Picture: ISTOCK
Picture: ISTOCK

Former international rugby star Jamie Cudmore has sounded a warning about head injuries and sport, saying players were under such pressure from their coaches and fans to continue the game after a bad knock that they were putting their long-term health at risk.

There is growing evidence that repeated head injuries are associated with degenerative brain conditions later in life, which makes athletes who play contact sport such as rugby, soccer and boxing particularly vulnerable. However, there are still such limitations on scientists’ understanding of the mechanics of brain injuries that there are no objective tests to determine how badly athletes have been hurt.

Although sporting bodies around the world have guidelines in place to determine whether players who sustain head injuries during a match should play on, they are based on subjective assessments and are frequently ignored, Cudmore said on Thursday at the EuroScience Open Forum (Esof) 2018 in Toulouse.

Esof is Europe’s biggest interdisciplinary science meeting and runs every two years. It casts the spotlight on a wide range of topical issues spanning policy, social sciences and basic science.

"There is enormous pressure to win," said Cudmore, who has first-hand experience of the problem. He sustained a serious head injury in the high-profile 2015 European Cup semifinal, playing for Clermont, but finished the game. He was cleared by a doctor to play in the final two weeks later, but had two more head injuries during the match, suggesting he had not properly recovered, he said.

The effects on his health were severe. "During the months after that final game I slept virtually not at all; bright light and noise made me blow up [and] every time I closed my eyes I felt I had bees around my eyes. Those types of symptoms are not uncommon, but the guys are not talking about it," said Cudmore, who is now manager of the second division French team Provence Rugby.

He and his wife have founded a nonprofit foundation called Rugby Safety Network to raise awareness about the dangers of head injuries and tackle the stigma associated with it.

Concussion symptoms can include sleep disturbances (either sleeping too much or too little), mood changes, and sensory problems.

Part of the problem with managing head injuries in sport is the lack of objective tests, said Jamie Stewart, a neuropathologist at Queen Elizabeth University Hospital in Glasgow, who is an expert in concussion in sport.

"Concussion is an invisible brain injury. No blood tests or brain scans will identify it," said Stewart, who is a member of World Rugby’s independent concussion advisory group.

To make matters worse, it can take time for outward symptoms of brain injury to develop. Thus players who have had a blow to the head may show no apparent signs of trauma and are told to continue with their match, he said.

He said athletes and their coaches should err on the side of caution, and stop playing immediately after a head injury. "If in doubt, pull them out," said Stewart.

Stewart said the number of traumatic brain injuries in rugby matches was staggering: an audit of English rugby union matches found there were 21 concussions per 1,000 players. "That is the same as one concussion per match: a player has injured their brain in every professional rugby game. That is higher than boxing," he said.