The long-term effects of sports concussion on retired Australian football players: A study using Transcranial Magnetic Stimulation
Abstract
This study investigated corticomotor excitability and inhibition, cognitive functioning, and fine motor dexterity in retired elite and amateur Australian football (AF) players who had sustained concussions during their playing careers. Forty male AF players who played at the elite level (n=20; mean age 49.7±5.7 years) or amateur level (n=20; mean age 48.4±6.9 years), and had sustained on average 3.2 concussions 21.9 years previously, were compared with 20 healthy age-matched male controls (mean age 47.56±6.85 years). All participants completed assessments of fine dexterity, visuomotor reaction time, spatial working memory (SWM), and associative learning (AL). Transcranial magnetic stimulation (TMS) was used to measure corticospinal excitability: stimulus-response (SR) curves and motor evoked potential (MEP) 125% of active motor threshold (aMT); and intracortical inhibition: cortical silent period (cSP), short-interval intracortical inhibition (SICI), and long-interval intracortical inhibition (LICI). Healthy participants performed better in dexterity (p=0.003), reaction (p=0.003), and movement time (p=0.037) than did both AF groups. Differences between AF groups were found in AL (p=0.027) and SWM (p=0.024). TMS measures revealed that both AF groups showed reduced cSP duration at 125% aMT (p>0.001) and differences in SR curves (p>0.001) than did healthy controls. Similarly, SICI (p=0.012) and LICI (p=0.009) were reduced in both AF groups compared with controls. Regression analyses revealed a significant contribution to differences in motor outcomes with the three measures of intracortical inhibition. The measures of inhibition differed, however, in terms of which performance measure they had a significant and unique predictive relationship with, reflecting the variety of participant concussion injuries. This study is the first to demonstrate differences in motor control and intracortical inhibition in AF players who had sustained concussions during their playing career two decades previously.
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The third finding, on the effects of recurrent injuries, is broadly consistent with the emerging literature on the adverse consequences of sports and combat-related neurotrauma.
“Our third finding, on the effects of recurrent injuries, is broadly consistent with the emerging literature on the adverse consequences of sports and combat-related neurotrauma [7,9,11–14,46–49].”
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Self-citationPostconcussion Symptoms and Neuropsychological Performance in Athletes: A Literature Review
Ahmed, B. Z., Benton, A. H., Serra-Jovenich, M., & Toldi, J. P. (2023) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000001028 · Cited by 7 · see citing works
Pearce, A. J., Kidgell, D. J., Frazer, A. K., Rist, B., & Tallent, J. (2023) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2023.120777 · Cited by 8 · see citing works
Self-citationA History of Concussion Does Not Lead to an Increase in Ocular Near Point of Convergence
van Donkelaar, P., Dierijck, J. K., Wright, A., & Smirl, J. D. (2018) · International Journal of Sports Medicine · doi:10.1055/s-0044-101454 · Cited by 7 · see citing works
Köfler, M., Ziemann, U., & Kimiskidis, V. Κ. (2021) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780198832256.013.12 · Cited by 6 · see citing works
Locke, M. B., Toepp, S. L., Turco, C. V., Harasym, D., Rathbone, M. P., Noseworthy, M. D., & Nelson, A. J. (2020) · Clinical Neurophysiology Practice · doi:10.1016/j.cnp.2020.07.004 · Cited by 6 · see citing works
Developing Cognition Endpoints for the CENTER-TBI Neuropsychological Test Battery
Stenberg, J., Karr, J. E., Terry, D. P., Saksvik, S. B., Vik, A., Skandsen, T., Silverberg, N. D., & Iverson, G. L. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.00670 · Cited by 6 · see citing works
Batten, J., Smith, M. J., Young, J. A., Braim, A. G., Jull, R. E., Samuels, C., Pearce, A. J., & White, A. J. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22030393 · Cited by 5 · see citing works
Self-citationPearce, A. J., King, D. A., Kidgell, D. J., Frazer, A. K., Tommerdahl, M., & Suter, C. M. (2022) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk7040109 · Cited by 4 · see citing works
Self-citationPearce, A. J., King, D. A., Kidgell, D. J., Frazer, A. K., Tommerdahl, M., & Suter, C. M. (2022) · medRxiv · doi:10.1101/2022.07.20.22277880 · Cited by 4 · see citing works
Self-citationMild traumatic brain injury alters function in the dorsolateral prefrontal cortex: a TMS-EEG study
Moore, E., Webb, E., Sasaki, R., Rogasch, N. C., Foo, N., Semmler, J. G., & Opie, G. M. (2025) · doi:10.1101/2025.05.22.655676 · Cited by 3 · see citing works
Transcranial Magnetic Stimulation Neurophysiology of Pediatric Traumatic Brain Injury
Barlow, K. M., & Seeger, T. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-802001-2.00017-5 · Cited by 3 · see citing works
Rau, T. F., Patel, S. A., Guzik, E. E., Sorich, E., & Pearce, A. J. (2017) · Concussion · doi:10.2217/cnc-2017-0002 · Cited by 3 · see citing works
Self-citationWard, J. R., Haakonssen, E., & Parsonage, J. R. (2024) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0000000000001271 · Cited by 2 · see citing works
Pearce, A. J., Davies, C. B., Major, B. P., & Maller, J. J. (2014) · Journal of Acute Disease · doi:10.1016/s2221-6189(14)60042-1 · Cited by 2 · see citing works
Self-citationMild Quadriceps and Hamstring Strength Deficits Do Not Persist After Sport-Related Concussion
Chmielewski, T. L., Suzuki, S., DuBose, D. F., Herman, D. C., Clugston, J. R., & Horodyski, M. (2022) · Sports Health A Multidisciplinary Approach · doi:10.1177/19417381221136140 · Cited by 2 · see citing works
Noninvasive brain stimulation and athletic performance: a critical narrative review
Deng, J., Chen, Q., Luo, L., Wang, Q., Lv, Z., Luo, X., & Liang, J. (2025) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-025-01455-1 · Cited by 1 · see citing works
Rist, B., Young, J. A., & Pearce, A. J. (2018) · International journal of exercise science · doi:10.70252/iiat2928 · Cited by 1 · see citing works
Self-citationPearce, A. J. (2019) · OBM Neurobiology · doi:10.21926/obm.neurobiol.1903042 · Cited by 1 · see citing works
Self-citationPearce, A. J., Tallent, J., Frazer, A. K., Rist, B., & Kidgell, D. J. (2024) · medRxiv · doi:10.1101/2024.05.28.24308010 · Cited by 1 · see citing works
Self-citationMobbs, R. E., Batchelor, J., Teunisse, A. K., Erskine, E., Brown, E., Hood, J., Mobbs, A. E. D., Fraser, C. L., Pearce, A. J., Stevenson, R. J., et al. (2021) · medRxiv · doi:10.1101/2021.04.20.21255372
Self-citationPearce, A. J., Kidgell, D. J., Fraser, A. K., Rist, B., & Tallent, J. (2023) · medRxiv · doi:10.1101/2023.03.18.23287431
Self-citationSomatosensory differences between symptomatic and non-symptomatic retired contact sport athletesPreprint
Beck, B., Kidgell, D. J., King, D. A., Frazer, A. K., Tommerdahl, M., & Pearce, A. J. (2024) · medRxiv · doi:10.1101/2024.09.01.24312914
Self-citationPearce, A. J., Tallent, J., Frazer, A. K., Rist, B., & Kidgell, D. J. (2025) · Journal of Clinical Neurophysiology · doi:10.1097/wnp.0000000000001155
Self-citationPearce, A. J., & King, D. A. (2025) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk10040414
Self-citationEpifano, D. J., Wheat, J. S., Heller, B. W., Pearce, A. J., & Middleton, K. J. (2025) · Applied Sciences · doi:10.3390/app152312814
Self-citationPauhl, A. N., Kells, A. M., MacNeill, C., MacKenzie, H. M., & Christie, A. D. (2026) · Brain Injury · doi:10.1080/02699052.2026.2614067
- Authors
- Pearce, A. J., Hoy, K., Rogers, M. A., Corp, D. T., Maller, J. J., Drury, H. G. K., & Fitzgerald, P. B.
- Affiliations
- Deakin University (AU)
- The Alfred Hospital (AU)
- Deakin University
- Corresponding author
- Pearce, Alan J.
- Venue
- Journal of Neurotrauma
- Publisher
- SAGE Publications
- Published
- 2014-07
- Volume
- 31
- Issue
- 13
- Pages
- 1139-1145
- ISSN
- 0897-7151 (ISSN-L)
- 1557-9042
- OpenAlex
- W1971975638
- Cited by
- 73
- References
- 50
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 5 · 2020: 12 · 2019: 5 · 2018: 6 · 2017: 3 · 2016: 13 · 2015: 6 · 2014: 4
- FWCI
- 6.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Neurotrauma (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- sports-related concussion, Australian football, former athletes, long-term effects, corticospinal excitability, intracortical inhibition, corticomotor excitability, fine motor dexterity, spatial working memory, associative learning, reaction time, cortical silent period, short-interval intracortical inhibition, long-interval intracortical inhibition, motor control
- MeSH terms
- Adult, Athletic Injuries, Australia, Brain Concussion, Electromyography, Female, Humans, Male, Middle Aged, Soccer, Transcranial Magnetic Stimulation
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