A Rugby Player-Turned-Researcher Tackles the Reality of Concussions
Exercise science assistant professor Katie Hunzinger has a personal drive to understand the risks and lifelong impacts of head injuries.
In the US, about 13-19% of all sports-related injuries are concussions. Concussions are a mild form of traumatic brain injury (TBI), where a sudden movement or impact causes the brain to bounce around in the skull. Most people will recover from concussions without long-term effects, but a growing body of research showing the dangers of large accumulations of head impacts and concussions has sparked more scientific interest in understanding the injury.
Still, there are a lot of misconceptions and unknowns about TBIs. Assistant professor of Exercise Science, Katie Hunzinger, PhD, ACSM-CEP, is working to change that, and she’s doing it from a unique position: as a rugby player and referee. She’s experienced concussions herself, and she’s now built a career researching the effects of head injuries. In this Q&A, Dr. Hunzinger talks about how her own experience with concussions prompted her to enter the field to make a change, and she mulls over a big question: whether she, knowing more about TBIs now, would let her future child play a high-contact sport like rugby.
How would you describe your research to the person riding the elevator with you?
My research focuses on the long-term effects of traumatic brain injury (TBI) and repetitive head impacts (RHIs) from sport. I use large datasets to ask how the long-term effects of RHIs and TBIs relate to health outcomes such as disease, injury and death. I’m personally interested in rugby as it is the only collision sport where men and women play by the same rules, and I’m a former collegiate rugby player and current rugby referee. I hope that by identifying how TBI impacts health, we can create targeted measures to reduce and prevent future injury risk, reduce symptom progression and lessen the healthcare burden of TBI.
What first sparked your interest in rugby and TBIs?
I suffered multiple sport-related concussions from basketball in college, which led me to playing rugby (go figure). The rugby team found me working out one day and said, “Do you want to play”? My dad played once, and I grew up playing tackle football, so it was a natural progression. During my time in graduate school, I suffered from persistent concussion symptoms related to a car accident; unfortunately, my treatment as a student was handled very differently than how it was when I was a student-athlete.
How did your lackluster concussion treatment motivate your eventual research career?
As a collegiate athlete, I was closely monitored by a multidisciplinary team and had a targeted rehabilitation program. As just a student, I was told to sit in a dark room and avoid school and exercise until I felt better. This “cocoon” therapy has been shown to exacerbate symptoms of concussion and slow healing. It is not recommended. This angered me — there was existing research supporting graded return to sport and return to learning, and data showing that cocoon therapy doesn’t work and shouldn’t be prescribed in the majority of cases. Historically in medicine, it takes about 14 years between the research being published to it reaching standard clinical practice. This delay in knowledge translation means that there may be answers and treatments out there that patients and their providers aren’t aware of.
What’s one question you’re exploring currently?
Currently, I’m looking at the relationship between prior TBI and gait in older adults: how do those with TBI history walk and perform a cognitive task (i.e., do two things at once) compared to those without TBI? This builds off of my previous work in middle-aged adults. It’s an important question because our daily lives often involve doing two things at once, be it walking while carrying our grandchildren, cooking while standing on a foam kitchen mat (i.e., an uneven surface), or walking and talking on the phone. The inability to do two things at once causes walking and balance errors, putting us at risk for falls and future injury.
What’s a unique fact about TBIs?
If you’ve seen one concussion, you’ve seen one concussion. It is a very heterogeneous injury, and everyone presents differently with different recovery timelines.
Is rugby still a big part of your life?
Yes! I am part of the regional development group of referees, representing the “top 100” rugby referees in the country. This permits me the ability to still be involved in rugby outside of playing. I am also serving on the Medical Board of Directors for Women’s Elite Rugby (WER) – the first ever professional women’s rugby league in the U.S.!
How do you reconcile your love of a high-contact sport like rugby with the growing research about the dangers of concussions? Do you think it’s possible to do these types of sports safely?
This is a tough question and one my spouse and I are constantly encountering as we look towards potential family planning. Most data on the long-term effects of contact sport participation rely on brain donations—this is an inherently biased sample as those experiencing neuropsychiatric distress are more likely to donate than those without any issues or dysfunction. Moreover, the brains of deceased 60–80-year-olds participated in contact sports in an era whereby if you were symptom free for 15 minutes, you were allowed to return to play. As such, these individuals may have experienced repetitive neurotrauma events, before the first brain injury healed. This is not to say that hitting your head is good; however, every sport comes with an injury risk, and I think the positive health benefits of sport outweigh the risk of injury. If our children decide that they would like to play a contact/collision sport, they will be permitted to. However, we will aim to reduce all unnecessary subconcussive impacts and if they experience an injury, we will consider if the risks outweigh the rewards as a family.
Is there a piece of advice that stuck with you or that you try to pass on to young researchers?
All of my advisors have served as role models and mentors, in addition to other friends from academia. Every academic wants to quit, but we don’t because we are stubborn and fueled by scientific inquiry. At the end of the day a done dissertation is a good dissertation; no one will change the world with one study. All of this is to say that your mental health matters, and you have to prioritize your wellness before the science.
