2019 has seen a dramatic spike in interest surrounding player welfare, especially in the area of concussions.
We recently learnt that Chronic Traumatic Encephalopathy, or CTE, was discovered in the brains of two former NRL players.
Currently the only way to know if a player has CTE, sadly, is via an autopsy.
This is of little help to current and past players – but what is of help is the painstaking research being undertaken to learn more about CTE and, hopefully, discover some way to detect it while the patient is still alive.
CTE is a disease of the brain which is predominantly caused by repeated head knocks. It’s something that has been studied for nearly a century now, starting with boxers back in the 1920s.
For near 80 years this condition was largely thought to only affect boxers, due to the tremendous volume of blows to the head that they took.
However by the mid 2000s it was found that this disease existed in athletes from other sports, with the case of legendary NFL player Mike Webster the most prominent.
This discovery saw all contact sports around the world immediately open their eyes to the very real and serious risks of CTE in players.
In Rugby League, there had long been penalties for players who attacked the head of an opponent, however in the past decade the game has enacted two major rule changes – banning the shoulder charge and banning punching.
While those rule changes were not directly due to CTE research, they have seen a reduction in high impact blows to the head, or serious whiplash cases which are just as bad.
These decisions have been welcomed improvements for players health and safety, it wasn’t until the NRL introduced mandatory Head Injury Assessments (HIAs), to determine the severity of a head knock and whether a player was fit to return to the field or not, that the game made its first rule change specifically in response to the growing evidence of CTE.
Recently I spoke with doctor Alan Pearce, a neuroscientist and associate professor at La Trobe University and concussion expert on my podcast Fergo and The Freak, where he explained an issue with the current HIA protocols which almost makes them seem archaic despite being only a recent addition to the game.
”What we’re finding from some of the research is that symptom recovery resolution, or recovery, doesn’t necessarily equal physiological recovery,” said Dr Pearce.
”Someone can get a concussion, they can show no symptoms within three or four days after – their headaches are gone, they can answer all the questions and do all the reverse number and reverse months quite comfortably, but what we’re seeing, and this has been shown in the United States and Canada, is that when we do some physiological measures, they haven’t returned to baseline.
He then went on to reveal that American and European studies into CTE found “if you are concussed, your risk of injury, musculoskeletal risk, could be an ankle, could be a knee, is increased by two and a half times if not fully recovered.”
“So you might see people who get concussed and then several weeks later they do a knee or an ankle. We haven’t linked the research back to brain physiology or brain processing, but my thinking is that, if there is an increased risk in injury after a concussion, maybe it’s because that split second awareness and processing you’ve got to do, and decision making is compromised, even by say a few hundred milliseconds, could be the difference between making a decision to go into that contest or not.”
I asked Dr Pearce “whether it would be smarter to (say), if they’ve had a head knock that’s been serious enough to determine a HIA is required, that they just don’t come onto the field at all?” to which his reply was unambiguous: “that’s right, yes.”
This revelation immediately casts doubts over the legitimate value of HIAs. There’s evidence which shows that each concussion a player suffers makes them more susceptible to concussion in the future.
More concussions makes you more likely to get knocked out more frequently. But to also know that returning to play too soon after suffering from a concussion can also increase the risk of other injuries surely means that head knocks need to be more seriously and intensely treated and studied for the sake of all parties involved.
The alternative clearly has to be independent doctors who specialise in neuroscience and concussion to evaluate every concussed player closely to ensure that they return to the field at precisely the right time.
The NRL needs to commence working much more openly and honestly with scientists to help the work in this area and hopefully make a safer environment for everyone to play the game, without compromising on the physicality and toughness that makes Rugby League exquisite.
Not doing so could well lead to the NRL introducing policies and laws, like the HIA, which is well-intentioned but not quite achieving what it is set out to do.
Players too, not just at the elite level and not just from the NRL, need to get in touch with people like Dr Pearce so as to assist his research. He is available on Twitter and also has a website.
Some players like Parramatta legend Peter Sterling and current Dragons big man James Graham have stated that they will dedicate their brains to science to help further this research, which is a noble and brilliant gesture to help future generations of players.
Hopefully more athletes, not just professionals, will follow suit and help this vitally important research.
Tom
Guest
This comment just shows the massive cultural barriers the NRL will face in dealing with the issue. In the past few weeks it has been revealed that Steve Folkes had CTE, and his family came out and said that in his latter years he exhibited numerous symptoms of that disease. Yet despite that, we still have 'fans' here saying the whole thing is fake news. The mind boggles.
Rob
Guest
I think the NRL (Rugby League) along with other sports as a whole are taking positive steps to address the issue by at least accepting the research.Certainly we don’t need the dinosaurs of yesteryear whining about the game going soft. I particularly agree with the crack down high impact late hit on players not in possession of the ball. The shoulder charge with no intent of wrapping the arms are a good start or head slams. It’s a collision sport but I would rather see officials penalise this out of the game than knit pick hold down interpretations. Watching players with pure football skills have long careers is better than watching rubbish thuggery.
Noosa Duck
Roar Rookie
It is not about doctors making rules the administration of the game makes the rules Doctors just advise. As for litigation, well we all know it is a volatile contact sport so no one holds a gun at your head to play the game , so buggered if I know how litigation can actually succeed
Noosa Duck
Roar Rookie
Having suffered a very severe concussion at around 17.5 years of age I understand just how debilitating such an event can be, regardless of how fit you may be. I was 6 weeks of recovery and it was without medical help, I was so sick that if I just jumped up & down once the pain in my head was excruciating, Lucky for me I did not shrug it off and there has been no obvious damage at this stage of my life, I say obvious for you never know. As far as I am concerned all players should have to have MRI brain scans twice yearly to be cleared to play.
Adam
Roar Guru
Yeah but surely most surfers learn to swim...cause you know that's the smart thing to do. Risk mitigation is a thing afterall
Andrew Ferguson
Expert
An opportunity is here to learn about detecting CTE while the patient is still alive and then work can commence on finding some form of remedy. It's not fake news.
Andrew Ferguson
Expert
Beer drinking impacts the brain in a different region to CTE. Current players have great trainers who ensure dehydration is avoided. The problem isn't imaginery. It is very real.
Insider
Roar Rookie
If my job gave me brain damage I’d sue as well
RogerTA
Roar Rookie
And yet ex-players in many sports are sueing. Go figure...
RogerTA
Roar Rookie
You must be brokenhearted by BHP chief Andrew Mackenzie's speech regarding the certainty of mass extinctions because of man made climate change and the need to act now?
The Barry
Roar Guru
I agree completely. I think it’s tenuous in the extreme for a player to suggest they didn’t know they were at risk of head injury and every day that passes it becomes less likely that anyone can claim they didn’t know. I work in WHS and workers compensation. There was this idea a few years ago about ‘towards zero’. Zero harm, zero injuries. It’s a lovely idea but completely impractical. It’s sort of where the cliche of the uptight WHS fun police came from. As you say there’s a level of residual and acceptable risk in everything we do. League is trying to find that point now. My comment is more pointing out what happens if you follow this path all the way, not what I think should happen.
elvis
Roar Rookie
This what happens when you start having doctors make the rules. 10 years studying to reduce harm but 0 on free choices in a liberal democracy. Everything is measured in length of life not quality of life and experiences. It is up to the individual if they want to take the risk of, in most cases minor brain damage, to play a sport they love, by all means make it safer, but just like skydiving or surfing there is always some inherent risk and people who are going to die doing it.
Albo
Roar Rookie
But Baz, going to work every day is never truly safe. Most of our diets are never truly safe. All we can really do is to minimise the risks and educate people. Like policing speed limits on our freeways driving to work, or ensuring OHS aspects are followed at work. But we can't just ban work because of its possible risks , just as we shouldn't ban sports for associated risks. We just need to minimise the risks as much as possible.
Insider
Roar Rookie
Max, fake news ? Hmmmmm you do agree though concussion is not healthy yeah ? Blokes hit each other and the force is equivalent to a car accident at approx 30-40 ks! You don’t see a problem with this ? You do know why boxers wear gloves? And it’s not to protect the head yeah ! ? It’s so hands don’t break when they make contact with the human skull, you are aware that you brain is protected by bone followed by CSF fluid which acts as a buffer, how about you go grab a raw egg, shake it as vigorously as you can they crack it, what happens to the yolk is what happens to you brain
Albo
Roar Rookie
I've long thought Tepai Moeroa should give it away and take up chess after the number of times he's been to the HIA. Instead he is going back to Rugby ?
Max
Guest
How many youg blokes get fit every year to play rugby league? Thousands. If they kill off rugby league to protect this fake news brain stuff, there will be thousands of men getting sick and dying from not having played an active sport. Someone do the maths? Which one is the better option? The one thing that could possibly work is touch footy. But who wants to watch that instead of NRL or AFL?
Max
Guest
Bonkers theory that belongs with climate change. The evidence can just as easily be the fault of too much beer drinking every week. Or maybe its from being repeatedly dehydrated from playing and training too much. When they've stopped sports where people actually die like rock fishing or hang gliding or climbing Mt Everest, then maybe they can start on 'fixing' league's imaginery problem.
The Barry
Roar Guru
This is a really tough issue. Interesting read and pretty confronting. Obviously we want the game to be as safe as possible, but it’s impossible for contact sports like league to be completely safe and maintain the essence of the game(s). I think there’s quite clearly a decision point coming. Do we accept there’s an inherent risk to these sports and players participate of their own free will? Or do we scrap these sorts of sports altogether? Ten years ago there were no HIAs. Today HIAs aren’t enough. Now we’re seeing players like Keary and Morgan take weeks out of the game to recover from concussions as they would from a musculoskeletal injury. I’ll bet what you like that will be found to not be enough before long, if it hasn’t already. Part of managing risk is determining what is an acceptable level of post control risk. If the decision is that any head knock or concussion or CTE is not acceptable, then the game will be done. It’s impossible to have 110kg blokes running into each other at 30km/hr and not have these types of injury. So while we strive to minimise harm, it can never be truly safe.
The Barry
Roar Guru
I’m pretty sure Liam Fulton retired because of repeated concussions.
up in the north
Roar Rookie
With respect to two recent cases with Luke Keary and Michael Morgan sitting out several weeks due to the severity of the concussions and the repetition of them, maybe we're already quite close to an early retirement from the game. If you were to do a risk assesment into league and try to factor out the dangerous elements then the game as we know it would disappear forever.