Repeat Blows To The Head Linked To Brain Disease In NRL Players
The first reported cases of degenerative brain disease in Australian rugby league players have been described as a "wake-up call" to Aussie athletes taking repeated blows to the head.
Chronic Traumatic Encephalopathy (CTE) is a regressive neurological condition found in athletes, military veterans and others with a history of repetitive brain trauma, specifically concussions.
Researchers from the Royal Prince Alfred Hospital, NSW Health Pathology and the University of Sydney's Brain and Mind Centre believe they have identified CTE in the brains of two former rugby league players.
The players, whose brains were examined after death, were not named in the report published in the journal Acta Neuropathologica Communications.
Both cases were middle-aged former professionals who had played more than 150 first grade games in the NRL over many years, the study said.
"The changes in the two brains were distinctive, definitive, and met consensus diagnostic criteria for CTE," said lead author Clinical Associate Professor Michael Buckland.
"I have looked at about 1000 brains over the last 10 years, and I have not seen this sort of pathology in any other case before."
Once known as 'punch-drunk syndrome' -- named for the ex-boxers who struggled to walk and talk clearly following a career of taking blows to the head in the 1920s -- CTE leads to a multitude of symptoms including memory loss, depression, and impulse control issues.
Pathologically, it presents as a build-up of abnormal Tau protein in the brain and a subsequent breakdown of brain tissue.
The only known risk factor is repetitive head injuries, and it can only be formally diagnosed with an autopsy.
The diagnoses are just the second and third reported cases of TCE in Australian sportspeople. Former rugby union player and coach Barry “Tizza” Taylor became the first known case after his brain was sent to a concussion research centre in Boston for analysis in 2013.
Ex-Wallaby Peter FitzSimons said the discovery of CTE in former rugby league players "is not remotely surprising".
"It's simply confirmation of what we all must know must be there," he told 10 daily.
"When I was playing rugby and the rugby league guys of my generation, I think we were all naive enough to think it was only boxers who could sustain brain damage."
The rate of concussions in professional rugby league is estimated to be just under nine per 1000 match hours -- about one every 3.35 games.
Given few people today undergo brain autopsies, the prevalence of the CTE in Australia remains largely unknown.
"There is still a significant number of medical professionals that don't acknowledge that CTE is a real disease, so it's still quite controversial," Buckland told 10 daily.
"I think the USA is probably 10 years ahead of Australia with this conversation and public awareness. [The findings] are just a bit of a wake-up call that we're not immune in Australia and Australian sports. The same thing is going on here as it is overseas."
In 2016, American's National Football League publicly acknowledged for the first time a connection between American football and CTE.
It followed an unprecedented class-action lawsuit settlement between the NFL and thousands of retired players, who were provided with payments of up to $5 million each for serious medical conditions associated with repeated head trauma.
More recently, the National Hockey League settled a $19 million deal with retired players who had sued the league for hiding the dangers of head hits.
The cases sparked widespread debate about where to go from here, and what changes, if any, should be made to contact sports.
"The nature of contact sport is that there will always be a risk, and I don't by any means say cut out contact sport," FitzSimons said.
"But what it does mean is we need to be rigid about the protocols for when people get concussed. Teach our kids, when in doubt, sit it out."
Buckland hopes the findings will encourage people to donate their brains to Australia's Sports Brain Bank -- a research facility opened last year to better understand the links between head impacts and diseases like CTE.
"The only way we're going to get a good comparative study is if we get not only players that have had head exposure but players of sports that have had no exposure to head injury and even their family and friends," he said.
FitzSimons is one of the Aussie athletes to have pledged his brain to the facility, though he urges it's not just the brains of former Wallabies and Kangaroos that are needed.
10 daily has reached out to the NRL for comment.