Ex-rugby international Kathryn Dane: ‘I got exposed to concussions from a pretty young age’

Former Ireland rugby international Kathryn Dane (29) started playing the game at the age of eight with boys in her hometown of Enniskillen, Co Fermanagh.

“I got exposed to head impacts and concussions from a pretty young age because of the volunteer-led nature of community rugby,” she says. “None of those concussions in my adolescence were diagnosed. I think my first diagnosed concussion was when I was 18.”

She had moved to Dublin to study physiotherapy at Trinity College Dublin and was playing for Old Belvedere. Her concussion was identified “purely because one of the girls that I was playing with was a doctor”.

One of the big barriers, she suggests, to concussion recognition, diagnosis and management in community rugby, especially for girls and women, is lack of access to healthcare professionals. She recalls two concussions in her international career, both during training. A scrumhalf, she got her first cap in the 2019 Six Nations and continued to play regularly for Ireland until 2024.

A brain haemorrhage she suffered in 2022 at age 26, while recovering from an injury to her anterior cruciate ligament (ACL), was nothing to do with rugby, she says. It was caused by an arteriovenous malformation in her brain. This is an abnormal cluster of blood vessels, vulnerable to rupture, which she was probably born with.

“I was rehabbing my ACL injury in the IRFU gym one morning and I was doing very moderate weights to warm myself up – that’s when I had the stroke.”

She considers herself very lucky that there was expertise on hand to recognise what was happening and to ensure her speedy transfer to hospital.

Remarkably, she returned to playing rugby, and her last international game was for the Barbarians in September 2024. She didn’t formally announce her retirement.

“I just hoped to disappear into my work,” says Dane in a video call from Canada, where she is a postdoctoral associate with the Sport Injury Prevention Research Centre in the University of Calgary. “A lot of my work focuses on the gender differences in injury risk and injury management and the social-cultural factors surrounding athletes.”

[ How women’s concussions differ biologically from men’sOpens in new window ]

She believes that, historically, research has overemphasised biological components of brain injuries. Whereas, she adds, “gender imbalances and the factors that impact an athlete’s access to the right help and the proper recognition and management of concussion, to prevent recurrent concussions”, remain underexplored.

We know levels of sport for younger people are much less resourced than the adult game, she points out, and there are also gaps between boys’ and girls’ teams.

“In the boys’ levels of the games, there are performance pathways, and typically coaches are probably a bit more experienced or better qualified too. So they likely have a better grasp or procedural knowledge of concussion protocols than, say, the volunteer parent in the girls’ rugby team.”

However, she stresses “the benefits of the game far outweigh the risk of concussion in my mind, especially the social benefits of playing a sport like rugby. But we could do a hell of a lot better job of resourcing, or having at least care pathways, available to young people playing the sport”.

She is also critical of a “putting your body on the line” culture in sports such as rugby, Gaelic football and others. One woman she interviewed in her research spoke of how “you put your head at somebody’s laces”.

[ ‘He was back on in five minutes’: The former Munster captain now suffering with dementiaOpens in new window ]

“That’s just like totally normalising the kind of risk-taking behaviours that come with these sports,” says Dane, who has witnessed how parents “are some of the worst offenders for perpetuating those sport-ethic norms”.

She has also seen how gender-related pressure leads to risk-taking among female players. In the face of an attitude that it’s no game for “the fairer sex”, they feel they have to prove themselves on the pitch. “It’s another angle that has to be considered in prevention of concussion in girls and women.”

Learning to tackle properly is a big preventive factor. Dane’s PhD at Trinity explored the safety and optimal tackle outcomes in women’s rugby. Policy and laws around any sport are also important, such as lowering of the tackle height in rugby, but this needs to refereed and sanctioned. More attention is also being paid to neck strengthening and body bracing in training.

“The research is ongoing with that, but it’s looking really promising for reducing injuries.”

However the male bias is still a problem. “Until we start having female, women and girls-specific data to inform practice and policy, that’s where we’re going to make the most progress, I think, for prevention and proper management.”

[ Kathryn Dane: ‘I was surprised by the lack of preparation women had for rugby tackles’Opens in new window ]

Meanwhile, groundbreaking research at Trinity has pinpointed a breakdown in the blood-brain barrier as a key link between head injuries and poor brain health in retired athletes.

[ ‘Leaky’ brain barrier a key link between head trauma and brain disease, study findsOpens in new window ]

The properties of blood vessels in the brain are such that they tightly regulate what gets in and out of the brain on a daily basis, explains the research co-leader, Prof Matthew Campbell, professor of neurovascular genetics and head of Trinity’s genetics department. But when this barrier is “leaky”, inflammatory proteins seep in. This can lead to the build-up of p-Tau, a toxic protein associated with dementia.

“We found that retired athletes with the most extensive ‘leakage’ in their brain barrier also scored significantly lower on cognitive tests, specifically those measuring memory and executive function,” says Campbell. What he describes as a “weird conclusion” from the research, which was published in March, is that the number of concussions does not appear to be the issue.

“It’s the length of the playing career, which would then suggest that it’s the repetitive nature of the sport, the repetitive, sub-concussive forces, that are actually the problem.”

The Trinity researchers are starting to recruit retired female athletes for the research, which is male-biased, Campbell acknowledges, simply because of the lack of older women meeting the criteria.

Having started so young, Dane had many more playing years under her belt than most of her international team-mates. But she is not sure of the merit of delaying contact in rugby until into the teenage years, as practised in some countries, to reduce the number of hits a player takes over a career.

Her early days “were formative for me developing really good technique ... Whereas I think if I started contact at 18, I would probably just be a lot clumsier”.

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