Influence of playing rugby on long-term brain health following retirement: a systematic review

Rugby Match

The severity and lifelong implications of rugby related head injuries has been central to press coverage this season. The same can be said for other contact sports such as American Football which has come under fire for allowing players to continue after sustaining head injuries. Further pressure for action was applied after postmortem examinations of former NFL pros raised concerns of increased prevalence of neurodegenerative diseases as a result of repeated head trauma.

As Cunningham et al suggest, rugby has a higher incidence of concussion than American Football, therefore more is needed to be done to understand the long-term impact on brain health of former players, so they can be protected. Therefore they decided to investigate this question by performing a systematic review.

They were specifically searching for research assessing the cognitive abilities of retired professional male or female players. What became clear during their search and analysis of the relevant research is that there is  a lack of an international standardized definition and criteria of concussion in rugby. This has therefore limited injury surveillance and means that there is a lack of comparable and robust long-term studies.

What the available evidence did suggest is that,  for most ex-professional players, neurocognitive ability and performance was largely normal apart from fine motor control which had diminished.

This loss in fine motor control could be explained in part by the increased alcohol intake associated with rugby culture at most levels of the game. The tendency for players to sustain chronic upper limb musculoskeletal injuries during their careers could also explain this finding.

The studies included within the review were inconsistent in their methodology and quality. An example of this was the selection in age inclusion/exclusion criteria; this could have added bias. Studies which only involve players up to the age of 40 or 50 would likely see no change in neurofunction or life changing impact in their players. This would miss the potential change in neurofunction as people age. You could argue that head injury impact could be more influential as people transition to age due to an increase in prevalence of mild cognitive impairments.

Another consideration of interpreting the results of this review is the fact that rugby has changed a lot in the past decade. It has a much faster physical style of play and, it could be argued, that the retired players within these studies had shorter careers (as not a professional game) and played a less intense form of the game.

Also there was often an absence of control groups within the studies and often they did not state whether they discounted TBI/HI occurring outside of the sport.

Clearly more evidence is needed to assess the true long term impact of the game on neurological abilities. What we do know is the impact of concussion in the short-term and this is a serious concern for players, particularly youth players. More and more is being done to reduce the impact of concussion on players and this can only be a good thing. Examples include the research performed at Bath University, a new pioneering exercise programme which has achieved staggering results including a 72% & 59% reduction in concussion and injury rates respectively. The programme is shown below.

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Top 5 Fridays! 5 Variations on Cervical Retractions

The cervical retraction exercise is a classic and works very well for cervical pain, cervicogenic HA, and general upper quarter complaints. Yes, posture does not directly predict or relate to pain any more than knee flexion causes knee pain. However, common prolonged or repeated activities often cause predictable triggers that should be avoided and novel movements in the opposite direction often desensitize the area and reset the symptoms.

Here are 5 variations on the cervical retraction to make it as comfortable and effective as possible. Remember, it’s the dosage of the home program that really promotes recovery between patient visits, not what you treat the patient with in the clinic.
5 Variations on Cervical Retractions




Remember – the big EDGE Mobility, IASTM Technique 2.0, and MMT Premium sale is in full swing! 3 more days to save! Details below.
I am having a sale on all EDGE Mobility System products with the coupon code – save 20 may20
This includes our popular and new EDGE Back SupportEDGE Suspension TrainerThe Occlusion Cuff for BFR, as well as our classics – The EDGE Mobility ToolMirror Box, and EDGE Mobility Bands!

Sale runs from Wed May 23 to midnight May 28, EST. Click below to save!
Click here to apply the 20% off coupon to your cart! Ends Memorial Day at midnight, EST!
IASTM Technique 2.0 is 9.0 of training in IASTM, Compression Wrapping, and Functional Cupping! Eligible for CEUs and $50 off with the link below! Coupon edge25, saves you 25% or $50! Sale also ends May 29th at midnight EST!
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With our popular new MMT Webinars, full lectures from my MMT seminars, Q&A, live cases and hundreds of manual techniques, there hasn’t been a better time to check out Modern Manual Therapy Premium! Save $20/year on yearly subscriptions and $2.00/month on monthly subscriptions by clicking on the links below.
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Thanks for all your support, comments, and questions! Keep them coming! I hope everyone in the USA has a safe and wonderful holiday and everywhere else, have an amazing week!
Keeping it Eclectic…

Key Speakers Announced!

Save the date! WCPT Congress Geneva, Switzerland 10th-13th May 2019.

With less than a year to go the list of the prestigious focused symposia have been released. They are both impressive and inspiring and it’s going to be a real challenge deciding which ones to attend.

If you are new to conference life and are unsure what focused symposia are, they one of congress’s key sessions and a must go to event. They are one-and-a-half-hour sessions led by a chair who is a recognised expert in the field. The chair has the responsibility for inviting and leading a group of international speakers, from at least three WCPT regions, through a series of evidence based and critically reflective linked presentations, drawing out the relevance to practitioners, managers, educators, researchers and/or policy makers.

Focused symposia provide a forum where cutting edge topics can be explored and debated, drawing together different research and practice perspectives. As part of an international team, focused symposium chairs and speakers can explore the implications of the latest research and thinking as well as debate controversies and lay the foundations for future interactions and initiatives. As an example of what to expect the video below is a session from South Africa.

In 2019, the congress programme includes 26 focused symposia featuring 119 speakers from around the world. And here they are:

If you’ve got some top tips for how to make the most out of symposia sessions for our readers please let us know in the comments!

Talking Tendons: Tech Focused Systematic Reviews That Will Change Your Practice

I’m inspired by “the patient will see you now” by Dr Eric Topol which I recently read so this weeks podcast covers 2 technology focused systematic reviews. The first is on the efficacy of exergames for treating musculoskeletal pain, and the second is on basically the use of accelerometers and other wearable sensors to monitor rehab exercises.

An exciting area that is set to grow hugely and will be part of all of our practices soon.

Keeping it Eclectic…

[SUMMER SALE] Save on EDGE Mobility, IASTM Technique, and MMT Premium!

 

I hope you’re getting a break soon with the upcoming holiday weekend! We are starting out the summer with an amazing sale – 20% off everything at EDGE Mobility System! Click on the picture above or the button below to have the coupon applied to your cart! You will see the discount at checkout.
Thanks to everyone for supporting MMT Blog this year. The team and I are taking a break from blogging Monday next week but we’ll be by mid week with more posts, videos, and podcasts!
To give thanks, I am having a sale on all EDGE Mobility System products with the coupon code may20
This includes our popular and new EDGE Back SupportEDGE Suspension TrainerThe Occlusion Cuff for BFR, as well as our classics – The EDGE Mobility ToolMirror Box, and EDGE Mobility Bands!

Sale runs from Wed May 23 to midnight May 28, EST. Click below to save!

Click here to apply the 20% off coupon to your cart! Ends Memorial Day at midnight, EST!
IASTM Technique 2.0 is 9.0 of training in IASTM, Compression Wrapping, and Functional Cupping! Eligible for CEUs and $50 off with the link below! Coupon edge25, saves you 25% or $50! Sale also ends May 29th at midnight EST!
Click to save $50 on IASTM Technique 2.0 coupon code edge25
With our popular new MMT Webinars, full lectures from my MMT seminars, Q&A, live cases and hundreds of manual techniques, there hasn’t been a better time to check out Modern Manual Therapy Premium! Save $20/year on yearly subscriptions and $2.00/month on monthly subscriptions by clicking on the links below.
MMT Sale Monthly
Thanks for all your support, comments, and questions! Keep them coming! I hope everyone in the USA has a safe and wonderful holiday and everywhere else, have an amazing week!
Keeping it Eclectic…

Reducing falls in older adults recently discharged from hospital: systematic review

With our aging population pressure is mounting on health services to provide the best possible care for more and more frail individuals. As resources are stretched more risks are taken to discharge patients as soon as possible, with as little support as required. This is absolutely the right thing to do and there is a huge amount of evidence to show why this is the case. Hospital is dangerous for frail individuals, take #endPJparalysis as a high profile example highlighting the risk of deconditioning.

One of the concerns which physiotherapists have when discharging a frail patient home from hospital is whether they are going to fall. We know that falls increase during the post-discharge period. Compared to the average annual fall rate of 30% in the general older community, 40% of older adults recently discharged from hospital fall at least once in the 6-month period following discharge and 54% of these falls result in a serious injury.

As Naseri et al report, many systematic reviews have taken place in the past and demonstrated the effectiveness of falls prevention interventions in the community. However these reviews did not evaluate interventions aimed at reducing falls risk in the post-discharge period. Naseri et al primary objective of their systematic review was to evaluate just that.

Their search used a respected systematic review strategy and they specifically looked at interventions provided to patients over 60 who were discharged from hospital to the community. To be included within the review the intervention MUST have been commenced in hospital or within 1 month of discharge.

The results of this systematic review suggest that:

  • Home hazard modifications alone has a limited evidence that they reduce falls post-discharge. If services were tailored, individualised and were evaluated specifically for the post-discharge period results may be different.
  • A home hazard modification may be beneficial for people with recurrent falls history.
  • Falls prevention exercise programmes are beneficial for older people generally however during the post-discharge period they may be detrimental. If they contain exercises which provide a moderate to high challenge on balance falls increase. This is likely because this population is deconditioned as a result of their admission and acute illness. These programmes are usually unsupervised and have limited 1:1 contact time. To correct this more supervision, tapered intensity and duration is advised. Build up slowly!
  • Vitamin D & calcium supplements alone do not reduce falls risk however are advised to protect against reduced bone mineral density.
  • Nutrition supplementation for malnourished elderly was effective at reducing the risk of falls post-discharge.
  • Services which target specific elements of frailty are likely to have a positive effect on falls risk and fall outcomes.

If you’d like to lean more about the falls risk factors discussed in this post then check out the content on Physiopedia:

Untold Physio Stories (S9:E1) – You Can’t Practice on the Instructor

Why you shouldn’t let students manipulate your neck [too much?]. Listen in to Erson’s story of having his neck manipulated.
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Untold Physio Stories is sponsored by the EDGE Mobility System, featuring the EDGE Mobility Tool for IASTM, EDGE Mobility Bands, webinars, ebooks, Pain Science Education products and more! Check it out at edgemobilitysystem.com .  Be sure to also connect with Dr. Erson Religioso at Modern Manual Therapy and Jason Shane at Shane Physiotherapy.

Keeping it Eclectic…