How can we reduce head injuries in sport?

Given we do see some association between sport and brain injuries, and with head knocks a common feature of many sports like football and rugby, attention has turned to how we can make them safer. Adel Helmy is an Associate Professor of Neurosurgery at the University of Cambridge…

Adam - So there's lots of important research going on about the burden of concussion in sports and thinking about how that might be reduced in a practical way. The issue with changing the rules or dynamics of sport is getting the balance right. We don't want to take away the competitive element or the essence of the sporting endeavour in itself. But at the same time, having recognised that there may be these risks in the very long term, we want to appropriately risk mitigate. And that's different for different sports. Probably the best example that people will have come across is the change in tackle height rules in rugby. We had a talk about that within the public session. And one of the things that came out within that talk is the enormous resistance in the first instance to a new approach such as this, but the fact that in the longer term it actually gains great traction because people have recognised that although it is a change to the way that the game is conducted, it may in the longer term accrue substantial benefit. Another example would be the change in heading rules, particularly for grassroots football. This was first taken up by the Scottish FA, but also the English Football Association from this year has introduced those new heading rules. And those will be filtered through at the different age groups, such that in three years time, no primary school children will be heading the ball. It does require a change to the sport. It does require engagement of parents, coaches and so on. But I think in the longer term, until we better understand the risks that are associated with these endeavours, it does make sense, particularly at grassroots, particularly for young people, that we try and minimise the risk of concussion in the longer term.

James - We heard about Jeff Astle's story earlier in the programme. I'm thinking of a BBC documentary where Alan Shearer, another prominent footballer, underwent an MRI scan to have a look at his brain. He must have headed the ball as much as anyone in his professional career. And the MRI scan showed a very healthy brain. We don't really know enough yet about who is affected, and that's why people show this initial aversion to the rules being changed, maybe?

Adam - I think in different contexts, there are different reasons. It's not a simple problem. And you're absolutely right: the absolute risk is not that large. There's definitely an increased risk, but many people may not be affected by these conditions. And the other risk factors, whether they be genetic or some other aspect, are critical. And because we don't understand these and we have to be upfront about that, it's very difficult for us to counsel people in a reliable or confident way.

James - We've been talking a lot about dangers associated with participating in contact sports, but the huge raft of health benefits that have been proven again and again in study after study associated with doing sport and levels of physical activity shouldn't go amiss in our conversation.

Adam - Clearly, as scientists and doctors working in this field, we're very interested in the pathophysiology, how repeated concussions may injure the brain and lead to this increased risk in the very long term of conditions such as dementia. But it's really important that this is put in context. So we recognise that sport is an important part of British national life, and that there are huge benefits that accrue from that to individuals in terms of team building, learning discipline, teaching our children how to win and lose in the right way. We shouldn't dismiss all of those things. And the difficulty that we have, particularly when we're talking to members of the public, is to balance those risks. What we don't know yet is how big a risk is it to an individual? And clearly a lot of the evidence has come from professional sports for very good reasons. Those are the people with the highest exposure to these things like concussions. But it's really important to recognise that for grassroots or amateur sport, both the dose (the number of concussions that you might be suffering) and also the magnitude (how bad those concussions are) are likely to be much reduced. And really we need to look at this in much greater detail before we can give you an idea of the relative balance of risks.

James - To bridge this gap between the crucial research that people like you are doing and the public understanding, what can we do? I'm referring, really, to the event not so long ago here in Cambridge.

Adam - We are very lucky to host one of the largest neurotrauma meetings that runs. It's something called the International Neurotrauma Symposium. It brings together both head and spine trauma, and it also brings together both basic scientists, those people who work within universities, perhaps in model systems looking at head injury, but also the doctors like ourselves who treat head injury in an active way. The conference covers absolutely every aspect of neurotrauma. That can be inflicted violence, it can be military trauma, it can be modelling biomechanics, it can be looking at blood biomarkers, it can be looking at scans and imaging, it can be looking at new trials. But we're very acutely aware that this research is not just for us, it's not an ivory tower within the university system. It's really important that this has direct applicability to people's lives. And given the recent advances and the public perception and the media coverage of sports concussion and dementia risk in particular, we chose a number of speakers from a range of sports: football, Rugby Union, Formula One and also the Paralympic movement. this is essential both to engage with the public and learn what the priorities are for them to allow us to draw in funding and engagement from different charities, but also to shape the sort of research that we do.