60% that's the percentage of elite rugby league players that are concerned around the long term implications of concussion.
Sports have so much to offer, but they also have risks. All sports do. So in a society that's becoming more risk averse, how do we balance the risk of sports against the benefits that they offer?
My name is Ben Jones, I'm a professor in the Carnegie School of Sports at Leeds Beckett University. I'm also the Sports Science and Medicine Research Lead for Premiership Rugby and also the Head of Performance Science and Research at the Rugby Football League.
I've been undertaking research for the last decade in how we can reduce the risks of sport whilst optimising performance. I've published almost 300 publications, most of which are in rugby, a sport, like many people in the audience I'm fond of and a fan of.
So today, over the next 10 minutes, I'm going to tell you about three things. Firstly, what is concussion and what are the risks? Second, what do we know about head impacts? And three, how our research is being used to reduce the risk of concussion and head injuries in sport.
I want you to leave today knowing what the risks are of sports which offers so much to so many people. So I'm going to start with, what is a concussion?
So firstly, I'm not a clinician, therefore I can't diagnose nor treat a concussion. But what I can do is tell you about what we know about concussions through the scientific literature, the evidence base, which informs everything that we know.
Now, the definition of a concussion was developed through a recent meeting in Amsterdam, which was the concussion in sport consensus group. And you can see the definition behind me.
So the definition is a sport related concussion is a traumatic brain injury caused by a direct blow to the head, neck or body. And the definition goes on. You'll see it's not very straightforward, but actually we're talking about a brain injury and brains are complex.
Therefore it's clear that the definition of a brain injury is also relatively complex. But if I cut to the heart of what a sport related concussion is, it's a traumatic brain injury. Therefore it should be reduced where possible.
So the next question that you may ask is how often do concussions occur? If I use some of our research that we've been undertaking in rugby league, in the Men's Super League, which is the highest level of rugby league in England we've seen since 2016, on average 1 concussion every two games.
OK, now that's 15 concussions per 1000 playing hours. And we always report things for 1000 playing hours.
So we standardise the amount of duration of time that we're counting things and that rate of concussion is similar to men's rugby union and slightly higher than the women's rugby league and rugby union.
If we take a step back before 2016, what were the rates of concussion?
In the same cohort of rugby league players, the rates of concussion in 2015 were eight per 1000 hours, and in 2014 they were 4 and in 2013 they were two. So you can see since 2013 we've seen this incremental rate and doubling of concussion rates from 2:00 to 4:00 to 8 to 16, and now this plateau in in concussion.
And you may ask why? Well, the simple answer is we know more today than we knew yesterday, and we certainly know more today than we knew 20 years ago. And the research has focused on making sure that we can accurately identify and recognise and diagnose concussions to protect players and make sure that they can recover.
But we've got this plateau and we should be trying to reduce concussion where possible. So the next thing that we need to know is what do players think about concussion.
So I started the talk by saying that 60% of elite players were concerned around the long term implications and that's 40% of community players are also concerned around the long term implication of concussion and 50% of parents of community players are also concerned.
We have our rates of concussion and we have our playing population that are broadly concerned around concussion. But what if I then said that 20% of elite players told us that they didn't report concussions and that 40% of community players also told us that they hid concussive symptoms from medical staff?
Well, why is that? If they're concerned around the long term implications, surely they would want to be treated and diagnosed by medical staff? Well, maybe that's this gets to everyone's different perception of risk.
So at this point, we'll think about swimming with sharks. OK, Would you swim with a shark? The answer may be based on the enjoyment of swimming with a shark versus the potential risk and your appetite for risk.
So if I said there was one shark bite or shark attack every two swims, would you? What about one in four or one in 68 or one in 600 or one in 2000?
So you can see as the, the number of swims increases, the risk seems to be reducing and, and maybe anyone who was sat on the fence may now think it's actually a good thing or would be enjoyable to them with Sharks.
Well, those numbers that I that I shared then they're precise with how you can present concussions in rugby. So there's one concussion every two games. That's what you see on TV.
There's two team play is playing, so there's one concussion every four games for the team involved, and there's multiple players, so there's one concussion every 68 player matches on average.
And a match is more than just a match. There's the tackle events. So there's one concussion every 600 tackle events that occur. And there's multiple people and different players involving the tackle events. There's one concussion every 2000 tackle events from a player's level.
So you can kind of see now every individual may have a different perception of the risk to them. We still know that a concussion is a traumatic brain injury and we still know that on average there's one concussion every two games.
So we should try and reduce concussion where possible. And I'm going to talk about something else now in addition to concussion, and that's head impacts or head acceleration events as they're so eloquently named.
Now a head acceleration event is every time the head moves. And the reason this is important is recent research has shown that the more head impacts or head acceleration event an athlete is exposed to over their career, the greater their potential risk of negative long term brain health outcomes can be in the future.
So effectively we should try and reduce head acceleration events and head impacts where possible. But this does propose a challenge. How do you measure and how do you count head acceleration events or head impacts? They're effectively unseen data.
Well, until now. So there's a new technology which allows us to do this, and this is an instrumented mouth guard, and it's a gum shield with embedded sensors in.
And what this allows us to do, because the gum shield is fixed to the teeth, the teeth are fixed to the skull and, and obviously every time the school moves, we can then model what happens with the brain.
We can now precisely measure every time there's a head impact or a head acceleration event in sports. Now, some of our recent work has been validating instrument in mouth guards. So we've been working with various sporting organisations and instrument in mouth guard companies to make sure that the data that they provide are valid and accurate.
And this has then led to sports adopting these validated instrumented mouth guards. For example, World Rugby now mandate all elite players to wear instrumented mouth guards during training and matches.
The Rugby Football League also mandate elite players to wear instrumented mouth guards during matches. So the unseen data can now be seen.
So what do we see and what have we started to see in this data? We start to see that join a rugby union, men's rugby union match, take the Premiership that we see during a tackle or a carry.
50% will result in a head acceleration event above 10G and 10G is relatively low. You could get a 10G head acceleration event during normal daily activity and then if you go a little bit higher to 25, G20, 5G is a threshold which is more unique to contact sport athletes.
We see that on average about 15% of the time during tackles and carries, but that does mean that 85% of tackles and carries don't result in these. But you can start to see how we can become far more precise with our prevention strategies.
And what we also see is we see lower rates of head acceleration events and low magnitudes in in the women's rugby and also in youth and younger age groups.
So maybe the risk of being bitten by a shark is different based on different levels, but we do need to be careful because the precise clinical consequences of head acceleration events to different groups is unknown.
And that's something that we're all trying to understand more going forwards. So now we have our head acceleration event rates, we have our concussion rates and we know broadly what the place perceptions are.
This allows us to move to prevention, which is really important. During our work in prevention we've identified areas which are the highest risk and one of those is a tackle event.
So the tackle event is the highest risk of a concussion and a head acceleration event in both rugby league and rugby union.
Now the tackle, the tackle is like porridge, OK, hot porridge is bad, it burns and cold porridge isn't nice. And these porridge of a temperature that's in the middle of a Goldilocks zone porridge OK. And this is just like a tackle, OK.
Tackles that are too high are dangerous. And then the tackles that are in the sweet spot in the middle of the body are actually lower risk for both the ball carrier and the tackler.
And we've shown this during some of our work with rugby league where we started to where we started to evaluate different law trials, we reduced the legal height of the tackle and we saw that it reduced head acceleration events and it reduced the risk of concussion.
And this led to the Rugby Football League reducing the legal height of the tackle in rugby league in the UK or all community and age grade levels. So we now have a safer tackle for athletes and rugby union have also reduced their tackle height in the community game so we can start to see how contact sports are reducing the risk.
We also reduced the rates of head on head collisions in Women's Super League by 50%. We identified 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. So we worked with coaches and players to look at different tackle techniques and over a season we reduced these by 50%.
More recently we've seen the rates of concussion in Women's Super League reduced to five concussions per thousand hours, where historically they were 12. So again, we can see how players and coaches are changing behaviour to reduce the risk of concussion.
At the start of the 2024 season, the Rugby Football League made 44 changes to the game based on our research. Some of those around tackle height, some of those around mandate and instruments in mouth guards. But they also included specific limits for players based on their position or their age, evaluating and developing new tackle techniques, different age, different levels in which age groups start contact.
So again, we can see how sports are evolving based on the evolving scientific literature. Now we've made a lot of progress, but we shouldn't get ahead of ourselves because actually head injuries and concussion in sport presenters with a wicked problem and actually wicked problems are hard to solve.
They're often characterised by incomplete data. They're hard to define. Different stakeholders see them differently. And this is what we see in in head injuries and concussion.
One of the challenges in the in the study where we saw a 50% reduction in head on head rates, the better performing teams actually had more head on head collisions.
So potentially there was a performance and a welfare trade off and that's why we've been looking at head injuries in sport through both a performance and a welfare lens because we've got to make sure that we do balance both the safety and the spectacle and the reason why people got involved in sport in the 1st place, especially collision sports.
OK, so let's take a step back and see how far we've come. Over the last decade, there's been an immense amount of research, and that's evolved our knowledge around what concussions are, what the risk factors for concussions are. And we've seen sports adopt new rules, implement new equipment, and change their policies based on this research.
Every day you will make a decision about the risk versus reward of something and sports are no different and this is what we continue need to do.
So the question is how should we tackle concussion in sport? Well, we need to continue to use the latest technology, the best scientific evidence that we have and the inherent knowledge that lives within sport to work together to tackle concussion head on.
Thank you.
