Top scientist Dr Helen Murray recommends introducing high-contact sports at older ages to minimise head-injury risks.
The Centre for Brain Research collaborates globally to study Chronic Traumatic Encephalopathy (CTE), aiming for a diagnostic test within a decade.
Two New Zealand athletes, including former rugby player Billy Guyton, were diagnosed with CTE this year.
New Zealand Rugby acknowledges the need for more research on rugby and CTE.
As she sits down with the Herald to discuss the important work of studying brain injuries, Dr Helen Murray – one of New Zealand’s top neuroscientists – sports a fresh bruise under her right eye, which she believes she picked up playing ice hockey.
With her two passions attimes overlapping, Murray is more qualified than most to understand the link between Chronic Traumatic Encephalopathy (CTE) and contact sport.
Aside from her years of work studying the human brain, she was also captain of New Zealand’s national ice hockey team, the Ice Fernz.
CTE is a neurological condition linked to repeated head trauma, where a patient’s brain deteriorates over time. Symptoms include memory deficits, mood changes and movement issues, among others.
As society becomes more aware of CTE and its relationship with contact sports, the work of the New Zealand Brain Bank is more important than ever.
This year, former Tasman, Blues, and Māori All Blacks halfback Billy Guyton was confirmed to have died with CTE. He was the first New Zealand athlete to be found with the condition.
In 2021, former All Blacks prop Carl Hayman revealed he’d been diagnosed with early onset dementia, as a result of numerous head injuries he sustained over his playing career.
While most research on CTE and sport originated from the United States, and concerns the NFL, New Zealand is playing its part.
In the early 1990s, the Neurological Foundation’s Human Brain Bank was established, allowing for research to be carried out in Aotearoa, with donations from families.
More than 700 brains have been stored in the bank since its opening, with nine different neurological conditions including Alzheimer’s, Parkinson’s, and CTE, stored at -80C.
Since 2009, the Centre for Brain Research (CBR) has studied numerous neurological conditions, including CTE, in collaboration with other brain banks of its kind around the world. In 2019, a specialised unit for sport was opened, allowing former athletes’ brains to be donated after they had died. The brains would be researched to better understand the link to head trauma.
Dr Helen Murray wants there to be a similar study applicable to female athletes or non-elite athletes. Photo / Michael Craig
But as much as we already know about CTE, there is still so much more to learn and understand.
“This is an ongoing story,” CBR director Sir Richard Faull told the Herald. “This is not the conclusion. We’re just beginning on the journey of trying to unravel the science.
“The outcome from such a study is going to be gradual over years.
“Getting a real scientific profile is the real problem. How much head injury is too much? Is any too much?”
For Murray, none of these cases come as a surprise. Given the national significance of contact sport, and rugby in particular, there will be thousands of cases in athletes that have gone undiagnosed for years.
Now, though, with the condition coming into mainstream focus, it’s hoped more and more affected people can come forward.
“It reflects what we probably already knew,” Murray said. “New Zealanders are affected by CTE.
“Just because there hadn’t been a case reported in New Zealand prior to our sports brain bank doesn’t mean it didn’t exist.
“The other reaction is it reflects there’s a raised awareness, these head injuries can have a long-term implication. That’s been a good thing, that people aren’t dismissing it.
“Also, a lot of these cases make me think of how we think of dementia and cognitive decline as being an ‘older person’s condition’. This is a situation where we’ve got relatively young people experiencing cognitive changes.
“It is a little bit scary. That’s what makes this quite different to some of the other things we study here.”
At present, one of the biggest problems around CTE is the fact that it can’t be diagnosed in living people. Both Guyton and the unnamed player’s cases were discovered after their deaths.
It’s hoped that within the next decade - possibly in five years - there will be a way to test for the condition in living people.
For now, thought, it’s important to understand the difference between concussion and CTE.
“Concussion is the symptoms you experience after a head injury,” Murray explained. “You can have heaps of these impacts during trainings, games where you feel absolutely fine. Asymptomatic things.
“We know that a lot of those sharp acceleration, deceleration twisting forces are building up over time. That’s the risk factor for CTE.
“It’s more about the exposure, accumulative number of impacts and the force of impacts over a long period of time.
“That’s the risk factor for CTE, as opposed to the number of concussions.
“The number one priority when I talk to people is diagnosis, and getting that right. If we can diagnose, we can get some idea of how many people are affected.”
New Zealand’s two biggest at-risk codes are taking steps to minimalism the risk of repeated head injuries.
Professional rugby requires players who fail head injury assessments (HIAs) to observe a 12-day stand down period before they are allowed to return to play in any capacity.
That window extends to 21 days at the amateur level, taking into account the lack of professional support, without access to the same resources.
In the NRL, an 11-day stand down is in place for the same reason, before any return is allowed to occur.
While Murray does commend the sports for having something in place to reduce risk for players, having a set time period to allow for recovery isn’t as simple as just putting a number of days on it.
“Every injury and every individual is going to be different,” she said. “For some people, that’s going to be nowhere near long enough. For others, it might be fine.
“It’s just so hard to put a blanket number and say ‘this is what’s safe’.
“You’re basing it on how someone’s feeling, whether their symptoms are gone. But we don’t have many measures where we can take an image, or a blood test and say ‘actually, your brain is still showing signs of damage, you should sit out for longer’.
“As guidelines, it’s hard to say what is enough time. My mindset is people should be super cautious. If you have any symptoms, irrespective of a stand down, you should listen to your body.”
That overlap hasn’t gone unnoticed either, with teammates and fellow players consistently coming to her with concerns over potential head injury worries.
And naturally, her two passions overlapping has affected the way Murray competes.
“I was always a cautious player,” she admits.
Away from the ice, veteran Ice Fernz player Helen Murray (left) is a neuroscientist, whose research centres around repeat head injuries and dementia. Photo / NZ Ice Hockey
“I’m never the type of player who’d run head-first into a collision with someone way bigger than me. I’m injury adverse. I haven’t had many head injuries because of the way I play.
“I’m way more aware now of impacts I would have dismissed before. Sometimes even the smaller impacts or what I think is a small impact can have a consequence for my long-term health.
“I’m just way more aware of it.”
In 2023, New Zealand Rugby moved to reject the link between repeated head injuries and CTE. When asked by the Herald for its current position, NZR said it believes more research is required to ascertain the full understanding of the link between its own sport and the condition.
“NZR acknowledges that there is an association between repeated head impacts and chronic traumatic encephalopathy neuropathologic change (CTE-NC), as identified in the autopsies of contact sport athletes. More rigorous research designs are required, including cohort studies which allow those involved in contact sports to be properly compared with those who have not played.
“NZR is actively contributing to understanding this area more with the largest study of its kind ever undertaken.
“Whilst there is debate about CTE-NC and scientific research associated with it, what can’t be disagreed with is that repeated head impacts are a safety risk in contact sports like rugby. NZR continues to prioritise reducing and mitigating that risk to participants at all levels of the game.
“Player welfare is one of NZR’s major priorities and we are absolutely focused on doing everything we can to keep players as safe as possible from the risks of concussion.
“We believe that we are world-leading in our approach, including providing ongoing care and concern to players through our work with the New Zealand Rugby Players Association, the New Zealand Rugby Foundation, and World Rugby.”
The risk of permanent injury, be it neurological or otherwise, has always been part of sport. But now more than ever, that risk is front and centre.
While it would perhaps be easy within the scientific community to find those willing to draw a line through participation in contact sport at any level, Murray and Sir Richard Faull are different.
Instead, Murray advises minimising risk through later participation in high-contact sport, introducing participation at later ages to allow for the brain to further develop before its placed at risk.
What’s more, the window of opportunity for head knocks to be suffered would also diminish, by reducing the number of years any player is exposed to contact.
However, at no point will exclusion from contact sport, or getting rid of it altogether be put forward by New Zealand’s experts.
“You’ve got to maintain perspective,” she said. “Not everyone who plays a contact sport is going to develop a neurodegenerative condition.
“In fact, the vast majority won’t. Part of the research is trying to figure out why some people do and some people don’t.
“We need to be careful. Diagnosis of dementia or cognitive decline is a life-changing thing, for the person, for their family. We don’t want to get it wrong. That weighs on me a lot.
“We don’t want to incite fear. Sport has so many positive benefits to our lives. I don’t think we should forget that.
“As someone who plays a contact sport, and loves my contact sport, I’d never tell someone that they shouldn’t do something they’re passionate about.
“We just have to look really honestly at the sports we play and ask where there is risk that doesn’t need to be there?
“I’ve thought about this so much. I don’t think I’d ever stop my kids from doing something they’re passionate about.
Former Blues halfback Billy Guyton (right). Photo / Photosport
“I’m not anti-sport at all. There’s risk in everything we do in life, but there is stuff we can do to make it as safe as we can.”
While the CBR continues to make strides in research of the brain and CTE in particular, it is limited in resources.
Funding will always be needed for research, but most significantly, so are brains.
People worried about damage or cognitive change in their loved ones are always welcomed to donate brains.
Anyone who has played contact sport for at least six years with an extended history of head injury in particular is what’s wanted.
However, control brains without any damage are also equally important, as control subjects to compare to those being studied.
That’s not just limited to men either; the rapid growth in the popularity of women’s sport will also see the same issues arise further down the track.
With more research, will come greater understanding. And most importantly for Kiwis, it’s hoped that understanding will pave the way for science to plot the best possible course for treatment and management of a condition that threatens to impact so many lives.
“You don’t have to be a rocket scientist to work out a hit to the head isn’t good for you,” Sir Richard said. “We need to put that into perspective for Aotearoa New Zealand. That’s where we can add to it.
“Ultimately, the outcome we want is to see how much of a problem we really do have. It’s probably going to take 10 years for that.
“But then [we have to] make sure we feed this on in a non-emotional way to influence the future of how we look after ourselves, make sure sport is being played as safely as we can, but not taking the fun out of it.”
Alex Powell is an Online Sports Editor for the NZ Herald. He has been a sports journalist since 2016, and previously worked for both Newshub and 1News.
