It was in 2006 that Joost van der Westhuizen, one of the most capped Springbok rugby players of all time, was admitted to hospital with concussion and a neck injury after hitting his neck against an opponent’s hip in the Golden Oldie match.
He was 35. It wasn’t the first time. He had suffered several knocks to the head during his international rugby career, including a number that had resulted in concussion.
At the time neurosurgeon Dr Pieter Slabbert said Van der Westhuizen had soft-tissue injuries in his neck and brain oedema, which caused severe headaches.
His injuries, said Slabbert “cannot be underestimated”.
Were they prophetic words? Or can rugby injuries be completely discounted as the cause of later brain disorders?
Scientists say that apart from a small proportion of people who inherit the gene for motor neuron disease (MND), other causes are unclear.
It is rare under the age of 40, usually developing between the ages of 50 and 70. It is twice as common in men than women.
Van der Westhuizen’s former South Africa teammate Andre Venter is also suffering from a form of MND, which has recently seen him confined to a wheelchair, while former London Irish wing Jarrod Cunningham died from the disease aged 38 in 2007.
All of them, including Van der Westhuizen, were under 40 when the symptoms first appeared.
Although probably unrelated, another of his rugby compatriots, former Springbok flank Ruben Kruger, died from a brain tumour last year.
The main feature of MND is muscle weakness, which gradually becomes worse.
The first symptoms commonly develop in the hands and arms, or feet and legs.
While the MND link to a sporting injury remains mostly unfounded, new research seems to indicate that frequent episodes of concussion could be linked to a number of neurological conditions, including Parkinson’s, depression and Alzheimer’s.
A report by the American College of Sports Medicine said traumatic brain injuries were “implicated” in neuronal loss and cell death, which can cause depression. This is compounded by additional concussions.
Dr Ann McKee of the Boston University School of Medicine reported in a recent Journal of Neuropathology & Experimental Neurology that there was pathological proof “that showed an association of repetitive head trauma experienced in collision sports, with motor neuron disease”.
The study, in which McKee was the lead researcher, involved autopsies of 12 athletes who had died with brain or neurological disease.
All of them had a newly characterised disease called chronic traumatic encephalopathy, or CTE, in which dementia set in years after repeated concussions.
She said the study also found the strongest evidence yet that repeated concussions could cause nerve degenerative diseases like Alzheimer’s.
Professional rugby players and boxers were just two of the groups who could suffer long-term damage from their careers.
While statistically MND affects about two out of 100 000 people, three of the athletes on whom the autopsies were performed were diagnosed with MND. Explaining the pathology of head injuries, biokineticist Conrad Booysen said “concussion can be sustained through a variety of mechanisms”.
These include a direct blow to the head, a blow to the jaw, a sudden twisting or shearing force on the head and a sudden deceleration of the head.
“It is important to bear in mind that it is not necessary for a player who has suffered concussion to fall to the ground,” said Booysen.
“Also important is the fact that loss of consciousness is not a necessary sign of concussion, but may indicate its severity.”
South African sports scientist Ross Tucker said that in just two Super 14 rugby seasons, a total of 1 475 injuries were reported, an average of three injuries a player.
Although most of the injuries were to the legs, a proportion of the injuries were concussion related.
The rate of injuries was high, he said, emphasising the importance of “good player management”.
The next question, he said, might be whether these injuries were serious. - Weekend Argus