Are rugby-related Traumatic Brain Injuries (TBIs) comparable to Shark attacks?

SUMMARY: Rugby-related TBIs are relatively rare events, yet the public’s perception of their actual risk may be greatly exaggerated. This mismatch could be explained by the feeling that partaking in volitional (such as sport) should be safer than non-volitional activities (e.g. driving one’s car). Nonetheless, TBIs should be reduced as much as practically possible to enhance the enjoyment of volitional activities.


PLEASE NOTE: This article does NOT consider concussions, which are a subset of mild Traumatic Brain Injuries (mTBIs)

This is a common misconception that contact or collision sports are the main cause of traumatic brain injuries (TBIs). This public misconception was highlighted recently in an article by a Sports Physician, Dr Bergeron, with over 20 years of clinical experience in the Pittsburgh Post-Gazette (Link to article). In this response to an earlier article in the same tabloid calling for an end to American Football, Dr Bergeron argues that general activities such as bike riding should be blamed long before ‘organised sport’ (such as rugby, cricket, soccer).

Moreover, evidence unequivocally shows that TBIs from recreational activities (organised sports and other activities such as bike riding) only account for approximately 10% (Bruns, 2003) of all brain injuries. Obviously, the majority of TBIs result from motor vehicle or ‘transport-related’ accidents. In South Africa for example, there are on average only two rugby-related traumatic brain injuries per year.

Of course travelling by car to work or school is not comparable to voluntarily partaking in an organised activity (such as rugby). However, research conducted on risk perceptions of soccer and rugby spectators indicates that what is considered ‘acceptable risk’ in these sports is not different to occupational levels (Fuller, 2008). This suggests that people consider the inherent of risks of sport to be comparable to those of everyday work-related activities.

So then why do organised sports have such a bad reputation for their association with brain injuries? The answer may lie in recent research on the Australian publics’ perception of shark attacks – an event that is as equally rare as rugby-related traumatic brain injuries (Crossley 2014). The Australia public’s fear of sustaining a shark attack was far greater than the true risk of such an event. The reason for this mismatch is complex, but related to the fact that humans’ emotions override logic when there is the possibility of any form of loss (unfortunately this is a loss of human life, in this context). Humans could also be more emotional about death resulting from volitional activities (swimming in the ocean or rugby) than driving one’s car to work because the volitional activities are done for enjoyment whereas driving one’s car could be seen as more of a necessity.

Nonetheless, if there is any possibility of reducing the risk of TBI, regardless of the activity, then these measures should obviously be employed. RugbySmart and BokSmart are two examples of prevention programmes that have the prevention of rugby-related TBIs as part of their mandate in New Zealand and South Africa, respectively. With on-going research, it is hoped that these programmes will be able to reduce the risk of these injuries as much as possible while still allowing the participants to enjoy the activities that they love.

What are your thoughts on this controversial topic of head injuries in sport? We’d like to hear them!


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