The Effect of Sub-Concussive Impacts during a Rugby Tackling Drill on Brain Function

Sub-concussive head impacts from heading footballs do not acutely alter brain excitability as compared to a control group

BACKGROUND

Repeated sub-concussive head impacts are a growing brain health concern, but their possible biomarkers remain elusive. One impediment is the lack of a randomised controlled human experimental model to study their effects on the human brain.

OBJECTIVES

This work had two objectives. The first one was to provide a randomised controlled human experimental model to study the acute effects of head impacts on brain functions. To achieve this, this work's second objective was to investigate if head impacts from heading footballs acutely alter brain excitability by increasing corticospinal inhibition as compared to a control group.

METHODS

In practised and unpractised young healthy adults, transcranial magnetic stimulation was used to assess corticospinal silent period (CSP) duration and corticospinal excitability (CSE) before and immediately after performing headings by returning 20 hand-thrown balls directed to the head (Headings; n = 30) or the dominant foot (Control; n = 30). Moreover, the Rivermead Post-Concussion Questionnaire (RPQ) was used to assess the symptoms of head impacts. Head acceleration was also assessed in subgroups of participants.

RESULTS

The intervention lengthened CSP duration in both the Headings (6.4 ± 7.5%) and Control groups (4.6 ± 2.6%), with no difference in lengthening between the two groups. Moreover, CSE was not altered by the intervention and did not differ between groups. However, performing headings increased headaches and dizziness symptoms and resulted in greater head acceleration upon each football throw (12.5 ± 1.9g) as compared to the control intervention (5.5 ± 1.3g).

CONCLUSIONS

The results suggest that head impacts from football headings do not acutely alter brain excitability as compared to a control intervention. However, the results also suggest that the present protocol can be used as an experimental model to investigate the acute effects of head impacts on the human brain.

The Acute Effects of Ball Pressure on Anticipation Timing Following a Series of Purposeful Headers in Adult Football (Soccer) Players

The purpose of this study is to investigate the acute effects of ball pressure on anticipation timing following a series of purposeful headers in adult football (soccer) players. There is evidence to suggest acute neurophysiological changes to the brain following purposeful heading; this may lead to altered anticipation timing as a result, potentially having future safety implications for players. A repeated measures crossover design was used. Seventeen participants aged between 20 and 30 years performed (i) 20 rotational headers with a lower-pressure match ball (58.6 kPa; 8.5 psi), (ii) 20 rotational headers with a higher-pressure match ball (103.4 kPa; 15 psi), or (iii) 20 non-headers (kicks) as a control each on separate days. The effect of ball pressure on anticipation timing accuracy, measured as absolute, constant, and variable errors, was assessed before and immediately after each intervention session using an anticipation timing task. Differences between group means were compared using repeated measures ANOVA and linear mixed effects models, with p-values of <0.05 considered statistically significant. No significant differences in anticipation timing accuracy across interventions were detected between control, occluded, and non-occluded trials. This finding differs from the previous literature regarding the measurable, acute effects of purposeful heading. The anticipation timing task may lack sensitivity for detecting the effects of repeated heading on brain function.

The Reliability of Transcranial Magnetic Stimulation-Derived Corticomotor Inhibition as a Brain Health Evaluation Tool in Soccer Players

Background

The suitability of corticomotor inhibition and corticospinal excitability to measure brain health outcomes and recovery of sport-related head impact (concussion and subconcussion) depends on good inter-day reliability, which is evaluated in this study. Transcranial magnetic stimulation (TMS) reliability in soccer players is assessed by comparing soccer players, for whom reliability on this measure may be reduced due to exposure to head impacts, to generally active individuals not engaged in contact sport.

Methods

TMS-derived corticomotor inhibition and corticospinal excitability were recorded from the rectus femoris muscle during two testing sessions, spaced 1–2 weeks apart in 19 soccer players (SOC—age 22 ± 3 years) and 20 generally active (CON—age 24 ± 4 years) healthy volunteers. Inter-day reliability between the two time points was quantified by using intra-class correlation coefficients (ICC). Intra-group reliability and group differences on actual measurement values were also explored.

Results

Good inter-day reliability was evident for corticomotor inhibition (ICC_SOC = 0.61; ICC_CON = 0.70) and corticospinal excitability (ICC_SOC = 0.59; ICC_CON = 0.70) in both generally active individuals and soccer players routinely exposed to sport-related head impacts. Corticomotor inhibition showed lower coefficients of variation than excitability for both groups (Inhib_SOC = 15.2%; Inhib_CON = 9.7%; Excitab_SOC = 41.6%; Excitab_CON = 39.5%). No group differences between soccer players and generally active individuals were found on the corticomotor inhibition value (p > 0.05), but levels of corticospinal excitability were significantly lower in soccer players (45.1 ± 20.8 vs 85.4 ± 6.2%Mmax, p < 0.0001). Corticomotor inhibition also showed excellent inter-rater reliability (ICC = 0.87).

Conclusions

Corticomotor inhibition and corticospinal excitability are stable and maintain good degrees of reliability when assessed over different days in soccer players, despite their routine exposure to head impacts. However, based on intra-group reliability and group differences of the levels of excitability, we conclude that corticomotor inhibition is best suited for the evaluation of neuromuscular alterations associated with head impacts in contact sports.

Tacklers' Head Inertial Accelerations Can Be Decreased by Altering the Way They Engage in Contact with Ball Carriers' Torsos

PURPOSE

This study aimed to investigate how four types of successfully executed, legal front-on, one-on-one torso tackles influence the tacklers' and ball carriers' inertial head kinematics.

METHODS

A total of 455 successful front-on, one-on-one torso tackle trials completed by 15 rugby code players using three-dimensional motion capture were recorded. Tackles differed with respects to the height of the contact point on the ball carrier's torso. A series of mixed general linear models were conducted.

RESULTS

The tackler sustained the highest peak resultant linear ( P < 0.001) and angular ( P < 0.01) head accelerations when contacting the lower torso to execute a "dominant" tackle compared with mid or upper torso, although these latter tackle types had the lowest ball carrier inertial head kinematics. When executing a "smother" tackle technique, a significant decrease in peak resultant linear head acceleration was observed with a vertical "pop" then lock action used, compared with the traditional upper torso tackling technique ( P < 0.001).

CONCLUSIONS

Modifying the tackler's engagement with a ball carrier's torso, with respect to height and technical execution, alters the inertial head kinematics of the tackler and the ball carrier. The traditional thinking about optimal tackle technique, as instructed, may need to be reevaluated, with the midtorso being a potential alternative target contact height, whereas changes in tackle execution may be relatively protective for tacklers when executing either a dominant or smother tackle. This study provides critical scientific evidence to underpin revised coaching tackling technique interventions that might enhance player safety. Tackles in which the tackler contacts the ball carrier around the midtorso region, rather than lower torso, produce the lowest acceleration and thus may contribute to reducing head injury risk for the tackler.

Repeated Sub-Concussive Impacts and the Negative Effects of Contact Sports on Cognition and Brain Integrity

Sports are yielding a wealth of benefits for cardiovascular fitness, for psychological resilience, and for cognition. The amount of practice, and the type of practiced sports, are of importance to obtain these benefits and avoid any side effects. This is especially important in the context of contact sports. Contact sports are not only known to be a major source of injuries of the musculoskeletal apparatus, they are also significantly related to concussion and sub-concussion. Sub-concussive head impacts accumulate throughout the active sports career, and thus can cause measurable deficits and changes to brain health. Emerging research in the area of cumulative sub-concussions in contact sports has revealed several associated markers of brain injury. For example, recent studies discovered that repeated headers in soccer not only cause measurable signs of cognitive impairment but are also related to a prolonged cortical silent period in transcranial magnetic stimulation measurements. Other cognitive and neuroimaging biomarkers are also pointing to adverse effects of heading. A range of fluid biomarkers completes the picture of cumulating effects of sub-concussive impacts. Those accumulating effects can cause significant cognitive impairment later in life of active contact sportswomen and men. The aim of this review is to highlight the current scientific evidence on the effects of repeated sub-concussive head impacts on contact sports athletes’ brains, identify the areas in need of further investigation, highlight the potential of advanced neuroscientific methods, and comment on the steps governing bodies have made to address this issue. We conclude that there are indeed neural and biofluid markers that can help better understand the effects of repeated sub-concussive head impacts and that some aspects of contact sports should be redefined, especially in situations where sub-concussive impacts and concussions can be minimized.

Dual-Task Gait Performance Following Head Impact Exposure in Male and Female Collegiate Rugby Players

Background

Gait impairments have been well-studied in concussed athletes. However, the sex-specific effect of cumulative head impacts on gait is not well understood. When a cognitive task is added to a walking task, dual-task gait assessments can help amplify deficits in gait and are representative of tasks in everyday life. Dual-task cost is the difference in performance from walking (single-task) to walking with a cognitive load (dual-task).

Purpose

The objectives of this study were to explore the differences between sexes in 1) dual-task gait metrics, 2) gait metric changes from pre-season to post-concussion and post-season, and 3) the dual-task costs associated with gait metrics.

Study Design

Cross-sectional study.

Methods

Over two seasons, 77 female athlete-seasons and 64 male athlete-seasons from collegiate club rugby teams participated in this study. Subjects wore inertial sensors and completed walking trials with and without a cognitive test at pre-season, post-season, and post-concussion (if applicable).

Results

Females athletes showed improvement in cadence (mean = 2.7 step/min increase), double support time (mean = -0.8% gait cycle time decrease), gait speed (mean = 0.1 m/s increase), and stride length (mean = 0.2 m increase) in both task conditions over the course of the season (p < 0.030). Male athletes showed no differences in gait metrics over the course of the season, except for faster gait speeds and longer stride lengths in the dual-task condition (p < 0.034). In all four gait characteristics, at baseline and post-season, females had higher dual-task costs (mean difference = 4.4, p < 0.003) than the males.

Conclusions

This results of this study showed little evidence suggesting a relationship between repetitive head impact exposure and gait deficits. However, there are sex-specific differences that should be considered during the diagnosis and management of sports-related concussion.

Level of Evidence

Level 2b.

Head Accelerations during a 1-on-1 Rugby Tackling Drill Performed by Experienced Rugby Union Players

Rugby Union is a popular sport played by males and females worldwide, from junior to elite levels. The highly physical skill of tackling occurs every few seconds throughout a match and various injuries associated with tackling are relatively common. Of particular interest are head injuries that result in a concussion. Recently, repeated non-injurious head impacts in sport have attracted the attention of researchers interested in brain health. Therefore, this study assessed head movement during repeated rugby tackle drills among experienced Rugby Union players. Experienced male and female participants performed 15 1-on-1 tackles in a motion analysis laboratory to measure the head movements of the ball carrier and tackler during each tackle, using three-dimensional motion capture. The average peak acceleration of the head for ball carriers was 28.9 ± 24.08 g and 36.67 ± 28.91 g for the tacklers. This study found that the type of head impacts common while performing a tackle in Rugby Union are similar to those experienced by soccer players during heading, which has been found to alter brain function that lasts hours after the event. This has important implications for player health and suggests that mitigation strategies should be considered for Rugby Union.

Evidence of residual cognitive deficits in young adults with a concussion history from adolescence

The present study investigated executive function and sustained attention of non-athlete, young adults (ages 18-23) with a history of concussion beyond ten months post incident. Cognitive functioning was examined in 24 non-athletic, college students with a concussion history (mean age 21 yrs.; mean time and range post-injury: 4 years, 10-90 months) and 24 non-athletic controls with no history (NH) of concussion. Computerized versions of two cognitive assessment techniques were utilized to examine executive functioning (Stroop) and sustained attention capacity (D2). Primary dependent variables were response time, error score, and sustained attention score. Relationships between dependent variables and concussion metrics were also analyzed. ANOVA's revealed a significantly higher error rate in concussion history (CH) participants when performing the Stroop task (p < 0.05), including a trend for greater errors in the incongruent task condition (p < 0.05). Group measures did not differ in the sustained attention test (all p > 0.05). Nevertheless, there was a significant relationship between D2 error rate and time since concussion (p < 0.01), showing that D2 error rate was greater for participants with more time since concussion sustainment. Our findings indicate the potential for prolonged cognitive dysfunction linked to decision-making, but not to processing speed, in young adult non-athletes with a CH averaging four years post-injury. These findings may provide evidence of residual cognitive deficits in young adults with a concussion history over time.