Jeff Probyn: Now we must research the true risk of dementia

With all the excitement of the announcement of the new elite player squad some rather bad news almost slipped under the radar last week. Brain injuries expert Dr. Willie Stewart is claiming to have discovered a case of early onset dementia that was linked to an individual who played rugby.
Doctor Stewart worryingly said, “What the numbers are, what proportion of people who play rugby, how often you may have to get concussed, how long after you may develop problems, these are questions we can’t answer.”
This comes at a time when there have been a number of calls (not least from former medical advisor Dr Barry O’Driscoll) for the IRB to revisit the newly- introduced Pitch Side Suspected Concussion Assessment (PSCA).
The susceptibility to the early onset of dementia as a result of a number of sustained blows to the head is not new – but until now there were no officially recorded incidents involving rugby players.
Dr Stewart examined the brain tissue of a former rugby player, now in his 50s, and found that the ex-player had a higher level of ‘abnormal proteins’ associated with head injuries and dementia than many retired boxers suffering punch drunk syndrome (dementia pugillistica).
The implications of this research could be very damaging for the sport just at the time of the start of the RFU‘s World Cup legacy programmes including All Schools.
The question that has to be asked is, would improved concussion protocols help stop or reduce the potential risk of dementia across the game? Particularly as so far the conclusions of the study has been focused on or around Six Nations players with an estimate that every Six Nation’s weekend (three games) one or two players (around one per cent) could sustain sufficient damage to bring on early dementia in later life that otherwise would not occur.
The numbers Dr Stewart has suggested, if multiplied out across the sport, would potentially result in a substantial number of cases and many would have had little or no proper assessment at the time of injury and would therefore be unable to take the necessary precautions to protect themselves from further and possibly more damaging injury by playing again too early.
What makes the situation slightly worse is that many players and parents would believe that they can protect themselves or their children by buying ‘protective clothing’ including a scrum cap.
One thing that every player and parent should know is that because of regulations from the IRB none of the ‘protective’ clothing protects anyone and the only true protective equipment  is a dental mouth guard and shin pads.
Whether shoulder pads, chest protectors or scrumcaps,  all that are allowed to be worn by the IRB, must be of specific design and thickness dependant on materials used, so as not to be able to protect the wearer (beyond preventing abrasions) and offer ‘an advantage’ against any opponents who are not wearing it.
If, for instance, a scrumcap was actually able to absorb a concussion causing contact it could be used to cause a concussion in an opposition player – and the same is true of shoulder pads in that if they protected the tackler against an injury causing impact they could be used to create one and therein is the dilemma for the IRB.
If they allowed clothing that would protect the wearer they would have to legislate that all players must wear the same level of protection and we would end up with American football style playing kit where players have to wear helmets and so have to wear chest protectors, neck braces, shoulder pads, elbow and knee protection as one begets the other.
Interestingly, helmets don’t provide protection against early dementia as American football has a higher rate of players with the abnormal proteins than those currently found in rugby.
The problem for the IRB is that players that wear protective clothing believe it works and therefore take greater risks than they would were they not wearing it.
This obviously increases the potential of greater long-term injury – but how can they stop players from wearing sanctioned protective equipment when they have approved its use?
I have to say I don’t know if concussion is ‘policed’ in mini and junior rugby and if injured players are not allowed to play for a statutory period like in the adult game or even if Dr Stewart’s research is applicable to children.
However if it is applicable then by his estimates of about 1-2 players per every three games with an average 13,000 matches per weekend, as many as 6,000 mini and juniors could potentially be affected each weekend. All this may sound a little alarmist and may seem likely to turn people off the sport but that would not be my intention, in fact quite the reverse.
Just like all sports and outdoor activities, there always has been a level risk in rugby and when you take part in the game you accept a degree of responsibility for a potential level of injury that might occur.
However, that is an informed choice where you know and accept the risk. What Dr Stewart has discovered is a totally new risk. It is now essential for the sport that this research is developed to find a conclusive level of risk for all levels of the game so that parents and players can once again make an informed choice.
As Dr Stewart said, “There is undoubted evidence that people try to play on. Just as we discourage people from playing on with a damaged knee, even more so we would really try not to have people carry on with a damaged brain.”