DOCTOR JAMES ROBSON has welcomed the publication of a medical article which indicates that former international rugby players face a significantly increased risk of neurodegenerative diseases compared to the general population – but Scottish Rugby’s Chief Medical Officer has warned that the small sample size and scope of the study means that the alarming headline figures need further investigation.
The study, which was led by the University of Glasgow and published on Tuesday night, compared health outcomes among 412 male former Scottish international players against 1,236 matched individuals from the general population.
The research showed that the increased risk for the former international rugby players ranged from around a doubling of risk of a dementia diagnosis to an over 10-fold increased risk for motor neurone disease diagnosis.
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“On the face of it, it is concerning,” acknowledged Robson. “But that concern has to be taken with the view that it is a relatively small study of a small population. So, there are various things that may lead into that and what we need is outside expertise to come in and take that information about increased risk and tell us what the next questions are.”
Robson also welcomed the news that MND Scotland plan to convene an expert group, in light of the study’s results, to provide advice to Scottish Rugby on how screening could be developed and built into health checks for current and former players.
“The offer of being able to speak to some of these eminent people which will inform what we do as a union and as a sport is really welcome,” he said. “I will work with anybody, and it would be particularly good if we could get an international expert panel because this may not just be pertinent to Scotland.
“We need to find out if this is a cluster of some sort, a statistical anomaly, but you’ve to take it on face value because that way everybody treats it with the utmost seriousness.
“We know that the cause of motor neurone disease is multifactorial. It is a complex mixture of environmental factors, but the study wasn’t set up to actually show cause and effect. It is largely a study to show health outcomes, and what they are doing is interrogating health records and death certificates of ex-players, so at some point somebody must have had the diagnosis, or been prescribed a drug, or attended a clinic, which has led to a label. But it does require more urgent research into that.
“There are so many unknowns and that’s part of the reason why nobody knows what the cause is and hence nobody has managed, apart from in a very small number, to devise drugs to help treat this hideous condition,” he added.
“What it does is stimulate more discussion, and it gives us a chance to reach out to other people, or other people reach out to us in the research sphere. I have been overwhelmed by the number people who have offered help on the back of this, in terms of Motor Neurone Disease Scotland, Brain Health Scotland, all of these bodies are willing to help us make our game safer.”
Doctor Jane Haley, Director of Research at MND Scotland, shared Doctor Robson’s cautious approach to interpreting the findings of the report.
“While the initial results do seem concerning, the study is based on a small sample size which means that, because MND is a relatively uncommon condition, larger studies will be needed to determine whether this result can be confirmed more widely,” she said.
“A connection between elite level sports and MND has been proposed before, but this is the first time an increased risk has been indicated for rugby players.”
Meanwhile, Professor Willie Stewart, lead author of the paper, expressed his frustration at rugby’s slow response to the risks associated with brain injuries when he spoke to the press on Tuesday.
“Rugby has talked a lot about head injury management [but] I think those conversations have gone on a while and progress is pretty slow,” he said. “I think this should be a stimulus for them to pick up their heels and start making pretty dramatic changes as quickly as possible to try to reduce risk.
In response, Robson highlighted some of the work which has gone into researching this issue and reducing risk.
“We’ve been doing work for years. We don’t stand still. For example, we launched the brain health clinic in April, so that our men and women ex-internationals can have their brain health examined using the best knowledge we have at the moment, and a plan to mitigate risk going forward can be formulated,” he explained
“In March, World Rugby announced five massive pieces of research looking at injury rates, concussion rates and preventative strategies. That kind of press doesn’t get the traction that this kind of headline gets, and yet it is all integrated and it is all about what are we doing to make this game safer.
“We’ve had the evolution at elite level of pitch-side care, namely HIA [Head Injury Assessment], and we’ve all evolved pitch-side care courses that the general public can tap into.
“Over the years, training sessions have got much shorter. There was an immense piece of work out by World Rugby three and a bit years ago, before the last World Cup, about contact work and how to monitor it, and how to modify it.”
“We’re now at the stage of: how do we measure these things? And with that in mind we’ve got a great partnership with Hit IQ, the major manufacturer of mouthguard technology [which provides real-time and comprehensive head impact data] and we also use video analysis to delineate what we’re doing in the training week.
“But remember, in order to put people safely on the park on a Saturday there is a certain amount of conditioning you need to do,” he added. “Largely, that can be done in pre-season, and once you get into the season you can adjust the amount of contact you are doing in the training week.
“So, we’re always looking for angles to improve and some of it is technology and some of it just old fashioned and saying: ‘I think we’ve done enough’.
“Medicine is a mixture of science and art. For example, a player can pass the head injury assessment and the clinician can say: ‘I’m not putting you back on because I think that you have been concussed’.
“Sometimes that’s what happens in our camp. Sometimes I will sidle up to Gregor Townsend or [defence coach] Steve Tandy and say: ‘I think we’ve done enough today’.”
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Willie Stewart has been raising the alarm in contact sports for many years. He was the first to identify CTE in a Scottish player. All the research points to issues for players especially those at the elite end wether that’s increased dementia or MND risks.
I agree with other comments. The response is quite defensive. Hardly surprising given the legal battles the Unions and WR are facing.
Interesting that Scottish Rugby required all players to sign off on various protocols like anti doping, corruption and risk of playing a contact sport to be able to play this season. No sign no play.
Whoever thought up a breakdown that encourages the “ jackal”was clearly not considering player safety at all. The old fashioned ruck was a far more dynamic process for generating quick ball as opposed to the static collision breakdowns we have in todays game. How can we seriously say we take players safety seriously when the jackal still exists in our game – it is truly an awful position from so many perspectives , back of head and neck exposed , legs vulnerable to clumsy clearouts and a static target for every opposition player. Very difficult to go back to old processes but old fashioned rucking was a far safer method of play. Interesting thoughts around ball in play but reducing the team number to 13 would probably have the same impact on creating more space and in turn more dynamic , athletic runners but then we are to all intents and purposes playing rugby league. Probably a good example of why sevens is the purest form of the game. It is still physical but players speed , skill is paramount and lengthy delays for set pieces are much reduced with the ball in play time very high.
Reducing team numbers to 13 wouldn’t result in rugby league if the integrity of the set pieces are retained & is something I’ve advocated for years. Aside from player safety, the space on the pitch has been greatly reduced by increases in players size, speed & strength, we can’t increase pitch size but by reducing team numbers to 13 there would be an increase in space available.
again post not appearing
the responses to the study are defensive, perhaps understandably, but more unfortunately give an impression of almost denial.
The study actually says further study is appropriate. It is also very clear that head impacts correlate with permanent problems. It is of course virtually impossible to blame an individual case on anything, but the correlation is such (and not just rugby, soccer and NFL and boxing) then its pretty damned stupid to put head in sand cross fingers and hope its something else. While we wait for further research, more players are being unnecessarily damaged.
There are very simple things World Rugby can do, should do, immediately. Like asking refs to apply the current laws re attempting to stay on feet at rucks, hammering high tackles, suspending SH Unions until they issue proper red cards, banning the jackal (player exposes head/neck to a shoulder, legal or not)
All simple stuff.
the responses to the study are defensive, perhaps understandably, but more unfortunately give an impression of almost denial.
The study actually says further study is appropriate. It is also very clear that head impacts correlate with permanent problems. It is of course virtually impossible to blame an individual case on anything, but the correlation is such (and not just rugby, soccer and NFL and boxing) then its pretty damned stupid to put head in sand cross fingers and hope its something else. While we wait for further research, more players are being unnecessarily damaged.
There are very simple things World Rugby can do, should do, immediately. Like asking refs to apply the current laws re attempting to stay on feet at rucks, hammering high tackles, suspending SH Unions until they issue proper red cards, banning the jackal (player exposes head/neck to a shoulder, legal or not)
All simple stuff.
There are a few simple steps that can be taken by World Rugby to make the game safer and more attractive
* reduce number of players on the bench to 2/3
only used in case of injury
* create more ball in play time by stopping the clock
for scrums , line outs , penalties etc – RL for example has
50% more ball in play time than RU
The above two changes alone would lead to fewer
60 minute only heavy weights and more athletic ,
slimmer players running for space and not collision
Add to that no double tackling and tackles waist high
and below , then you have a good start to creating
a safer and more attractive game
Keep the changes simple 😀
Fully in agreement with GRob. All talk, reports, reviews & studies – but little action.
Overarching all subsidiary considerations in the field, the precautionary approach should take precedence at all times. Robson’s response, like that of Haley is quite clearly defensive and while (nit)picking away at matters of detail underlying the University of Glasgow study, completely overlooks the undeniable fact that there exists a major, increasing, problem from head injuries in contact sports, most notably in rugby.
It appears that the authorities from World Rugby through to national Unions have developed high levels of excellence in trotting out reassuring platitudes in the wake of increasing research projects and fresh studies highlighting risks and concerns.
Regrettably, few if any appear to have taken a prudent leaf out of Willie Stewart’s book – in particular to introduce real-life, tangible fully-precautionary measures to eliminate not just actual but potential causes of serious head injuries and associated trauma.
Head injuries occur at any level of rugby not just elite level so no real excuse for the small sample size in this trial, it should have been taken from all levels of rugby.
I strongly disagree about the suggestion that training sessions are getting shorter , not in the ones I am aware of ..
The demands made of youth rugby / Academy players are ridiculous with players training several times a week with both club and Academy running contact sessions without any consideration for each other. Not only does this increase the risk of significant injury , it is probably why so many players drop out out of adult rugby , most have had a full rugby career before they get to adult.
This study will undoubtedly and correctly create significant concern across rugby circles. The significant injuries in todays game are getting worse , not only head injuries but other serious limb injuries that will have long lasting effects long after a rugby career has ended. Synthetic pitches continue to be contentious with few paying interest into the frequency or severity of injuries occurring on these pitches which includes the awful scarring burns from the surface , more often than not exacerbated by poor maintenance of these pitches and a failure to water them before games.
The surfacea of the these pitches are acknowledged as far more physically punishing on the limbs and it is likely in the years to come that players having to play / train regularly on these surfaces will be left with a legacy of discomfort in later life.
Time for rugby to stop giving lip service to these issues and start removing some of the awful positions and collisions that players are subjected to these days otherwise the player number will continue to drop and who can blame them.