Are we overlooking serious injury?

In the 2018 AFL season there were 207 matches. Of these 207 matches there was a staggering 74 reported concussions. A number which has risen 11 cases from the 2017 season. This works out to a concussion reporting every 2.8 games. In Australian rugby league it is reported a concussion is sustained every 3.35 games.   

These statistics are more than alarming. Over the last few AFL seasons we have seen a number of rule changes to attempt to minimise concussion injuries, all based around protecting the player with his head over the ball. So why are we seeing a rise in reported cases?  

It is debatable that the National Football League of America is leading the way with concussion management protocols. Utilising a game day checklist comprising of numerous subjective and objective measures athletes are assessed for any sign of loss of conscious, gross motor instability, confusion or amnesia. If there are any positive signs the athlete is not allowed to return to the field. Prior to their return the athlete than follows a 5 step program to return to play which progresses from baseline balance assessments and vestibular acclimatisation tasks to light cardiovascular exercise. Following successful completion the athlete is then progressed to activity specific tasks before returning to contact drills. The final step however is what I believe to be the greatest advancement of the protocol. Once the team medical professional has cleared the athlete to return to play they are than assessed by an Independent Neurological Consultant (INC). It is up to the INC decision whether the player returns. Do we need to begin the implementation of INC’s into Australian sport? Is the competitive side of sport and the need to get a player back to the team being put ahead of possible future implications of concussion injury? 

The true extent of a concussion injury is not clear. It is not known whether return to play is detrimental or if prior injury is an indicator of further injury. In 1984 the term second-impact syndrome (SIS) was termed describing a situation where a concussion had been sustained a second time when the first incident had not been resolved.  This can result in serious swelling, oedema and herniation within the brain which may have catastrophic outcomes. There have been less than 20 reported cases in the medical literature of SIS therefore the true risk and pathophysiology is still not understood clearly. That said one condition which is beginning to hit the headlines more often is Chronic Traumatic Encephalopathy (CTE).  

CTE is a condition sustained post repetitive concussion injuries. The prevalence of CTE is very hard to quantify as it requires post coronal brain autopsies, something which isn’t commonly completed in today‘s studies. But what are the known effects of CTE? With the rise in concussion awareness more professional athletes are beginning to donate their brain for medical study. Prior to recent years it had not been found in Australian athletes however 2 cases have now been discovered in past NRL athletes. Symptoms of CTE have now been linked to such conditions as early onset Alzheimer’s (AD) and dementias. Often a diagnosis of AD or dementia is clear to make however it is not until post death that the diagnosis of CTE is able to be made. 

In professional sport athletes are educated and taught correct technique for tackling, falling and how to protect their body during game play. This has to make us wonder what the statistical figures are for our children playing weekend sports.  Often our kids are motivated to go into a game with the all or nothing mentality which may result in more injury risk. The development of a child and teenager brain is very important and, for males, may not fully mature until the mid to late 20’s.   

Often we may see clients with a musculoskeletal injury sustained during sport however the brain injury associated with a fall may be overlooked.  With the developments of Concussion injury in recent year it is time that we start being more proactive with concussion management in our kids sports. No longer is it acceptable to play the “you’ll be right. Run it off card”. As a parent, coach and spectator we now have the responsibility to question the decision of return to play and look for further assessment to minimise the risk of future complications in life. After all, sport is a socially inviting activity and important part of a child’s development but let’s not implicate their future development by the naivety of possible brain injury. Let your kids run, jump, push and pull and as a society lets make concussion a socially accepted discussion topic.  

Mitch Rabjones

Physiotherapist / Exercise Physiologist

Regenerate Physiotherapy

References: 

Australian Associated Press (2019, June 26th) Concussion in sport brain disease found in two former NRL player. Retrieved at: https://www.theguardian.com/sport/2019/jun/27/concussion-in-sport-brain-disease-found-in-two-former-nrl-players 

McGowan. M. ( 2019, June 27th). AFL Injury Report: Players missing more matches than ever. Retrieved from:https://www.foxsports.com.au/afl/afl-injury-report-hamstrings-concussion-costing-more-games-than-ever-before-in-2018/news-story/d7584d812f5d8932e28861fe58b4334d 

Play Smart, Play Safe (2018, June 22nd). NFL Head, Neck and Spine Committee’s Concussion Protocol Overview. Retrieved from:  https://www.playsmartplaysafe.com/newsroom/videos/nfl-head-neck-spine-committees-concussion-protocol-overview/ 

ALFMOA. ( 2013) Guidelines: AFL level. Cited at: http://www.neurosurgery.net.au/resources/Concussion/AFLMOA-Guidelines-AFL-Level.pdf 

White, P. E., Donaldson, A., Sullivan, S. J., Newton, J., & Finch, C. F. (2016). Australian Football League concussion guidelines: what do community players think?. BMJ open sport & exercise medicine, 2(1), e000169. 

McCrory P, Meeuwisse W, Aubry M et al. Consensus Statement on Concussion in Sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. British Journal of Sports Medicine 2013;47(5):1-11.