In March 2014, Jonathan Sexton lay flat on the turf of the Stade de France following a collision with French colossus, Mathieu Bastareaud. For Sexton, this was the latest in a worrying trend of concussions that would plague him for years. RTÉ analyst George Hook addressed the issue in a typically bombastic way, claiming Sexton should retire from the sport immediately for the sake of his health.
Hook’s isn’t a theory Prof Matthew Campbell subscribes to. Sitting down with The University Times, he highlighted the expert medical care afforded to professional players. “That’s an insult to the physicians they are working with”, he states passionately, addressing Hook’s comments. “They wouldn’t let Sexton and [George] North back out to play if they didn’t think it was safe.” In his opinion, the focus on concussions must be centred on the amateur game, and with players who don’t have access to the high level medical specialists.
Campbell explains that brain conditions vary in severity, and concussion is a mild injury on this spectrum. “We’re at a point in society where we really don’t know what a concussion is”, begins Campbell. “Clinically there are very few hallmarks.” This means that unlike a broken leg for example, where you can clearly see the break, it can be very hard to identify a concussion. Consequently it is very difficult to set any firm guidelines on what sports organisations should be doing to look out for and deal with such injuries. Whilst it is undeniable that these “repetitive blows” to the head will have long term consequences (for example, among boxers 20 per cent of former professionals will develop a form of dementia called Chronic Traumatic Encephalopathy, commonly known as CTE) neurologists are still unsure of what exactly that long term damage will be and whether “it is person specific damage”.
We’re at a point in society where we really don’t know what a concussion is
A major obstacle in researching the condition is the underreporting of concussive incidents. The competitive nature of sport ensures that players are always desperate to get back on the field of play, making them more likely to ignore possible symptoms. However, Campbell and his partners have identified boxing and MMA as possible treasure troves of data. “Two thirds of MMA fights finish with a TKO [technical knockout] so there’s something there that we can use and tap into.” In light of this information, Dr David Camarillo of Stanford University, who is working in tandem with Campbell, and who also spoke at yesterday’s conference, has developed a mouth guard with which they plan to measure the force of a blow. They hope that when correlated with blood samples and MRI analysis this may provide a rough threshold for concussion.
A commonly held misconception in the sporting world is that helmets and protective headgear can prevent concussions. This is an issue Professor Campbell is keen to address. “It’s very clear looking at the NFL that wearing a helmet doesn’t stop a concussion”, he states firmly. “The helmets were predominantly designed to prevent a fractured skull.” He explains that concussions don’t require a direct impact to the areas of the brain affected, as the force acting on the brain is caused by the lateral movement of the head, which shears the centre of the brain, interfering with the flow of information and causing symptoms including disorientation and nausea.
Elaborating on his own work in Trinity, Campbell discussed the College’s collaboration with St James’s hospital and Dr Colin Doherty. In 2015, they began to examine their theory that the damage that occurs during concussive events is centred around the blood vessels in the brain. As every neuron in the brain effectively has its own vessel, Campbell has hypothesised that these vessels are damaged during a concussion. Under normal circumstances, a concussion will not appear on an MRI scan. However by injecting a tracer dye into blood vessels, these injuries will light up and emerge in an MRI showing if they are leaking or not. Putting their hypothesis into action by working with an elite schoolboy rugby team, Campbell and his partners performed MRI scans at the beginning and end of the season, as well as taking a full history of each concussive event, samples of blood and isolated DNA. The aim, according to Campbell, is that “if we join all these different parameters together we might have a really strong predictor” for whether someone is a candidate for long term conditions associated with concussion.
I’d like if they were more involved in research but maybe that’s a bias on me as a scientist
Yesterday’s conference, which took place in Trinity’s Biomedical Sciences Institute (TBSI), was a star-studded affair, with a variety of guests ranging from academics to leaders of the sporting world speaking. Campbell and Doherty presented their research, followed by ex-rugby internationals Keith Woods and Fergus Slattery along with Tipperary hurler Séamus Callanan, who discussed their own experiences of concussion. Speaking before the conference, Campbell is optimistic. He hopes that by drawing together such a diverse group of people, all sharing a vested interest in concussion, they can help to produce a national directive on how to deal with the issue, not just in sport but in general. He passionately emphasises how lacking the procedure for dealing with such injuries are currently. “In Ireland we are probably a decade behind the US.”
Despite this criticism, Campbell concedes that sporting organisations like the Irish Rugby Football Union (IRFU) are making huge strides with regard to dealing with the issue. In recent years, they have issued a number of directives aimed at both referees and coaches detailing the procedure to be followed in the event of concussions. These directives include removing players with any suspicion of injury from the field of play and the introduction of the new high tackle rule. For Campbell, the question of how much sporting organisations should be doing to combat the risk of concussions is a tough one. “Does this mean that they have to get involved in research?” he muses. “I’d like if they were more involved in research but maybe that’s a bias on me as a scientist.” Campbell warily predicts that a problem going forward for sporting organisations is the possibility of litigation, should the matter fail to be addressed and individuals begin to develop long term problems.
