports players can lead to chronic traumatic encephalopathy or CTE.

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CTE has also been identified as a potential environmental factor in many neurodegenerative diseases such as Motor Neuron disease or ALS, Alzheimer’s and Dementia. Although there has been a recent stir in the sporting community around concussion with the programs such as the IRFUS “recognize and remove” campaign (1) being implemented in rugby, this focuses on large traumatic impacts that illicit a loss of consciousness or disorientation.

Perhaps the insidious thing about CTE and resulting neurodegenerative diseases is that they don’t require multiple large concussions resulting in loss of consciousness to occur before they are incurred (but that would certainly help them on their way). In fact, they can be brought on by multiple sub-concussive blows sustained over time causing what is known as mild traumatic brain injury or MTBI.

There is, however, no doubt that extended careers in extreme pugilistic sport bring about neurodegenerative diseases with 97% of NFL players studied post-mortem having evidence of neurodegeneration! (2) . Anecdotally This month a New England Patriots star committed suicide in jail after a conviction for murder (3) When his brain was examined it was found to have one of the most advanced stages of chronic traumatic encephalopathy possible (4). Negative changes to personality and tendency towards paranoia and violence are well-documented symptoms of CTE (5) The fact is we still have no exact values to quantify just how many impacts of what magnitude a person can sustain during a sporting career before they increase their risk of neurodegenerative disease.

Image credit: Wikimedia commons

This begs the question; Could a casual career in weekend or school rugby lead to increased risk of depression, paranoia, violent behavior suicidality in the short term and neurodegeneration in later life?

We live in a society where sporting culture is becoming ever more performance orientated. Athletes are becoming larger, faster, and stronger at younger ages meaning the forces they generate and impart during training are greater than ever before. They are also training and competing more regularly which again implies more net impacts. However, society seems to see no problem with this because what little is entering the collective consciousness about brain injury in sport through that medium of movies like “concussion” tell us that these injuries only happen to professional NFL athletes in other countries. But what if it’s happening to our young men and women competing in boxing, rugby, American football etc right here? The problem is that we don’t know.

I am not advocating a blanket ban on these selected sports, I myself gained a tremendous amount of discipline and self-respect from training and competition in MMA and rugby. However, I believe these sports should at least implement a system of education around the risks faced by players until further investigation can influence their practice and prevent these things happening. Unfortunately, there is no way to avoid impacts to the head in certain sports and in these cases athletes should be educated about the long-term risk of brain injury they may well be exposing themselves to.

Finally, to return briefly to our attitudes on public health as a nation permit me to use some shocking but I believe justified imagery to highlight a paradox. What if there were a competitive children’s smoking league where despite the risk of cancer, heart disease and stroke we allowed children to go head to head in a ring smoking as many cigarettes as possible whilst we cheered from the side-lines?

Sounds ridiculous, right? And yet we allow children as young as 10 to begin careers in boxing and rugby. With evidence that sporting trauma in childhood can bring on neurodegeneration (6) we can only ignore these issues for so long.

1. http://www.irishrugby.ie/downloads/IRFU-Guide- to-Concussion%282%29.pdf 2. Gardner, R.C. and Yaffe, K., 2015. Epidemiology of mild traumatic brain injury and neurodegenerative disease. Molecular and Cellular Neuroscience, 66, pp.75-80. 3. https://www.washingtonpost.com/news/early-lead/wp/2017/04/19/aaron- hernandez- found-dead- in-prison- cell/ 4. http://www.freep.com/story/sports/nfl/patriots/2017/09/21/aaron-hernandez- cte-suicide- murder-new- england-patriots/690651001/ 5. http://www.alz.org/dementia/chronic-traumatic- encephalopathy-cte- symptoms.asp 6. Keightley, M.L., Sinopoli, K.J., Davis, K.D., Mikulis, D.J., Wennberg, R., Tartaglia, M.C., Chen, J.K. and Tator, C.H., 2014. Is there evidence for neurodegenerative change following traumatic brain injury in children and youth? A scoping review. Frontiers in human neuroscience.

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