The culture change in Concussion management

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It has recently occurred to me that despite good intentions, I have neglected to use this blog to comment on any or all things sports medicine. So here goes…

As someone who works in an elite junior Australian collision sporting environment (rugby union), I have always found the management of concussion at the senior level to be backwards and inadequate. Aussie fans and children are too used to seeing images of ‘punch-drunk’ athletes having to be assisted off the field, clearly concussed, only to return to the field of play at some stage. We are lucky to have several contact sporting codes (rugby union/league/AFL) in this country, which are characterised by not only great athletic prowess but also physical courage. International visitors are always astounded by the speed and ferocity of the collisions involved, and the absence of any protective equipment (headgear and mouth guards notwithstanding). I for one absolutely love this physicality, and I simply implore the respective governing bodies of these sports to show some leadership in the area of managing a clearly concussed player.

The evidence is mounting, and it is compelling. Dissections of deceased ex-athlete’s brains are showing widespread post-traumatic encephalopathy (PTE), which of course leads to early-onset dementia. We in junior footy (I comment only on our practices) immediately remove the concussed player from the field of play, and said player is not allowed to return to play even if he/she ‘comes good’ on the sideline. They are then observed for at least 24 hours, before following up with a sports physician or their GP to plan return to play as per the IRB concussion guidelines. I would argue that the administrators of the respective football codes would all expect this level of care be afforded to their children at school sport, so why then is there such a leadership vacuum and an lack of duty of care when it comes to the high paid sports stars?

Thankfully the winds of change are now blowing in Australia. NRL hard man and media commentator Matty Johns recently wrote a courageous piece on how his views were “prehistoric” and that he was “ashamed” of them, while journalist and ex-Wallaby Peter FitzSimons has been a campaigner in this area. It is sad to think that possibly our greatest Wallaby of all time, George Smith, was disgracefully allowed to return to the field of play in his final outing in the green and gold after suffering a very significant concussion, from which he was unable to stand without assistance. In that moment, he was failed not only by the system, but by the people around him.

We are a nation proud of our sporting culture, and indeed our sporting heroes. It is time we protected them, and their brains.

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