Athletes fear concussions—why don’t they report them? | Ben Jones | TEDxLeeds Beckett University

Key Concepts:

• Concussion: A traumatic brain injury caused by a blow to the head, neck, or body.
• Head Acceleration Event (HAE): Any instance of head movement, measured in 'g' force.
• Instrumented Mouthguard: A gumshield with embedded sensors to measure head impacts and acceleration.
• Tackle Height: The vertical location on the opposing player where a player makes contact during a tackle.
• Risk Perception: An individual's subjective assessment of the likelihood and severity of potential harm from concussion.
• Wicked Problem: A complex issue with incomplete data, varying stakeholder perspectives, and difficult solutions.
• Performance vs. Welfare Tradeoff: The potential conflict between optimizing athletic performance and ensuring player safety.

1. What is Concussion and What are the Risks?

• Definition: A sport-related concussion is defined as a traumatic brain injury caused by a direct blow to the head, neck, or body. It's a complex brain injury that should be reduced where possible.
• Incidence Rates: In men's Super League rugby league (England), concussion rates have increased significantly since 2013.
  • 2013: 2 concussions per 1,000 playing hours
  • 2014: 4 concussions per 1,000 playing hours
  • 2015: 8 concussions per 1,000 playing hours
  • 2016 onwards: Plateau at approximately 16 concussions per 1,000 playing hours (1 concussion every two games).
  • These rates are similar to men's Rugby Union and slightly higher than women's rugby league and Rugby Union.
• Player Perception:
  • 60% of elite rugby league players are concerned about the long-term implications of concussion.
  • 40% of community players share this concern.
  • 50% of parents of community players are also concerned.
  • However, 20% of elite players and 40% of community players admit to not reporting concussions or hiding symptoms.
• Risk Perception Analogy: The speaker uses the analogy of swimming with sharks to illustrate how different people perceive risk. The perceived risk changes based on the frequency of shark attacks (e.g., one attack every two swims vs. one attack every 2,000 swims).
• Concussion Presentation:
  • One concussion every two games (on TV).
  • One concussion every four games for the team involved.
  • One concussion every 68 player matches.
  • One concussion every 600 tackle events.
  • One concussion every 2,000 tackle events from a player's level.
• Key Argument: Despite varying perceptions of risk, concussion is a traumatic brain injury that should be reduced where possible.

2. What Do We Know About Head Impacts?

• Head Acceleration Events (HAEs): Recent research indicates that the more HAEs an athlete experiences, the greater the potential risk of negative long-term brain health outcomes.
• Measuring HAEs: Instrumented mouthguards are used to precisely measure head impacts and acceleration events. These mouthguards have embedded sensors that track head movement. World Rugby mandates the use of instrumented mouthguards for all elite players during training and matches. The Rugby Football League also mandates elite players to wear instrumenting mouth guards during matches.
• Data from Instrumented Mouthguards:
  • In men's Rugby Union (Premiership), 50% of tackles or carries result in a HAE above 10g (relatively low).
  • 15% of tackles and carries result in a HAE above 25g (more unique to contact sports).
  • Lower rates and magnitudes of HAEs are observed in women's rugby and younger age groups.
• Caution: The precise clinical consequences of HAEs for different groups are still unknown.

3. How Our Research is Being Used to Reduce the Risk of Concussion and Head Injuries in Sports

• Tackle Event Analysis: The tackle event is identified as the highest risk for concussion and HAEs in both rugby league and Rugby Union.
• Tackle Height and Risk: Tackles that are too high are dangerous, while tackles in the middle of the body (the "Goldilocks Zone") are lower risk for both the ball carrier and the tackler.
• Law Changes:
  • Rugby league reduced the legal height of the tackle, leading to a reduction in HAEs and concussion risk. This led to the Rugby Football League reducing the legal height of the tackle in rugby league at all community and age grade levels.
  • Rugby Union has also reduced tackle height in the community game.
• Head-on-Head Collisions: Rates of head-on-head collisions in women's Super League were reduced by 50% by identifying that the biggest risk of a concussion was when a ball carrier running into a tackle and a tackler were both upright and an accidental head Collision occurred. Coaches and players worked on different tackle techniques to achieve this reduction.
• Concussion Rate Reduction: The rates of concussion in women's Super League reduced to five concussions per thousand hours where historically they were 12.
• RFL Rule Changes: At the start of the 2024 season, the Rugby Football League made 44 changes to the game based on research, including tackle height adjustments, mandated instrumented mouthguards, specific limits for players based on position and age, and evaluation of new tackle techniques.
• Wicked Problem: Head injuries and concussion in sport are characterized as a "wicked problem" due to incomplete data, varying stakeholder perspectives, and the difficulty in defining and solving the issue.
• Performance vs. Welfare: The speaker highlights the potential tradeoff between performance and welfare, noting that better-performing teams sometimes had more head-on-head collisions.
• Progress and Future Directions: Over the last decade, research has significantly improved our understanding of concussions and risk factors. Sports have adopted new rules, equipment, and policies based on this research. The key is to continue using the latest technology, scientific evidence, and inherent knowledge within sport to tackle concussion.

5. Notable Quotes:

• "60% [of elite rugby league players are] concerned around the long-term implications of concussion."
• "A sport related concussion is a traumatic brain injury caused by a direct Blow To The Head Neck or body" - Concussion in Sport Consensus Group definition of concussion.
• "We know more today than we knew yesterday and we certainly know more today than we knew 20 years ago."
• "Head injuries and concussion in sport present us with a wicked problem."

Synthesis/Conclusion:

The speaker emphasizes the importance of understanding and mitigating the risks of concussion in sports, particularly rugby. While concussion rates have plateaued, ongoing research using technologies like instrumented mouthguards is providing valuable data on head impacts and acceleration events. This data is informing rule changes, tackle technique modifications, and other interventions aimed at reducing the risk of head injuries. The speaker acknowledges the complexity of the issue, framing it as a "wicked problem" with potential tradeoffs between performance and welfare. The key takeaway is the need for continued collaboration between researchers, sports organizations, and athletes to tackle concussion using the best available evidence and technology.