Concussions and Protecting Our Players

[The Ghost of Raelene]

Great points and yes it always gets put down to something like Rugby being the last instance and the trend.

I know it’s a bit different and touchy subject but look at Covid deaths. Covid technically did kill you but most of the people who unfortunately passed had a multitude of co morbidities like type 2 diabetes and others. These are just as responsible as the Covid but don’t get the attention.

 

[waiopehu oldboy]

"Mouthguards that flash red to signal a player needs checking for a head injury will be used by the Black Ferns and all other teams at the women’s Rugby World Cup before being introduced to all top-flight rugby."

'Red alert' — mouthguards to flash warning at Rugby World Cup

Black Ferns and all other teams at this year's Rugby World Cup will wear mouthguards that flash red after being hit by a significant impact.

www.1news.co.nz

 

[PhilClinton]

I love in the article how it says they've had players who are against it because they've got bluetooth in the them.

But I am sure those same players all wear wireless earbuds!

 

[Strewthcobber]

These mouthguards are going to be amazing for the data they'll be able to collect over a game/season/career

I wonder what the data around these mouthguards show for the repetitive sub-concussive impacts that cause CTE - ie how many times over a season are players having a head acceleration event, even while not getting concussed.

Edit - to answer my own question - https://link.springer.com/article/10.1007/s40279-023-01953-7

HAE incidence above 10 g was 22.7 and 13.2 per hour in men’s forwards and backs and 11.8 and 7.2 per hour in women’s forwards and backs, respectively.

Say 15 x 80 min games a season (?), that will be 400+ events per player per season. Question is, is 400 events at 10g (min) that bad?

 

[Wilson]

These mouthguards are going to be amazing for the data they'll be able to collect over a game/season/career

I wonder what the data around these mouthguards show for the repetitive sub-concussive impacts that cause CTE - ie how many times over a season are players having a head acceleration event, even while not getting concussed.

Edit - to answer my own question - https://link.springer.com/article/10.1007/s40279-023-01953-7


Say 15 x 80 min games a season (?), that will be 400+ events per player per season. Question is, is 400 events at 10g (min) that bad?

It's a big step forward, but unless they're wearing them in training and adding that to the picture it's a big gap in the data, particularly when it comes to those repeated sub-concussive impacts.

 

[Strewthcobber]

It's a big step forward, but unless they're wearing them in training and adding that to the picture it's a big gap in the data, particularly when it comes to those repeated sub-concussive impacts.

I had a bit of a read of some of the latest mouth guard studies on Google scholar, nd while training load is not nothing, by far the higher number of impacts, and magnitudes are during matches. 4x as many

 

[Wilson]

I had a bit of a read of some of the latest mouth guard studies and while training load is not nothing, by far the higher number of impacts, and magnitudes are during matches. 4x as many

Is that an average training session compared to a game, a weeks worth of training compared to a game, or based on the whole of season totals?

My biggest worry with the training load is that the events follow on closely from a game/other incidents in training that week and really limit the opportunity for rest and recovery, at least when there hasn't been a big enough incident to trigger an HIA initially. Hard to know if that's not being tracked.

 

[Strewthcobber]

Is that an average training session compared to a game, a weeks worth of training compared to a game, or based on the whole of season totals?

My biggest worry with the training load is that the events follow on closely from a game/other incidents in training that week and really limit the opportunity for rest and recovery, at least when there hasn't been a big enough incident to trigger an HIA initially. Hard to know if that's not being tracked.

All good questions. The study I read suggested this was comparing a season of training and matches, but probably much more research needed.

head acceleration events rugby union training - Google Scholar https://share.google/yXi7i5lPyeN1uIF6y

The average HAE incidence (~ 13–20% of weekly HAEs) and magnitude during an in-season training week is very low compared with matches. Opportunities to materially reduce HAE exposure in training are likely more limited than previously assumed

 

[LeCheese]

Looking forward to all of the inevitable "they shouldn't have even been on the field!" commentary any time a player does something good/bad and is caught on camera engaging in oral red light therapy

 

[Strewthcobber]

I hope they aren't putting too much faith in these mouth guards.

From World Rugby research (April 2024)

* Smart mouth guards are set at a trigger level that happens once per match on average (75g for men, 65g for women)

* 40 players had HIA1 wearing a mouthguard. 21 removed (9 triggered, 12 no trigger). 19 return to play (11 triggered, 8 no trigger)

* 21 failed HIA1, 2 or 3. (8 triggered, 13 no trigger)

 

[waiopehu oldboy]

I'd expect the tech to rapidly improve as uptake (& therefore revenue) increase. Will probably never be 100% but even 80-90% will save a lot of brains from irreparable damage.

 

[Strewthcobber]

Thats the hope.

The danger is these mouth guards replace the other checks and don't supplement. I think we are already seeing this, with players only taken off if the mouthguard triggers.

So concussed players are left on the field (the worst outcome)

By WR (World Rugby)'s own data, only 38% of concussed players triggered at current thresholds.

 

[liquor box]

Excuse my ignorance, but would the trigger point be the same for men and women, or even different genetic backgrounds?

Are some heads better designed to take a blow compared to others so the settings will be adjusted accordingly?

Do those with previous symptoms get a mouthguard that has a lower trigger point to ensure their safety?

 

[Strewthcobber]

Excuse my ignorance, but would the trigger point be the same for men and women, or even different genetic backgrounds?

Are some heads better designed to take a blow compared to others so the settings will be adjusted accordingly?

Do those with previous symptoms get a mouthguard that has a lower trigger point to ensure their safety?

Men = 75g, women = 65g.

It's literally set at a threshold that will trigger about once per game at pro level. It's not based on concussion risk

 

[Strewthcobber]

Interesting study comparing an estimate of mouth guard head acceleration events with diagnosed CTE from brain donors - mostly American footballers. Lots of caveats.

Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy in males - Nature Communications

The relationship between the components of repetitive head impacts and chronic traumatic encephalopathy (CTE) remains unclear. Here, the authors use American football helmet sensor data to show that duration of play, cumulative head impacts and linear and rotational accelerations are...

www.nature.com

No link between number of diagnosed concussions and CTE (although lots of other issues!)

In this research, a hit was generally recorded at 10g.

for those with low-stage CTE 5,553 hits (SD = 3,410), 107,650 total g-force (SD = 41,755) and 8.32 × 106 total rad/s2 (SD = 3.72 × 106) respectively; and for those with high-stage CTE was 7,641 hits (SD = 3,870), 148,777 total g-force (SD = 52,557) and 12.26 × 106 (SD = 5.0 × 106) respectively.

Pro rugby players are taking something like 500 "hits" per season with forwards having the same or even worse acceleration events when compared with the American footballers in this study

Here's another study comparing rugby union to American football which seems to back this up

Preliminary findings indicate that rugby union forwards experience a higher incidence of HAEs per player match over lower and higher magnitude thresholds, than American football defensive players. Overall, elite-level rugby union appears less favourable than American football in in almost all metrics pertinent to concussion and HAE exposure in the biomechanical comparison undertaken.

hae rugby American football - Google Scholar https://share.google/lmrfbeKAzMN4pB4Cc

 

[Adam84]

Interesting study comparing an estimate of mouth guard head acceleration events with diagnosed CTE from brain donors - mostly American footballers. Lots of caveats.

Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy in males - Nature Communications

The relationship between the components of repetitive head impacts and chronic traumatic encephalopathy (CTE) remains unclear. Here, the authors use American football helmet sensor data to show that duration of play, cumulative head impacts and linear and rotational accelerations are...

www.nature.com

No link between number of diagnosed concussions and CTE (although lots of other issues!)

In this research, a hit was generally recorded at 10g.


Pro rugby players are taking something like 500 "hits" per season with forwards having the same or even worse acceleration events when compared with the American footballers in this study

Here's another study comparing rugby union to American football which seems to back this up


hae rugby American football - Google Scholar https://share.google/lmrfbeKAzMN4pB4Cc

There's a nuance worth noting in this claim.

The report does suggest that self or informant-reported concussions were not associated with the presence or severity of CTE, but the intensity and cumulative force of head impacts were significantly associated with CTE.

Broadly, what the report does support is that repeated head impacts, even without diagnosed concussions, are linked to CTE, whilst single or occasional concussions alone aren't strong evidence to cause CTE.

 

[Strewthcobber]

There's a nuance worth noting in this claim.

The report does suggest that self or informant-reported concussions were not associated with the presence or severity of CTE, but the intensity and cumulative force of head impacts were significantly associated with CTE.

Broadly, what the report does support is that repeated head impacts, even without diagnosed concussions, are linked to CTE, whilst single or occasional concussions alone aren't strong evidence to cause CTE.

Yep. Still very early days in the research that the mouthguards will allow. I reckon we are getting there with the obvious concussion


But.....if the research continues to hold up, the cumulative non-concussive loads will be very interesting to keep an eye on.

Unless there's massive changes in the way rugby is played (ie no ball carries, or rucks?!?), then this is the issue that becomes the big problem I think.

Limiting the number of games over a season, and career becomes the only option.

 

[Dctarget]

Can someone explain the implications for amateur players?

 

[PhilClinton]

Can someone explain the implications for amateur players?

In terms of process change and game management - at the moment it would be nil I think - the same way the amateur game can't have the same level of concussion review protocols due to lack of video review etc.

But in terms of perceived risk, the more reports which are published that provide even a tenuous link to repeated head impacts being linked to CTE regardless of diagnosed concussion, the higher likelihood that parents won't be signing their kids up to contact sports.

 

[Dctarget]

But in terms of perceived risk, the more reports which are published that provide even a tenuous link to repeated head impacts being linked to CTE regardless of diagnosed concussion, the higher likelihood that parents won't be signing their kids up to contact sports.

And is the evidence there that amateurs are at risk too? Or does it only affect pros?