What do we currently know about the long-termeffects of concussions obtained through sport?

In short, the answer is ‘very little’. While we may recognize the short-term symptoms of a concussion, not much is known about the long-termimpact of both concussions and sub-concussive head impacts (for example, when heading a football).

Recent years have seen this topic brought into the public eye, with growing evidence pointing toward a potential increased risk of neurodegenerative disease in athletes exposed to repeated head impacts. You might have seen news stories both in British sports and some high-profile cases in the USA, particularly in American football – one such case was dramatized in the Will Smith film Concussion.

Much of this research points towards the neurodegenerative disease CTE (chronic traumatic encephalopathy), which can cause dementia and is associated with repeated blows to the head. Research around this association is gradually building, although much of this work to date has involved small cohorts.

For example, a 2017 study observed CTE in the brains of four former football (soccer) players known to have headed the ball frequently and reported a higher incidence of CTE in these footballers than the general population. This study was highly significant as it was the first time that CTE had been linked with association football, but of course, further research is required to validate these findings in larger cohorts.

Another difficulty is that, at present, CTE can only be diagnosed after death, so researchers are also working on ways to diagnose CTE in living people, which would likely accelerate this field of research considerably.

Overall, we can say that it is likely that there is an association between repeated head impacts and the development of neurodegenerative diseases, though the mechanisms behind this and the additional factors that contribute to disease risk remain in question.

There is no evidence that a single concussion increases the risk of neurodegenerative disease, and not everyone with a history of repetitive head impacts will go on to develop CTE or other neurodegenerative diseases. We hope that the next few years will yield crucial information on the long-term effects of head impacts in sports, which we can then use to support future players.  

The Drake Foundation is dedicated to concussion research. How did the charity start, and why do you feel that this area of research is important?

The Drake Foundation was founded in 2014 by James Drake, a businessman, and philanthropist with a passion for sport. Having been a keen rugby fan all his life, James was shocked to see a number of players in both national and international rugby matches sustain concussions and then return to play soon after, despite showing symptoms of a head injury.

Along with Saracens Rugby Club moving to James’ local area of Mill Hill in North London, this kick-started James’ desire to fund research into sports concussion, and so The Drake Foundation was established.

Over the past 5 years, we’ve invested over £2 million into research and resources across various sports and playing levels, but rugby is where it all started, with our first research project investigating potential biomarkers of rugby concussions launching with Saracens Rugby Club in 2015. Since then, the study has been extended to a number of Premiership and Championship teams across London.

At present, we are funding six ongoing studies across rugby and football, as well as a scientific journal, literature database, and our annual symposium, which brings together sporting bodies, clinicians and researchers across rugby, football, cricket, motorsport, boxing and more.

The hope is that all this research, information sharing, and collaboration will ultimately lead to improved sport safety and valuable insights into the processes underlying neurodegenerative disease. The benefits of taking part in sports are huge, so with more information, we’ll hopefully one day be able to negate any downsides with, for example, robust evidence-based concussion protocols.

You recently started the HEADING study. Please can you tell us about this research and what you expect to find?

HEADING – HEalth and Ageing Data IN the Game of football – is a study designed to examine the brain health of former professional football (soccer) players. Researchers from the London School of Hygiene and Tropical Medicine (LSHTM), Queen Mary University of London and the Institute of Occupational Medicine will investigate the possible link between a history of repetitive head impacts and the development of neurodegenerative disease in retired footballers.

The research team hope to recruit around 300 former professionals aged 50 plus. These players will take part in face-to-face assessments to gather data on their playing and work history; lifestyle factors; physical and cognitive ability; and a clinical neurological examination. The participants will also have the option to provide blood samples for biomarker analysis.

We hope that the HEADING study, which is supported by the FA, PFA, and RFU, will provide evidence on the long-term effects of professional football on cognitive function. The aim is to inform safe sporting practice in the future, as well as wider insights into neurodegeneration and cognitive health in the general population.

We’re passionate about taking part in sport, both as players and spectators, but also about investing in robust research to understand more about the short- and long-term impact of head injuries, so that participant safety can be improved and contact sports enjoyed more freely. HEADING will be a key study to grow our knowledge of the long-term impacts of head impacts, so we’re very pleased to kick it off this year.

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Why did The Foundation feel it important to work with professional athletes? How often do these athletes experience a concussion?

Athletes form a population regularly exposed to concussions: their day jobs involve a much higher risk of brain impacts than many other professions, and yet we know so little about the long-term effects of this on their health.

The 2016–17 Professional Rugby Injury Surveillance Project (PRISP) reported concussion to be the most commonly reported rugby match injury in English Premiership Clubs and the England Senior team, contributing to 22% of all match injuries. During the 2016–17 season a total of 169 match concussions were reported.

In football, no official statistics on concussion rates are released; however, data from a number of sources demonstrate football to be a source of concussions and head injury hospitalizations, particularly in the youth and school settings.

Research involving current and former sports players is crucial to understanding concussions and their long-term effects. The more players take part in research, the more evidence we can gather, allowing sporting bodies and medical teams to make fully informed decisions about sporting guidelines and concussion protocols, right through from grassroots organizations to professional levels.

What’s next for The Drake Foundation?

As well as our ongoing studies that focus primarily on head injury and long-term brain health in rugby and football, we’ve recently expanded our scope to cover more general player welfare in an effort to advance our knowledge of wider long-term health trends. Excitingly, we announced our first project in this area this month with the commitment of funding to a ground-breaking longitudinal study into the health of professional footballers.

The study – the Drake Football Study – is a collaboration with partners across Europe including the World Players’ Union (FIFPro), Amsterdam University Medical Centers and Mehiläinen NEO Hospital, with The Drake Foundation as founding funders.

It will be the most comprehensive study to date to measure the physical and mental health of professional footballers over time, with data collection anticipated to run for a minimum of 10 years over the players’ pre- and post-retirement years.

Researchers will gather epidemiological data on musculoskeletal, neurocognitive, cardiovascular and mental health trends of the footballers starting as they near retirement. The study will provide new insights into players’ health across their lives, which we hope will ultimately drive the development of preventative and curative measures for future players, as well as wider society.

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How can everyday people support the work of The Drake Foundation?

As well as funding research, The Drake Foundation funds resources and promotes collaboration across sport, science, and society: we work with researchers, doctors, sporting bodies like the FA and RFU, and players themselves.

Progression in this field is as much about research as it is communication, education and collaboration, which means that this topic needs to be talked about at home and on the pitch, as well as in the lab.

You can learn about research into head injuries in sport by following our work on The Drake Foundation website or on Twitter @DF_concussion. You can also learn more about head injuries and prevention via Headway.

About Lauren Pulling

Lauren Pulling received her degree in Neuroscience from University College London (UCL). She then went on to work in editorial roles in STM publishing, and since 2017 has been Publisher at Future Science Group in London, managing their digital publications across a range of medical and scientific subject areas.

Lauren is also the Program Manager at The Drake Foundation, bringing together her passions for neuroscience and football, and oversees the Foundation’s research funding, governance, and strategy.

About The Drake Foundation

The Drake Foundation is a not-for-profit organization committed to understanding and improving the health and welfare of sports players through scientific research and collaboration. Launched in 2014, the Foundation has already invested over £2 million into research funding and open access resources.

Much of the Foundation’s work to date has centered on concussion and head injuries in sport; knowledge that will serve not only to improve sports safety but also provide valuable insight into the processes underlying neurodegenerative diseases, such as dementia.

At present, The Drake Foundation is funding several ongoing studies across football and rugby, working with teams in the football Premier League; Premiership and Championship rugby union leagues; and leading researchers across the UK and beyond.

With multiple ground-breaking concussion projects underway, the Foundation is also in the process of growing their portfolio of research funding to investigate the long-term effects of playing and retiring from professional sport on mental and physical health.