By Dr Jacques Conradie — Neurosurgeon
Why Men Bear the Brunt of Brain Injury and How Smart Technology Is Fighting Back
Every minute, somewhere on a sports field, construction site, or highway, a man sustains a traumatic brain injury (TBI). It may result from a crushing tackle, a falling scaffold plank, or the violent force of a motor vehicle collision. Whatever the cause, the burden falls disproportionately on men. In South Africa, men account for more than 90% of traumatic brain injury hospitalisations.
This Men’s Health Month, neurosurgeons and public health advocates are calling for a more honest conversation about traumatic brain injury, not only the dramatic cases that make headlines, but also the cumulative, often invisible damage caused by repeated impacts over time.
The statistics are striking. Men are more than twice as likely as women to sustain a traumatic brain injury and significantly more likely to suffer a fatal one. The reasons are multifactorial. Men dominate participation in high-contact sports such as rugby and boxing, make up the majority of workers in physically hazardous occupations, and are more likely to engage in high-risk behaviours, including reckless driving and driving under the influence.
Yet perhaps the most concerning risk is one men are often least likely to acknowledge: the cumulative effect of repeated subconcussive blows. These are impacts that do not produce obvious concussion symptoms and often go unnoticed, yet over time can cause measurable neurological damage.
This is believed to underlie chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease identified in post-mortem brain tissue of former athletes and military personnel exposed to repetitive head trauma.
In South Africa, where rugby forms a central part of sporting culture, this is particularly relevant. From an early age, many children are encouraged to participate in contact sports, often accumulating years of repeated head impact exposure before adulthood.
Over time, these repeated blows may contribute to progressive cognitive decline, mood disturbances, impaired impulse control, and in severe cases, early-onset dementia. The consequences can be devastating, affecting men in the prime of their working lives and compromising their ability to support their families and participate fully in society.
The challenge is that CTE can currently only be definitively diagnosed after death. However, advances in technology are changing how we detect and manage brain injury long before that point.
A new generation of wearable technology is transforming concussion detection in real time. Smart mouthguards embedded with accelerometers can measure the force, direction, and rotational velocity of impacts sustained during play, transmitting data wirelessly to sideline monitoring systems within milliseconds. When a predefined threshold is exceeded, an alert is triggered before the player even leaves the field.
Artificial intelligence is also reshaping concussion assessment. AI-powered platforms can now incorporate oculomotor testing, measuring subtle abnormalities in eye movement that correlate strongly with brain injury. These systems can detect concussion with greater sensitivity than symptom-based questionnaires alone.
Some platforms already used in professional rugby environments generate an objective concussion likelihood score within minutes, reducing reliance on self-reporting in a culture where “playing through pain” is still often celebrated.
The applications extend beyond sport. In occupational health, wearable impact-monitoring systems are being trialled for construction workers and military personnel, two populations at particularly high risk for traumatic brain injury. The long-term vision is a continuous neurological exposure record that clinicians could reference years later when evaluating unexplained cognitive decline.
This Men’s Health Month, the message from neurosurgeons is clear: brain injury is not an inevitable price of physicality. With better detection tools, earlier intervention, and a cultural shift in how male pain and vulnerability are perceived, many of the long-term consequences of traumatic brain injury can be prevented. The technology already exists. The challenge now is getting it into the hands and onto the heads of the men who need it most.