Tackling the truth head-on
As concerns grow about the potential long-term effects of repeated concussions, the days of copping knocks to the head and continuing to play are over.
Preventing, identifying and treating concussion has been a major focus of many professional clubs for years now, with improved return-to-play protocols, pitch-side concussion spotters and independent match-day doctors tracking players in real time and on replay screens.
But WA experts worry low awareness still remains at the community sports level and that not enough has been done across the board to keep children’s brains safe while they play popular contact sports such as football and rugby.
“Probably the area of greatest need, in my opinion, is the people who are not at the professional level but at the amateur level because they do not have team doctors on the sidelines and TV cameras tracking someone who is looking like they are showing some signs and symptoms of concussion,” said Melinda Fitzgerald, professor of neurotrauma and dean of research at Curtin University.
“There are some schools and leagues where it is being taken seriously but I don’t think that’s across the board and there is a real need to raise awareness for people in those amateur leagues and where kids are playing sport.”
Professor Fitzgerald acknowledges protections such as doctors watching, as in the AFL, are not practical or affordable at a community level but believes “there should be mandatory training for sports coaches and even the mum and dad coaches should have some sort of training in awareness of concussion”.
Short courses online, at minimal to no cost, is an example of how concussion recognition and management training could be delivered broadly in communities, she added.
Half of concussions are not reported
Professor Fitzgerald said junior sport could be very competitive and some players wanted to play through a knock to the head because of not wanting to let their team down, which is dangerous.
She said others involved in the sport should take responsibility for player safety, not just the player.
Research already shows more than 50 per cent of concussions are never reported to coaches, trainers or club medical staff. Other studies show young players are hesitant to report their suspected concussions and are reluctant to take the required time off because they don’t want to disappoint their teams.
And, because not everyone will experience loss of consciousness, people need to know the signs of a concussion which can include balance problems, slow reaction to stimuli, headache, confusion, blurred vision and memory problems.
These may come on immediately or develop over hours, weeks or even months.
“Concussion can be a serious injury and we think there is an issue with people not seeking medical attention, so the message we want to get out there is that people should seek medical care if they think they have experienced a concussion,” Professor Fitzgerald said. “It is also important to understand children’s brains are different — they are not just small adults — and there is greater vulnerability.
“Following the injury, children take longer to recover.”
She said repeated knocks to the head are also believed to be putting people at increased risk of brain disorders including chronic traumatic encephalopathy (CTE), a neurodegenerative brain disease which can only be diagnosed after death.
Originally known as punch drunk syndrome, and found in a lot of boxers, CTE has since been diagnosed in players from other contact sports including in former Australian Rules players Polly Farmer, Danny Frawley and Shane Tuck.
The problem was that for many years the risk of suffering a head injury on the field was viewed as an acceptable hazard of the job.
Repeated knocks to the head linked with developing depression and anxiety
According to Professor Fitzgerald though there is still an awful lot we don’t know about CTE, the science so far is concerning.
Revelations last year that a group of former rugby players in the UK have been diagnosed with dementia and likely CTE and are taking legal action against World Rugby and the Rugby Football Union in England was another strong indication that sports organisations can’t afford to stand back and wait and see.
The NFL in America has already paid damages to thousands of former players who suffered repetitive head injuries while playing.
According to Dr Thomas Hill, a sport and exercise medicine physician at SportsMed Subiaco and the WACA, it should be a requirement that all levels of collision sport — not just elite — have concussion education and policies. “If you are going to run community sport there needs to be a certain level of education and understanding and action plans in place,” said Dr Hill, who has managed concussion in codes including cricket, Australian Rules, rugby and ice hockey.
“So that means what is the plan, who is going to manage this and how can we make sure this kid is managed safely and carefully and is in the right hands not just on the field but coming off the field.
“There is already the mantra ‘If in doubt, leave them out’, for kids, which I think is really important.
“But when kids are playing rugby, footy and cricket, it’s also reliant on parents to be educated.
“We see kids down to the ages of nine or 10 with concussions and kids who have been hit in the head, had a clear concussion and are missing one week and then playing — this is definitely something where there is cause for concern.
“Things like even getting back to full-time school needs slow integration because concentrating and staring at screens and mental fatigue worsens symptoms.”
Rugby is the worst Australian sport for concussions
Research published in the British Journal of Sports Medicine revealed tackles are responsible for 64 per cent of all injuries in youth rugby and 87 per cent of concussions.
Dr Hill said he’s not suggesting to parents to avoid enrolling their kids in contact sports — the benefits of playing sports are huge.
“It’s hard because you don’t want to completely bubble wrap kids ... but with kids you do just have to be a bit more cautious,” he added. “A couple of years ago I had a young kid in who was 13 and a footy fanatic but he’d had six concussions and seizures after two of them. I had to make a judgment call saying I don’t think you should be playing contact sport.
“It was really hard because there is no threshold of concussions that are OK and that are not OK but what you have to do is weigh it all up and think, if this was my child, and with the evidence growing around repetitive concussions. And here we have a kid with a brain that is trying to mature and grow. Kids are the ones we need to be really protective of.
“There is mounting evidence to say repetitive blows to the head cause CTE but it’s tricky because it’s not the scenario at the moment where it is clear cut and that is the reason we have things like the Australian Sports Brain Bank (ASBB).”
Founded by Michael Buckland, head of neuropathology at Royal Prince Alfred Hospital, the ASBB is using donated brains to understand the full impact of sports-related concussion on the human nervous system. Scientists are also looking into factors such as the importance of age at first concussion and the role that length of playing career has.
Dr Hill said the associations between head injuries and contact sports have become a significant area of research globally. “We are in a landscape that is changing and they are still trying to work it out but I think when you are talking about such a serious side effect then err on the side of caution if you are not sure,” he said.
Want to learn more about concussion?
From June, connectivity.org.au will offer short online courses.
While most people who experience a concussion make a full recovery, about 15-30 per cent of people will go on to have persistent symptoms such as headaches or dizziness.
How to recognise concussion:
Symptoms can be varied and often occur in clusters. These can include:
Headaches and migraines
Anxiety and depression
Vestibular system function
Did you know?
Occasional hits to the head, such as the bumps and tumbles that children experience when learning to walk, do not cause CTE.
Source: Centres for Disease Control and Prevention cdc.gov
The Australian sport with the highest concussion rate is rugby (Union/League):
Rugby reports the highest incidence of sports-related concussion in the world, right alongside American football and ice hockey.
Source: SportsMed Subiaco
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