The spotlight has again fallen on any risk associated with rugby and neurodegenerative illness with the announcement that former England captain and 2003 World Cup winner Lewis Moody has been diagnosed with motor neurone disease (MND).
MND causes muscle weakness which progressively gets worse over months or years. Messages from motor neurones in the spine and brain gradually stop reaching muscles, which causes them to weaken, stiffen and waste.
There is currently no cure for MND, but treatments can help manage symptoms for as long as possible, although people with MND have a reduced life expectancy, typically of between two and five years.
The condition usually develops after the age of 50, but several high-profile former rugby players have been diagnosed with MND in recent years, including ex-Leeds Rhinos star Rob Burrow and former Scotland rugby union international Doddie Weir, who both died from the illness.
Former South Africa captain Joost van der Westhuizen died aged 45, six years after he was diagnosed with MND.
It affects up to 5,000 adults in the UK at any one time.
What are the symptoms?
Early symptoms include stiff or weak hands – people may have problems holding or gripping things.
Moody, 47, said he first noticed something was wrong after noticing some weakness in his shoulder while training in the gym.
Other signs include weak legs and feet. This can cause problems with tripping over, lifting the feet or climbing stairs, for example.
People may also experience painful twitches, spasms or muscle cramps. Later signs of MND include issues with breathing, swallowing and speaking. Around half of people with MND experience changes to their thinking and behaviour.
Different forms of MND affect people in different ways. Amyotrophic lateral sclerosis (ALS) is the most common form of MND, causing weakness and wasting in the limbs, muscle stiffness and cramps.
Bulbar onset MND or progressive bulbar palsy (PBP) mainly affects the muscles of the face, throat and tongue, with early signs including slurring of speech or difficulty swallowing.
Progressive muscular atrophy (PMA) affects fewer people, while primary lateral sclerosis (PLS) is a rare form of MND.
Neurologists can typically diagnose MND following a patient being referred by a GP. Tests that help diagnose MND include blood tests, tests on the nerves, and MRI scans. MND symptoms can progress at varying speeds, which can make diagnosing the condition challenging.
Can sport cause the condition?
A 2022 study from the University of Glasgow, published in the Journal of Neurology, Neurosurgery and Psychiatry, found that former international rugby players had around a 2.5 times higher risk of neurodegenerative disease compared to the rest of the population, with a 15 times higher risk of MND.
Led by consultant neuropathologist Professor Willie Stewart, experts compared health outcomes among 412 male, Scottish, former international rugby players and over 1,200 matched individuals from the general population.
Professor Stewart said at the time his study was published: “I am genuinely concerned about what is happening in the modern game, and that if, in 20 years’ time, we repeat this study, we would see something even more concerning.
“Rugby has talked a lot and done a lot about head injury management and whether it can reduce head injury during (training). Those conversations have gone on a while and the pace of progress is pretty slow.”
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Other research has suggested that people who play football at a professional level also have an increased risk of neurodegenerative disease.
Former Gloucester and Leicester Tigers rugby player Ed Slater was diagnosed with MND in 2022, but other sportspeople have been affected.Former Liverpool and Bradford footballer Stephen Darby was forced to retire at the age of 29 in 2018 after also being diagnosed with MND.
Previous studies have suggested that people who play football at a professional level have an increased risk of neurodegenerative disease, with a few of these studies suggesting that being a professional footballer increases a person’s risk of developing MND.
In the past decade, some evidence has emerged suggesting a potential link between contact sport participation, including American Football (NFL), and an increased risk of neurodegenerative disease.
The MND Association says that while these studies suggest a correlation between these professional sports and MND, they do not demonstrate causation – so they recognise that professional footballers and rugby players are more likely to develop MND but they do not suggest that playing football professionally, or any particular aspect of doing that, directly leads to a person developing MND.
“It is also important to keep in mind the number of reported MND cases in these studies is still relatively low, and so concluding there is a definite increased risk could be misinterpreted if this is simply a cluster due to random chance,” the charity says.
“A combination of environmental and lifestyle factors likely act together with specific genes to predispose people to get MND. What we don’t know is the exact recipe of these factors that triggers onset of the disease.”
It continues to fund research that experts hope will lead to answers.
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