Assessment of blood biomarkers of mild traumatic brain injury in professional rugby: a case control study

Objective to investigate plasma S100b concentration following competitive play and concussive episodes; to compare plasma S100b concentration in professional rugby players with age matched non-contact athletic controls; to develop an objective blood biomarker to aid in the diagnosis of concussion.

Design Prospective case-control study

Setting Professional rugby club, Elite rowing clubs.

Participants Professional rugby players (n=44); elite rowers (age/activity matched athletic controls) (n=16).

Interventions Blood samples were collected at baseline (14 days prior to training/competitive play) in both the rugby and rowing cohort. Rugby players were again assessed one hour following competitive games in the early, middle and late season (3 times). This was repeated again the following season (6 data sets). Concussed players were re-evaluated following concussion.

Outcomes Plasma was prepared and assessed for S100b concentration by ELISA (Abnova). Metabolomic profiling of samples was carried out by two-dimensional gas chromatography coupled to time-of-flight mass spectrometry (GC×GC-TOFMS).

Main results There was significant increase in plasma S100b following competitive play, compared to baseline (p<0.001). Over 1000 metabolites were detected by GC×GC-TOFMS in a single sample run, covering a functionally wide range of small molecules. The post-match metabolic profile showed significant changes in several metabolites; these are at present being validated and analysed further.

Conclusions There is a significant effect of competitive play on circulating S100b. Data on metabolomic profiles are being collected continually throughout the season and being clustered according to concussive and non-concussive episodes. It is hoped that this analysis may reveal concussion-specific changes in the metabolomic profile of players.

Competing interests None.

What Is a Chiropractor?

A chiropractor is a licensed health care professional who focuses on your body's capability to heal itself.

Chiropractic is a health care profession that cares for your neuromusculoskeletal system—the bones, nerves, muscles, tendons, and ligaments. A chiropractor helps manage back and neck pain through the use of spinal adjustments to maintain good alignment.

Chiropractic is focused on the body's ability to self-heal and includes other treatments like nutrition and exercise.

By improving the neuromusculoskeletal system's ability to perform, chiropractors believe the benefits of spinal adjustment and realigning joints Strengthen the functioning of other systems throughout the body.

A chiropractor cares for the bones, nerves, muscles, tendons, and ligaments in your body. Photo Credit: Shestock / Getty Images

Chiropractor vs. osteopath

Both areas are very similar. Chiropractors and osteopaths both work with your bones, connective tissue, and muscles to help with your body's function and structure. Osteopaths usually take a 4-year course to earn their BSc degree (BOst). Chiropractors have 4-5 years of training including a BSc in human sciences and chiropractic, as well as a year of postgraduate training. Then, they'll earn their degree in chiropractic.

Both experts use a common technique called the "high velocity thrust." This is a short and sharp motion done on your spine. It can be done in many ways. Chiropractors usually push on your spine with their hands, while osteopaths tend to use your arms and legs to make the thrusts. Many other movements are shared between the two professions.

Your chiropractor might use X-rays to help diagnose you, while an osteopath usually uses them to rule out other potential issues.

Treatment with your chiropractor might include six sessions. The first ones might be more frequent, while the later sessions may be on a weekly basis. With an osteopath, you'll tend to go to them "as needed" instead.

Chiropractors conduct an examination of a patient, looking at their spine's position and muscle reflexes. They also perform tests to diagnose the patient's condition, then come up with a treatment plan and monitor progress.

Chiropractors do not prescribe pain medication. Instead, they rely on and assist the body's ability to heal itself. A chiropractor's primary therapy is spinal manipulation where they use hands or instruments to apply force to a joint in the spine, moving the joint in a specific direction for better alignment.

Your chiropractor may perform treatments such as:

Adjustments. This can help realign your body, allow you to move better, and lower any pain you have.

Exercise. Your chiropractor might have you stretch or do certain exercises to help with joint mobility and balance.

Soft tissue therapy. This can help ease spasms, tension, and tight muscles in your body.

Kinesio taping. Your chiropractor might perform joint bracing or tapping to help with sprained joints or muscles.

Other treatments might include hot and cold treatment, diet and weight loss counseling, or relaxation methods.

Sometimes to relieve pain, chiropractors will go further by using massage therapy, ultrasound, braces, and shoe inserts. They might also refer you to other certified like integrative medicine experts. They can supply you more information on how to lower inflammation and keep a healthy weight through nutrition.

Where do chiropractors work?

Many chiropractors work alone, many times in special rooms within their own homes. Some also work in group clinics, general practices, or multidisciplinary practices.

Some chiropractors have contracts with health authorities, primary care groups, or other practices as well.

While chiropractors don't hold a medical doctor (MD) degree, they are doctors of chiropractic care. They're not medical doctors but are still considered doctors. Chiropractors study a lot of the same subjects that medical doctors do. This includes physiology, orthopedics, anatomy, microbiology, radiology, and more. They also have a very similar amount of patient experience time, hours spent in classes, and time spent in labs like medical school students.

In the U.S., the Doctor of Chiropractic degree is usually a 4-year program on top of 3 years of undergraduate study.

All states require a chiropractor to earn a Doctor of Chiropractic degree, pass the National Board of Chiropractic Examiners exam, and obtain a license to practice in that state. Doctoral programs provide studies in life sciences like anatomy and physiology. They also provide supervised experience in making exams, hands-on spinal adjustment techniques, and business training.

In order to start a Doctor of Chiropractic degree program in the U.S., you must have at least 3 years of undergraduate education. To supply out this degree, an institution must be accredited by the Council on Chiropractic Education.

This degree includes classes that cover anatomy, physiology, and other basic sciences. It also provides supervised clinical experience where you learn different hands-on skills.

You may also choose to complete postgraduate education in more focused areas, like pediatrics or orthopedics.

Some states require a background check and exams in that state's laws about chiropractic. And as a condition of ongoing licensing, all states require continuing education.

Chiropractor salary

Chiropractors made a median salary of $75,000 per year (or $36.06 per hour) as of 2021.

Low back pain, neck pain, and headache are the most common problems for which people seek chiropractic adjustment. Chiropractic care is a useful pain management resource. Chiropractors ensure the muscles surrounding the joints are working properly.

Chiropractors can also treat arthritic joint functioning. Depending on the type of arthritis, the chiropractor may provide gentle manipulation to increase range of motion and reduce muscle spasms.

A chiropractor can also treat things like:

Chiropractor for sciatica

If you have pain, numbness, tingling, or weakness from sciatica, a chiropractor may be able to help you. They can help figure out what's causing the issue. Plus, you don't need a referral to see a chiropractor, and they're covered under most insurance plans.

Your chiropractor can analyze your symptoms and decide the next best step. This might include:

Therapy. This might include heat application, massage and manipulation, acupuncture, stretching, and exercise.

Medications. They may suggest you talk to your doctor about a short-term prescription muscle relaxer, anti-inflammatory drug, or steroid.

Imaging scans. You may need to have an X-ray or MRI to look deeper into your pain.

Referrals. Your chiropractor may refer you to an occupational therapist, a physical therapist, or an acupuncturist.

If you do not want to use medication, see a chiropractor to manage or eliminate your pain in the low back, neck, and head. But there are other reasons to seek chiropractic therapy. They include:

It generally takes 6-10 visits to a chiropractor for most people to experience relief.

How much does a chiropractor cost?

Every location will have different prices. On the low end, an appointment may cost as low as $20. But it could range anywhere up to a few hundred dollars per appointment. If you have insurance, check to see if it covers your appointments. But some practices don't take insurance at all. This is because it can be difficult for practices, especially smaller ones, to go through the process of working with insurance companies.

Some practices also offer sessions in packages. If you buy sessions from a practice that does this, you'll pay up front for multiple sessions as opposed to paying per session.

Your first visit to the chiropractor will begin with an exam. You will likely be given a list of health questions to complete. Your chiropractor may also want to know if you have a history of migraines, your sleeping patterns, your diet, and if you are physically active.

You will also have a physical exam including your posture, a test of your muscle strength, your arm and leg mobility, and anything out of the ordinary like a shoulder or hip out of alignment.

Your chiropractor may also take an X-ray.

During a chiropractic procedure

Your chiropractor is trained in over 150 techniques, most of which rely on gentle manipulation.

To access various areas of your body, your chiropractor may position you in different ways. But usually, you will be on a specially padded chiropractic table, face down for chiropractic adjustments. As your chiropractor realigns your spine or joints using controlled force, you may hear popping and cracking sounds.

Your chiropractor may place you on a drop table, designed with sections that drop down when pressure is applied to the back. Another piece of equipment your chiropractor may use is known as an activator, a small device that may be used for gentle manipulation.

Following a chiropractic procedure

For several days following your visit, you may have a mild headache or feel fatigued or have soreness in the treated areas.

On rare occasions following a chiropractic procedure, some people experience problems that include:

However, most people experience immediate relief and over time see their health improve. Your chiropractor can provide you with valuable information such as good posture when standing, sleeping, and sitting at a desk.

You should contact your primary care physician if your chiropractic care does not alleviate your pain or if it gets worse. Also, contact your doctor if you notice anything unusual like feeling weak or experiencing numbness.

Chiropractors focus on your body's capability to heal itself. They work on your bones, nerves, muscles, tendons, and ligaments. They perform things like adjustments, exercise therapy, soft tissue therapy, and kinesio tapping. Chiropractic is similar to osteopathy. Chiropractors aren't medical doctors, but they go through similar schooling and training like medical doctors. They treat many different issues including low back pain, neck pain, and headache.

What does a chiropractic adjustment do for you?

Controlled and sudden force on your spinal joint will help Strengthen the motion of your spine and your body's overall physical function.

Are chiropractors good for lower back pain?

Chiropractors can help you solve your lower back pain. In rare cases, you could have serious complications. Don't get adjusted for lower back pain if you have cancer in your spine, a higher risk of stroke, a bone abnormality in your upper back, severe osteoporosis, or numbness, tingling, and loss of strength in an arm or a leg.

What is chiropractic therapy used for?

Chiropractic therapy cares for your neuromusculoskeletal system (bones, nerves, muscles, tendons, and ligaments).

Is chiropractic therapy good for you?

Chiropractic therapy can be very helpful. In rare cases, it can lead to issues.

Is chiropractic safe for sciatica?

Yes, chiropractic is safe and effective for sciatica.

Can chiropractors reduce swelling?

In some cases, chiropractors could help with your swelling. But make sure you know the cause of inflammtion first. For example, swelling with arthritis shouldn't be treated with chiropractic.

First professional female athlete diagnosed with degenerative brain disease CTE

Scientists in Australia have diagnosed the world’s first case of chronic traumatic encephalopathy, or CTE, in a professional female athlete, with implications for millions of girls and women who play contact sport.

Heather Anderson, an Australian Football League (AFL) player, was found to have low-stage CTE during an autopsy by scientists at the Australian Sports Brain Bank, whose peer-reviewed findings were published last week in the medical journal Acta Neuropathologica.

CTE is a neurodegenerative disease that can occur after repeated traumatic brain injuries or hits to the head, with or without a concussion, and to date it has only been diagnosed in professional male athletes.

But the rise of women’s participation in the same sports over the past two decades means they too are susceptible, the paper said, and especially so given research indicates that women are more vulnerable to concussion than men.

“Colleagues overseas been watching the professionalization of women’s contact sports over the last 10 years, and the surge in popularity and surge in participation by women in contact sports, so we’ve all been sort of thinking sooner or later, this disease is going to pop up,” said neuropathologist Michael Buckland, the paper’s co-author.

“It’s a bit like smoking and lung cancer. Early on lung cancer was enormous in men … and then women took up smoking in equal numbers. Then 20 years later, there was a big surge in women’s lung cancer,” said Buckland, a clinical associate professor at the University of Sydney.

“So I think we’re at the start of seeing the consequences of that surge in participation, both at the amateur and professional level.”

Anderson started playing football when she was five years old and went on to play contact sport for 18 years across two codes – AFL and rugby league – before her death by suicide at 28 last November, according to the paper.

Her professional career included 8 games over the 2017 season with AFL Club the Adelaide Crows, before she suffered a shoulder injury that ended her sporting career. She also worked as a medic for the Australian Defence Force.

Story continues

Originally from Darwin, Anderson was known for wearing a bright pink helmet on the pitch so her vision-impaired mother could see her play. Scientists say helmets and headbands can prevent skull fractures but don’t keep the brain from moving around inside the skull when someone is hit.

During her career, Anderson had one confirmed concussion, and suffered another suspected four, according to her family, who donated her brain to the Australian Sports Brain Bank for more answers as to why she died.

According to the paper, Anderson had no known history of alcohol or non-prescription drug abuse and had not exhibited any signs of depression or unusual behavior in the months before her death.

“While there are insufficient data to draw conclusions on any association between CTE and manner of death, suicide deaths are not uncommon in the cohorts where CTE is sought at autopsy,” the paper said.

Buckland said Anderson’s diagnosis shows women’s contact sports also need CTE minimization plans to reduce players’ exposure to cumulative head injuries, and those plans need to start at the junior level.

“I don’t think any child should be playing the contact version of a sport before high school,” he said. Other ways to reduce exposure include restricting contact during training, playing just one contact sport, and taking time off after a game when players have suffered hits, he said.

Heather Anderson wore a pink helmet so her vision-impaired mother could see her on the pitch. - James Elsby/AFL Photos/Getty Images

Awareness of the risks of head injury in sport has been growing over the past two decades, and scientists are still working to examine the impact of repeated knocks on the brain.

The US Centers for Disease Control and Prevention says “the research to date suggests that CTE is caused in part by repeated traumatic brain injuries, including concussions, and repeated hits to the head, called subconcussive head impacts.”

Repeated knocks can lead to the degeneration of brain tissue and an unusual buildup of a protein called tau, which is associated with symptoms such as memory loss, confusion, impulse control problems, aggression, depression, impaired judgment and suicidal behavior.

In the United States, the most recent research from the Concussion Legacy Foundation and Boston University’s CTE Center found that nearly 92% of 376 former NFL players who were studied were diagnosed with the brain disease. It’s also been found in the brains of former boxers, and ice hockey and soccer players.

In Australia, lawyers representing dozens of former professional AFL players have filed a class action suit against the Australian Football League (AFL), seeking compensation for injuries caused by alleged negligence.

The AFL has acknowledged a link between head trauma and CTE and says it’s committed to mitigating the risks. It was one of dozens of parties to provide submissions to an Australian government inquiry into the issue that is due to report on August 2.

The AFL Player’s Association, which represents the athletes, is pushing for greater support for current and former players, many of whom are living with the impact of successive brain injuries.

But Buckland said with so many other competing priorities, including broadcast rights and ticket sales, the industry can’t be expected to self-regulate, and an outside body needs to set the rules to ensure they’re followed.

CTE has been diagnosed in people as young as 17, but symptoms usually don’t appear until years later.

In 2019, about 15% of all US high school students reported one or more sports- or recreation-related concussions in the previous year, according to the US Centers for Disease Control and Prevention. Boys’ football, girls’ soccer and boys’ ice hockey were the sports with the highest concussion rates, according to the study.

Buckland said what’s most needed is a shift in attitudes, so that it’s no longer encouraged or even acceptable to expose children to activities where repeated head injuries are part of the game.

“It’s more than just a medical problem, it’s a sociological problem, as well. How do they change society? I think in the long run, it’ll be like smoking. (Stopping) smoking has taken generational change, and I think that’s what we’re looking at here.”

CNN’s Katherine Dillinger contributed to this report.

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