Part of the email I received about the AFL injuries were some papers written about the concussion issue in the National Rugby League (NRL), Rugby Union and of course Footy. The first article was written by Fredric Gilbert, PhD and Bradley J. Partridge titled The need to tackle concussion in Australian football codes. The gist of the article was about the still hidden injury of concussion, relating to reporting and return to play. The authors wanted to point out that the cumulative effects of concussions are just now surfacing and that “all contact sports should adopt and evaluate the effects of precautionary policies that require concussed players to leave the field.”
What I really appreciated was the section devoted to youth sports;
Reducing the risk of concussive and subconcussive impacts is even more critical at the non-professional level, where there is a large population of vulnerable young players to whom a significant duty of care is owed.6 Most reported cases of second-impact syndrome (when a brain that has not healed from a previous injury suffers an additional trauma) that led to death or severe disability have occurred in young athletes.19 Yet most amateur teams do not have qualified health professionals or other staff who are trained to detect and assess concussion. At this level of sport, many concussions likely go unrecognised and incorrectly managed.20,21 However, if players and sporting organisations at the elite level change their approach to head injury and concussion, it is hoped that those at amateur levels will do likewise.
Although the state of athletic trainers – physios in Australia – is currently unknown to me it seems that the push is again for correct oversight for the youth. Gilbert and Partridge seem to be addressing the same issue we have been here about youth concussions, which is great to see. If the top-level of sport addresses the issue head on then it will trickle down. Just like those players sloughing off the concussions to play – and the young players trying to emulate – management can work the same way.
The article above did prompt an editorial reply from some heavy hitters in the continent of Australia, Dr. Andrew Kaye and Dr. Paul McCrory (the primary author of the Zurich Statement). The article was released May 14th and is titled Does football cause brain damage?
In the article Kaye and McCrory review the case of CTE and other anecdotal evidence that has been used against the collision sports, it is a great review and one that all should read. The parting two paragraphs caught my eye (as they should); the first was the information regarding head-gear the last was about the caution of media and using science to hammer out the issue;
There is no good clinical evidence that currently available protective equipment (especially soft-shell helmets) will prevent football-related concussion. Two randomised controlled trials have demonstrated the lack of efficacy of helmets in preventing concussion in rugby and Australian football, and extensive laboratory studies have shown that current helmets have little or no protective capability in this regard.16 The use of any protective equipment in contact sport is problematic, as players may adjust their play and take more risks. It has been recognised that hard helmets can be used as “weapons” by American footballers and may increase a tendency to engage in a more aggressive manner of play.1,2,17
At this stage, the available evidence suggests that current conservative management guidelines for acute concussion, if followed, are safe and appropriate.15 Sideline assessment tools for concussion have been developed for both lay and medical use and are freely available online or as apps for smartphones or tablet computers. The engagement of mainstream neuroscience in this area is important but, rather than driving the debate through the media, the issues raised need to be tested in the cold light of scientific peer review. We must remember that the plural of anecdote is not data.