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Opinion
If there are any concussion sceptics still out there, the net has been drawn in even closer, with the release of preliminary findings based on the first 21 completed studies from the Australian Sports Brain Bank.
Established in 2018, headed by Associate Professor Michael Buckland of Sydney University, its chief purpose has been to study Chronic Traumatic Encephalopathy (CTE) in Australia, diagnosable post-mortem, using donated brains.
While many prominent sportspeople, including rugby league legend, Peter Sterling, have pledged to donate their brains after death, the Brain Bank now has enough donations from which to be able to publish preliminary findings, released to the public today.
The report, published in the form of a peer reviewed research letter, makes for disturbing reading for all contact sports. It will almost certainly ramp up the pressure for the AFL, rugby league and rugby union administrations to do more to prevent and appropriately manage concussion.
Any person who experiences repetitive head injury, as commonly occurs in all of the main football codes, is at risk of CTE. CTE is associated with a range of neuro-psychological problems, including mood and behavioural symptoms, and cognitive impairment and dementia.
Fans will be aware of high-profile cases that have impacted on the lives of people like Danny Frawley, Shane Tuck and Jacinda Barclay (AFL), Steve Folkes, Steve Mortimer and Royce Simmons (rugby league), and Carl Hayman and Steve Thompson (rugby union).
These widely reported instances are the tip of a massive iceberg. The scourge of concussion extends from elite sport right down through community and school sport.
All 21 donors evaluated had participated in sports with risks of repetitive head injury. 11 were professional sportspeople, and 10 amateur. 19 were male. 17 donors were from across Australian rules football, rugby league and rugby union. The mean playing period, for both professional and amateur, was 15-16 years.
CTE was present in 12 of 21 cases. Disturbingly, 6 of the 12 donors with CTE had died by suicide, compared to one of the nine without; suggesting that CTE may be a risk factor in suicide.
Neurodegeneration of some form was identified in all but one donor brain, with CTE the most frequent neuropathology present.
(Photo by Cameron Spencer/Getty Images)
While it is important to recognise that ascertainment bias exists (the donor brains are not a sample from a random or normal population, but were motivated by clinical diagnoses or concerns of family members), there can be no hiding the concern of the Brain Bank and the report’s authors, around the prevalence of CTE in participants of contact sports.
The implications for sporting bodies are obvious. The report concludes by stating; “Our findings should encourage clinicians and policymakers to develop measures that further mitigate the risk of sport-related repetitive head injury.”
Frustratingly, concussion-related actions across sports continue to be focused on ‘low hanging fruit’; outcomes that are either easily achievable or are more aimed at signalling than genuinely achieving meaningful advancement.
In a general sense, management of participants who suffer head injuries has improved.
For example, last week, the NRL announced that it was removing club doctors from the in-match evaluation process, to ensure that decisions about taking concussed players from the field and/or allowing them to continue to play, were now solely in the hands of independent doctors.
Nevertheless, frustrations continue. The AFL, NRL and rugby union rely on a HIA assessment that is outmoded and assesses symptoms rather than the occurrence of concussion.
The AFL and NRL tout ‘best practice’ return to play protocols which include mandatory stand-down periods for concussed players of 12 and 11 days respectively, yet their own protocols contain loopholes that allow for players to return sooner.
Seemingly in the ‘too hard basket’ however, remain transformational measures that would ensure that the football codes are safer to play.
The AFL has taken some steps to minimise concussion incidences, with rules and judiciary changes ensuring that occurrences of sling tackles and players having their arms pinned while being tackled head-first into the ground, have reduced.
The nature of the sport however – where players enter contact zones from any angle – lends itself to incidences of head contact; often with high force. There are also serious concerns about the rapid growth of AFLW at a time where there is evidence that female players incur concussions at twice the rate of males, and that the negative effects of concussion on female brains, is more pronounced than in males.
This remains an issue that the AFL (and AFLW) has failed to acknowledge. What they are happy to talk about instead, is their goal for AFLW to “become the number one sporting choice for (Australian) girls and women.”
It is inconceivable that such an increase in participation could be achieved without a transparent and genuine attempt to inform all potential participants (and their parents) of the true risks of participation, and what measures and modifications are being pursued to reduce and minimise risk of concussion occurring in the first instance.
Despite the NRL heralding a ‘crack down’ on dangerous high contact last year, rugby league – at least in Australia – remains a game where avoidable high contact is tolerated too readily.
It is noteworthy that rugby league in the UK has made more progress on raising awareness of the dangers of concussion with participants and fans. But even if Australia was to ensure that high contact was refereed to the letter of the law and supported by a stronger judiciary, the NRL has not even started down the prevention path with respect to how tackling methods and defence philosophy might be adapted in order to minimise concussion instances.
Rugby union’s situation differs in that the laws are not set and regulated by the domestic Australian body, but by World Rugby, based in Dublin. In one sense, rugby’s global governance structure hinders nimble and decisive action, although on the other hand, it means that a lot more brainpower can be thrown at trying to solve important issues.
It has been achieved before; in the 1980s and 1990s there was a spate of players who died or suffered quadriplegia or paraplegia from scrum related neck and spine injuries. Another generation on, thanks to changes to laws and coaching methods, such injuries are now very rare.
Despite a lowering of tackle heights and increasing intolerance from officials with respect to high contact, there is a growing sense of unease amongst the rugby fraternity, that not enough is being done, quickly enough, to minimise concussion occurences.
Lobby groups such as the UK-based ‘Progressive Rugby’ have the ear of World Rugby, and there is a looming court case comprising a cohort of around 170 players which has the potential to change the landscape with respect to how rugby is played in the future.
Even so, it should not be the job of courts to determine how rugby is played. Inaction on concussion will ultimately kill the sport of its own accord, as professional and amateur players drop out at younger ages, and parents prevent their children from taking up rugby in the first place.
Management needs to be sharper as well. In the last few weeks, an England Under-20 team doctor argued on-pitch about a potentially concussed player with a referee who was correctly following protocol, and this weekend, Wales prop Tomas Francis was somehow allowed to play on against England – against protocol – despite showing obvious signs of concussion.
The value of the work conducted by the Australian Sports Brain Bank and other researchers around the world, cannot be underestimated. It will become increasingly impossible – if it isn’t already – for any sport to hide from the issue, or to continue to obfuscate and deflect.
These are difficult conversations for sports to have; how can all codes of football (including soccer) be made safer, without any modifications adversely changing the essence of what makes each sport great in the first place?
But initiating and facilitating such hard conversations should not be beyond any competent and genuine administrator who truly has the best long-term interest of their sport at heart.
That’s surely no more difficult a task than a doctor telling the family of a footballer who donated their brain, that it was their love of playing football that, ultimately, contributed to their death.
The full research letter, ‘Chronic traumatic encephalopathy in Australia: the first three years of the Australian Sports Brain Bank’, by Catherine M Suter, Andrew J Affleck, Alan J Pearce, Linda E Iles and Michael E Buckland, was published in the Medical Journal of Australia, on the 10th February, 2022.
Follow Geoff Parkes on Twitter @Allanthus