Sports bodies need a cultural shift around concussion

The current AFL season has been plagued by headlines about the dangers of concussions, with 6 players announcing their early retirement due to excessive head knocks. 

Chronic traumatic encephalopathy (CTE), along with long-term cognitive decline, is commonly recognised as one of the most serious and dangerous consequences of repetitive sports concussions. 

But a new study led by researchers from the University of New South Wales (UNSW) in collaboration with the Universities of Exeter, Oxford and Harvard University, has found that, contrary to longstanding concerns, the benefits of participation in sports may outweigh the negative effects of concussions. 

Dr Matt Lennon, lead author of the study, says that the findings suggest “there is something about playing sport, even though a person may experience concussion, that may be beneficial for long-term cognitive outcomes.”

The study, in the Journal of Neurology, Neurosurgery and Psychiatry, analysed data from more than 15,000 participants aged 50 to 90. It found that non-professional athletes who have sustained sport-related concussions perform better in certain cognitive areas compared to those who have never experienced a sports-related concussion. 

Concussion expert and neuroscientist Professor Alan Pearce from Swinburne University agrees with the general hypothesis that sport can produce great health benefits, but he argues that the new research may overshadow a larger problem within the sports industry.

“What we’ve been arguing for a number of years is that this issue about long-term outcomes isn’t around concussion injury. But rather exposure to repetitive neurotrauma,” Pearce told Cosmos.

Repetitive neurotrauma refers to the thousands of bumps and smaller tackles that professional and non-professional athletes take to the body throughout training and game day. 

“We’re talking about 20,000 maybe 40,000 impacts to the head over an athlete’s career, as opposed to say 3 or 5 or even 10 concussions.”

These smaller but more persistent bumps can greatly damage neurological health because athletes don’t take the time to recover from them. 

“The analogy we like to use is skin cancer,” says Pearce. “It’s not good to get burnt, but maybe if you got burnt once in the sun, and then you never really went out into the sun ever again, your chances of melanoma are probably reduced as opposed to someone who goes out every weekend, 5 hours a day, lying in the sun but not getting burnt.”

So, rather than just focusing on concussions, according to Pearce, athletes should be taking these repetitive head knocks just as seriously as concussions.

“We have people with dementia and CTE, who’ve never had a concussion. This is why we need to try and move the conversation away from just concussion in sport,” says Pearce.

He says we need a cultural shift within how the media and sports industry portray risky head knocks.

Concussion: a special Cosmos series

When it comes to sport, the first step in preventing CTE and other brain-related injuries is to give the brain a recovery period after a head knock before going back out to play. 

Earlier this year, the Australian Sports Commission extended the concussion recovery period at a community level to 3 weeks. However, at an elite level, AFL players are only required to take 12 days and NRL players only 11 days, before they can return after a concussion. 

But the latest research suggests that it can take up to 21-30 days to recover from concussions. 

“We know from the science that the brain takes longer than symptom recovery to be fully recovered,” says Pearce.

“So the concern is that players can still go back too soon, and they’re at greater risk of further injury, whether that be another concussion or a musculoskeletal injury.”

Returning too soon after a concussion can also be detrimental to an athlete’s physical health, with studies showing athletes can experience impaired motor control after concussions, increasing the risk of musculoskeletal injuries. 

Reducing contact at training can also help lower the amount of repetitive neuro trauma incidents that athletes experience. 

“We’re seeing that players who are not beaten around during training during the week are actually playing better on the weekends because they’re fresher, they’re not as fatigued and they’re not as beaten up,” said Pearce. 

More advanced monitoring tools will also be a part of the solution. Smart mouthguards, such as the one developed by HITQI, use 3D sensors to detect head impacts. Data from these tools can help athletes have a more informed idea of the impact their heads receive during a game to decide whether they need to sit out next week. 

Pearce advocates for the need to modify children’s sports to non-contact to reduce the exposure risk. 

For Pearce, it’s not a matter of stopping kids from playing sport, but rather altering the game to minimise the risk of head knocks. 

“CTE is not an old person’s disease. We’ve had people as young as 21 with CTE at the brain bank in Australia, and in America they’ve had cases as young as 17. And that’s because they’ve started playing full contact from the age of 5,” he says.

Pearce suggests that reducing kids’ exposure to contact sports until the age of 14 can help prevent CTE and other brain-trauma injuries. 

“We’ve had a number of female athletes in our brain bank cohort and a lot of them started full contact at 14-15 years of age, and we didn’t find CTE in their brains.”

Pearce says we need a cultural shift around concussions. 

“The same way we’ve now shifted our tone on smoking, and we’re starting to shift our tone on gambling. We’ve got to do the same thing with concussion,” he says.

Concussions and head knocks often rely on self-reporting as a main observation measure, but studies have shown that, on average, male athletes tend to be more dishonest when it comes to self-reporting.

“I don’t think that’s getting talked about enough. Female athletes are more honest and are more compliant to do their rehab than males, who don’t want to be seen as weak. They don’t want to be perceived as not committed to their sport,” says Pearce. 

Pearce says confronting these unhealthy stereotypes will be the key to better management of neurological health. 

“It’s not about being seen as weak or letting your teammates or coach down. It’s about your own neurological health, and that’s the most important thing.”

Velentina Boulter is a Cosmos intern, studying journalism at the University of Melbourne.