Planet Rugby investigates a concussion study that highlights serious concern for the long-term welfare of amateur players.
Throughout 2013, Dr Alan Pearce of Deakin University, Melbourne, conducted a study into professional and amateur ex-AFL players who had suffered serious concussions in their football careers.
Using a battery of physiological and psychological assessments, Pearce confirmed that multiple sports concussions can have a serious long-term impact on the brain, and found that amateur players are at just as great a risk as their professional counterparts.
Indeed, in a stark contradiction to the obvious disparities in size, strength and speed between the elite and recreational game, and despite the professional subjects sustaining, on average, more serious concussions, the amateur players were subject to the same neurological impact - a result Pearce admits he found personally surprising.
The neuroscientist and his team screened and examined twenty retired elite players and twenty retired amateur players; "weekend warriors" as they are colloquially known Down Under, with the aid of age-matched control subjects who had no history of playing contact sport or suffering concussion.
"A concussion is a concussion," Pearce told Planet Rugby.
"It really doesn't matter where you get a head injury - it's still a serious issue. We obviously had to screen players before we tested them; asking how many concussions they'd had, how serious they were.
"Some of the stories coming from amateur players were horrific - we had one guy who'd been knocked to the ground and had another player come through and kick him in the head - and they can be just as significant as what we see on television in the pro ranks.
"They may not be as big or as strong or causing as great an impact on each other; but when you talk about the hits that they are sustaining and ending up in hospital overnight, it really showed that it doesn't matter where you get your head injury, it's serious."
This, says Pearce, is reason aplenty to initiate a more vigilant and better informed approach to dealing with head injuries at the recreational level of contact sports, and a shift away from the macho, "shrug it off" attitude to concussion still perpetuated all too often across the board.
"The sports trainers or the first aiders on the sidelines at amateur level aren't necessarily able to recognise a concussion or know how to manage a head injury - particularly 25-30 years ago when these players were playing and there was even less understanding than now," stated Pearce.
"There was no reason why anyone would be looked at if they were kicked in the head. There's a great quote from a legendary Australian coach (John Kennedy) that I use when I'm giving presentations: "injuries above the neck don't count". That sums up the attitude of twenty-thirty years ago.
"Even though it was initially surprising to look back and hear what these guys have endured at amateur level, it doesn't surprise me now. They will probably suffer similar long-term consequences to the professionals as well."
Those long-term consequences could be quite marked. Pearce noted that, though the memory and association learning of both groups of players were largely intact, they performed poorly in tests assessing their motor skills and reaction times.
The Australian suggests this decline in motor control could act as something of a red flag for future cognitive impairments that characterise diseases such as dementia, Alzheimer's and Parkinson's.
So, what do Pearce's findings mean for a sport like rugby? With research emerging on a near-weekly basis regarding the link between repeated head trauma and those serious neurological conditions, the Australian urged sporting authorities like the IRB to face up to the issue.
Rugby's administrators, for their part, have appeared reluctant to accept this link in the past, prompting leading scientists to claim their heads are in the sand over the future neurological problems today's players may face.
"I would suggest we'll find similar symptoms in rugby players as well," added Pearce.
"Previously, I would have said rugby union or league would be different to AFL. Now, I'm of the view that if you get a head injury, it doesn't matter what sport you're playing, even a non-football code.
"I think that rugby needs to address the issue of taking those injuries seriously and making sure that rehab strategies and long-term outcomes are looked at as well. The literature is coming out every week showing more and more evidence from different sports, with different techniques.
"What we're showing is that there is definitely a link between repeated head injuries and the chance of someone getting dementia or Alzheimer's increasing significantly. We're learning more about this all the time.
"It'll be the responsibility of the administrators to acknowledge and make sure they do something about it, the way that the NFL has come round. We're not doing this to try and stop the sport or cause an issue; we're just trying to protect the health of these people long-term. We want people to play, but we want them to play safely."
Pearce argues that, while professional players have access to world-class medical attention, better care should be put in place to safeguard the "weekend warriors".
The neuroscientist is also keen to distance himself and his research from the media sensationalism that can take hold of many concussion studies; and is often highlighted by sporting governors as a distortion and misrepresentation of the true facts - "science by media", as Pearce terms it.
"Amateur players are getting head injuries and then going back to work," stated Pearce.
"If they're doing manual labour and they're still not right, workplace accidents could occur. In the acute study we did, the players that came in after a head injury just weren't with it. They often looked like they had the flu, they were visibly distant; it was quite observable that following a head injury there was something not right.
"That's why it's so important we address what's happening at recreational level - these people don't get looked after the same way as professionals. They don't have a medical team on hand; they don't get to rest on Monday.
"Professionals still get paid, but someone has to go back to work on a Monday. That's where we need to look at that more closely, that's where the majority of people who play the sport are at.
"Focussing on the recreational players is an area I want to look at in a number of different sports. The professional players are high-profile, and give you a bit of notoriety, but it's the people playing every weekend, getting head injuries, and not even realising it that's what I want to study.