'These injuries can happen to children every weekend, with serious results.' Photo: Ken Irwin
The US President Barack Obama spoke for all parents when he recently raised the topic of long-term damage caused by concussion in contact sports. In an interview with The New Republic, he said: ''I have to tell you, if I had a son, I'd have to think long and hard before I let him play football.''
The issue of long-term brain injury due to sport - whether professional or amateur - hit the headlines this week when Brownlow medallist and AFL premiership player Greg Williams talked of his own memory loss, which he blames on concussion he suffered while playing.
Williams is right when he says that - while it is important to recognise the risk of brain injury in our elite hockey, rugby, AFL and rugby union players - it's also critically important to recognise that these same injuries can happen to children every weekend, with much more serious results.
Last December, the international journal, Brain, published a study showing evidence of an increased risk of brain injury among athletes, military veterans and others who absorbed repeated hits to the head. The study, which included brain samples taken posthumously from 85 people who had histories of repeated mild traumatic brain injury, is further evidence that even mild head trauma can result in long-term cognitive impairment.
Of the group of 85 people, 80 per cent (68 men) - nearly all of whom played sports - showed evidence of chronic traumatic encephalopathy, or CTE, a degenerative and incurable disease whose symptoms can include memory loss, depression and dementia.
Together with researchers at the University of NSW and the George Institute, the Monash Injury Research Institute conducted a three-year study looking at the incidence of mild traumatic brain injury or concussion in rugby players. We followed almost 3000 Sydney school-grade and suburban rugby union players aged 15 to 48 for between one and three seasons to evaluate the frequency of concussions, injury management, and the impact on player brain function in subsequent days and weeks.
Not only did our findings show high numbers of concussions and relatively poor injury management - the situation was exacerbated when you step away from the professional league. While there is a recognition of the need to rest players after a concussion at the elite level, this same caution is not seen in the amateur games.
Coaches, sports doctors and physiotherapists assisted with the study, reporting that 48 per cent of players who sustained a concussion returned to play in the same game, and 34 per cent did not leave the field at all.
This is despite a recommendation from the International Rugby Board, supported by the Australian Rugby Union, that players who suffer a concussion take a three-week break from training and play. This regulation is mandatory for all international age-graded players under 19 years. Other players may return to play within three weeks if found to be symptom-free and declared fit to play by a recognised neurological specialist. The rules recognise that a knock to the head is serious and that players who suffer some loss of cognitive function and who return to the play without fully recovering may increase their risks of further injury.
But the message is not getting through: only 22 per cent of players identified as receiving a concussion in the study reported receiving any return-to-play advice. And 75 per cent of those players did not comply with the three-week stand-down period. Not one player in the study who received the recommended post-concussion advice complied; 87 per cent of concussed players returned to either training or competition within one week and 95 per cent had returned within three weeks of injury. So it's not just a lack of awareness of the rules regarding concussion - the rule itself is seen by the players as largely meaningless. It's not only a policing issue but one of education.
These findings indicate that return-to-play decisions and the management of sport-related concussion is a challenge for players, support staff and the sporting community. Sporting organisations and their regulatory bodies need to ensure adequate management, particularly as there is limited information on the long-term impact of mild traumatic brain injuries.
Australians love sport. Thousands of games are played over weekends, managed by volunteers. While it's worth saluting the parents on the sidelines with a bag of ice for injuries, there has to be greater recognition that sports injuries can be very serious and need to be properly managed.
If the risks are not being managed, more parents - like the Obamas - will either be glad their children don't play a contact sport, or refuse to let them do so because of the (very real) risk of brain injury.
Professor Mark Stevenson is director of the Monash University Accident Research Centre, within the Monash Injury Research Institute.
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