Neuroscientist Helen Murray — captain of our national women's ice hockey team — talks to Joanna Wane about her groundbreaking research into long-term brain injuries from contact sports and why it won't stop her playing the game.
It's the final game of the final weekend of the 2020 NZ Women's Ice Hockey League and the clock is counting down. In a lightning-fast breakaway attack, Auckland captain Helen Murray streams down the Queenstown ice rink, a defender hard on her heels.
At the last possible moment, she takes the shot, burying the puck deep into the net. A split second later, she runs out of room to pull up in time and smashes into the back wall.
Murray's shoulder takes the impact first, then her head hits the wall. It's a nasty collision, but before the end of the game — which Auckland wins — she's back out on the ice. It's not until a few weeks later, as she's packing her gear for the world championships in Iceland, that she realises her helmet is broken.
It's telling, perhaps, that Murray can't recall what team they were playing that day or the exact scoreline, although she didn't experience any of the standard symptoms of concussion other than a headache on the night.
"I remember feeling foggy the next week at work," she says. "Difficulty focusing and very tired. I didn't feel great, but at the same time I didn't feel like I couldn't play. That's our mindset, as athletes. I could play, so I should play. I don't think you can trust us to make that decision."
Now 31, Murray has captained the national women's ice hockey team, the Ice Fernz, since 2016 and has no plans to retire. That insight into the psychology of a high-performance athlete is real-life experience she brings to the lab in her work as a neuroscientist at the University of Auckland's Centre for Brain Research. When she slides a slice of brain tissue under her microscope, looking for the telltale signs of damage from repeated head knocks, it's fair to say she has skin in the game.
Murray, who did her PhD on Alzheimer's, is leading a research study into the long-term effects of head injuries on contact-sport athletes who develop chronic traumatic encephalopathy, a progressive neurological disease that causes dementia. Next week, she's giving an online talk about the project as part of Auckland University's 2022 Raising the Bar speaker series.
The result of accumulated microtrauma, CTE isn't just about the big king-hits associated with concussion but a series of milder blows that shake the brain without triggering red flags that would lead to an enforced stand down. The kind of injury Murray suffered in her collision at the ice rink and brushed off at the time.
Science still has much to learn about CTE, which can be definitively diagnosed only after death by analysing brain tissue, although some people will begin showing warning signs in their 40s. Symptoms include personality and mood changes (impulsive and/or aggressive behaviour, depression and suicidal thinking), cognitive impairment (difficulty thinking/focusing and memory loss) and motor symptoms associated with Parkinson's and motor neurone disease.
So far, Murray has been lucky — and as careful as it's possible to be in a high-performance contact sport, where some level of risk is inevitable. She's never been knocked out (checks, where players can use their bodies to take out an opponent who has the puck, are illegal in the women's game), but some of her teammates have experienced ongoing problems from multiple concussions.
Worryingly, as elite women's sport ramps up, recent studies suggest female athletes may be at greater risk of concussion. The duration of exposure is a key factor, too. Research shows even the repeated heading of footballs causes low-level brain trauma, with the danger of serious damage increasing over time.
"I talk to people who have a probable or likely diagnosis of CTE and, honestly, I can't help but be a little bit terrified that it could be either my future or a friend's future," she says. "So yeah, it's pretty personal. But if someone said to me, 'You should stop playing hockey,' that just doesn't compute. This is a piece of me just as much as science is.
"I'm a huge advocate of sport because it has given me so much. A lot of the things I've learned as an athlete have made me a better scientist. I truly believe that sport can be fast and skilful and safe. I just think that we need to have a better understanding of what changes are happening and a better understanding of the risk.
"Some of that is making a decision on how long you stay out, but also whether you go back at all. It's tragic to get to that point where you have to make a decision on whether to choose your long-term health over doing what you love. I guess I'm trying to be the voice that says, 'What about in 20 years' time when your kids need you?' Sport is part of your life. It's not your entire life."
Murray played inline hockey on rollerblades as a kid before following her big brother on to the ice rink. Her father was a keen fan of fast, adventure sports. When she was 15, he died of bladder cancer.
Science had always been one of her strengths at school but their experience as a family after he was diagnosed convinced her she didn't want to be a doctor. "I think it was a frustration, where we didn't have all the answers we needed. I realised at that point I wanted to be figuring things out."
Sir Richard Faull, who founded the Centre for Brain Research in 2009, was one of Murray's undergraduate professors at the University of Auckland and turned her on to neuroscience. After her PhD, she did research at the National Institute of Health in Washington DC, commuting between New Zealand and the US before coming home permanently in late 2019.
The day she moved back, Faull launched the Sports Human Brain Bank Initiative. Specifically targeting donors who have played contact sports, it's an extension to the Neurological Foundation Human Brain Bank, which collects and stores donations of human brains and brain tissue for scientific research.
So far, around 40 people with a significant sporting history, including repeated head knocks, have registered as brain donors. However, building resources will inevitably take time. To get her research underway, Murray is collaborating with the Australian Sports Brain Bank to access tissue from brains with a confirmed diagnosis of CTE. Multiple codes are represented, with a mixture of professional and amateur players. "That's one of the key take-home messages," says Murray. "It affects recreational athletes as well."
When it comes to high-impact sports, a lot of the data is grim. A recent University of Glasgow study of post-mortem brain tissue from long-term football and rugby players who had dementia showed 75 per cent had CTE. Canadian research has found playing rugby can cause subtle brain damage in young people after just three matches, even from head knocks that aren't severe enough to cause concussion.
At the professional level, former All Blacks Carl Hayman and Neemia Tialata have joined dozens of other international players in a legal action against World Rugby over brain injuries suffered while playing the game. Hayman, a prop who played 46 tests, was diagnosed with early-onset dementia and probable CTE at the age of 41.
Increasingly, sporting codes are taking the issue seriously on the sidelines. Elite rugby players are automatically sent off the field for head injury assessments (HIAs), for example. An intensive study at Otago University is analysing head-impact data recorded by hundreds of players wearing specialist mouthguards, during games and also at training practices.
Murray's area of study, which has been funded by a $250,000 grant from the Health Research Council, takes a much longer view. "A lot of people are researching those acute phases," she says. "We're looking 10 to 20 years down the line at the long-term, chronic effects of those head injuries over a whole playing career."
By analysing changes in the brain tissue, including a telltale build-up of tangled tau protein and blood-vessel damage, Murray hopes to get a clearer understanding of how multiple head trauma leads to neurodegenerative diseases such as dementia, and identify early warning signs.
One of the techniques she developed during her work in the US uses multiflexing technology to tease out multiple strands of information from a single sample. "Being able to look at these microscopic images, which are art, basically, makes me excited because now I can see more than I ever could before. There's so much possibility and so much to learn. We still have so many questions."
Eventually, she hopes to identify markers that will make it possible to diagnose CTE via an MRI scan or blood test, rather than post-mortem. Symptoms of early-onset dementia or personality changes are often missed in those who are relatively young, delaying access to treatment and support. "For a lot of people, the fact that we're doing something here in New Zealand gives them some hope."
Each donation made to the brain bank is incredibly precious, says Murray. "We definitely have a reverence about working with brain tissue. It's always personal because the seat of someone's whole being is this organ. We're its caretakers and we have a responsibility to do research that gives meaning back to their families."
Some 750 brains have been donated to the Neurological Foundation Human Brain Bank since it was founded in 1994 — a valuable asset for researchers trying to untangle neurological disorders such as Parkinson's, Alzheimer's, Huntington's, stroke and motor neurone disease. A sports brain bank initiative, focused on donors who have played contact sports, was launched in 2019 to explore the long-term consequences of repeated head knocks. Here's how the donation process works:
* Register your interest at www.brainbank.ac.nz. You'll be sent a donor information pack and a member of the team will give you a call.
* Talk it through with your family, rather than leaving instructions in your will. Knowing your intentions will help them be prepared emotionally and ready to act quickly. The brain needs to be removed within 24 hours after death; the body is then returned to the family and does not preclude a viewing or open-casket funeral.
* Small tissue samples are sent to a neuropathologist and the findings — which may include a definitive diagnosis — will be reported back to the family. The brain bank can also share general information on the type of research projects the donation will be used for (healthy brains are needed for comparative study too).
Co-director Professor Maurice Curtis says every donation is treated with the utmost respect and makes an "incredible difference" to our understanding of human brain diseases and the development of potential treatments.
Usually held across a number of inner-city bars on a single night, Auckland University's Raising the Bar event has gone online this year with a weekly series of six digitally streamed live talks. To register for Helen Murray's presentation on May 11 at 8pm, or for one of the other speakers, visit www.rtbevent.com/akl-home-edition-2022. Recordings will also be made available.