Keeping a-head of concussion in the world’s collision sports
All collision sports now live in the era of ‘Concussion’, and the greater need is for increased knowledge about head injuries relaying to the brain from trauma through contact with another body, the ball itself, or the fall to the ground.
Each day there are articles about concussion regarding the dangers, controversies, and denials and ‘what parents should know’. Now there are medical reports suggesting that concussions and recovery are slower in the female, who’s increasing participation in the contact sports is a development which is widely welcomed. What we all need to know and fully comprehend is how to make the game safer with the knowledge that it will never ever be completely safe. Indeed, there is no sport, whether team or individual, that is completely safe.
It would likely surprise most readers to know that Rugby League, as a sport, is far from top of the list when it comes to the world’s dangerous sports.
The playing fields of the National Rugby League (NRL) have for many years provided the medical world at large with the greatest of orthopaedic research laboratories, and the same for head injuries. The NRL has been a participant in collecting and disseminating the effects of, and the counter to Sports Related Injuries (SRI).
Continuation of the NRL involvement and the concerted effort by the major world contact and non-contact sports administration’s in Sports Allied for Educational Research (SAFER) with a prime directive of medical research into the prevention, diagnosis and treatment of head injuries.
It is of prime importance to recognise that the real challenge for the impact sports is to ensure their game remains increasingly popular whilst progressively making sure it becomes safer.
The rugby league media itself is to be complimented by their articulation of the concern around head injuries, both in the manner of the sensitivity of the subject and reporting the facts with integrity.
The media at large shows a shared common desire in retaining the inherent aggression of rugby league, whilst progressively and continually diminishing, even eliminating the chance of head injuries. The results of SAFER research would benefit all in the long and short term and be an enormous contribution to all of society, whether for the game or the wider community itself.
Some points of observation…
Question and Answer
Q.The NFL will continue to use the hard helmet albeit with modifications. Will this work in RLs favour should the NRL consider helmets?
A.Never The answer is in the helmet itself. The NFL helmet significantly reduces peripheral vision which is so necessary in a sport that requires the ball be always passed backwards.
Q What about soft headgear? Every research group and physiologist say, and I quote, “Cosmetic only”.
A. Not good enough from manufacturers. Certainly, the opportunity is there for the major manufacturers of head gear to use the game to conduct further research on the development of a safer head gear for use in the rugby codes.
Let’s say. just for the sake of discussion, that a well-designed ventilated leather or synthetic material headgear can be pumped up with air to the pressure required and thus limit the impact resulting from a head shot.
Extracts below are from the World meeting Concussion in Sport Group (CISG) in Berlin in 2017 which was attended by over a hundred Groups including Australians Universities. This is but a small part of the discussion.
CISG EXTRACT
Prevention, minimisation
“While it is impossible to eliminate all concussion in sport, concussion-prevention strategies can reduce the number and severity of concussions in many sports. Until the past decade, there has been a relative paucity of scientifically rigorous evaluation studies examining the effectiveness of concussion-prevention strategies in sport. The evidence examining the protective effect of helmets in reducing the risk of SRC is limited in many sports because of the nature of mandatory helmet regulations. There is enough evidence in terms of reduction of overall head injury in skiing/ snowboarding to support strong recommendations and policy to mandate helmet use in skiing/snowboarding. The evidence for mouthguard uses in preventing SRC is mixed, but meta-analysis suggests a non-significant trend towards a protective effect in collision sports, and rigorous case–control designs are required to further evaluate this finding. The strongest and most consistent evidence evaluating policy is related to body checking in youth ice hockey (i.e., disallowing body checking under age 13), which demonstrates a consistent protective effect in reducing the risk of SRC. This evidence has informed policy change in older age groups in non-elite levels, which requires further investigation. There is minimal evidence to support individual injury-prevention strategies addressing intrinsic risk factors for SRC in sport. However, there is some promise that vision training in collegiate American football players may reduce SRC. Limiting contact in youth football practices has demonstrated some promising results in reducing the frequency of head contact, but there is no evidence to support the translation of these findings to a reduction in SRC. Evaluation of fair play rules in youth ice hockey, tackle training without helmets and shoulder pads in youth American football, and tackle technique training in professional rugby do not lead to a reduction in SRC risk. A recommendation for stricter rule enforcement of red cards for high elbows in heading duels in professional soccer is based on evidence supporting a reduced risk of head contacts and concussion with such enforcement. Despite a myriad of studies examining SRC-prevention interventions across several sports, some findings remain inconclusive because of conflicting evidence, lack of rigorous study design, and inherent study biases. A clear understanding of potentially modifiable risk factors is required to design, implement and evaluate appropriate prevention interventions to reduce the risk of SRC. In addition, risk factors should be considered as potential confounders or effect modifiers in any evaluation. Biomechanical research (EG, video-analysis) to better understand injury risk behaviour and mechanisms of injury associated with rules will better inform practice and policy decisions. In addition, psychological and sociocultural factors in sport play a significant role in the uptake of any injury-prevention strategy and require consideration. Knowledge translation the value of knowledge translation (KT) as part of SRC education is increasingly becoming recognised. Target audiences benefit from specific learning strategies. SRC tools exist, but their effectiveness and impact require further evaluation. The media is valuable in drawing attention to SRC, but efforts need to ensure that the public is aware of the right information, including uncertainties about long-term risks of adverse outcomes. Social media is becoming more prominent as an SRC education tool. Implementation of KT models is one approach organisations can use to assess knowledge gaps, identify, develop and evaluate education strategies, and use the outcomes to facilitate decision-making. Implementing KT strategies requires a defined plan. Identifying the needs, learning styles and preferred learning strategies of target audiences, coupled with evaluation, should be a piece of the overall SRC education puzzle to have an impact on enhancing knowledge and awareness. As the ability to treat or reduce the effects of concussive injury after the event is an evolving science, education of athletes, colleagues and the general public is a mainstay of progress in this field. Athletes, referees, administrators, parents, coaches and healthcare providers must be educated regarding the detection of SRC, its clinical features, assessment techniques and principles of safe return to play. Methods to improve education, including web-based resources, educational videos and international outreach programmes, are important in delivering the message. Fair play and respect for opponents are ethical values that should be encouraged in all sports and sporting associations. Similarly, coaches, parents and managers play an important part in ensuring these values are implemented on the field of play. In addition, the support and endorsement of sporting bodies such as the International Ice Hockey Federation, Fédération Internationale de Football Association (FIFA) and the International Olympic Committee who initiated this endeavour, as well as organisations that have subsequently supported the CISG meetings, including World Rugby, the International Equestrian Federation and the International Paralympic Committee, should be commended. CONCLUSION Since the 1970s, clinicians and scientists have begun to distinguish SRC from other causes of concussion and TBI, such as motor vehicle crashes. While this seems like an arbitrary separation from other forms of TBI, which account for 80% of such injuries,44 45 it is largely driven by sporting bodies that see the need to have clear and practical guidelines to determine recovery and safe return to play for athletes with an SRC. In addition, sports participation provides unique opportunities to study SRC and mby, given the detailed SRC phenotype data that are typically available in many sports.46 Having said that, it is critical to understand that the lessons derived from non-sporting mby research informs the understanding of SRC (and vice versa), and this arbitrary separation of sporting versus non-sporting TBI should not be viewed as a dichotomous or exclusive view of TBI. One of the standout features of the Berlin CISG meeting was the engagement by experts from the TBI, This document is first and foremost intended to inform clinical practice; however, it must be remembered that, while agreement exists on the principal messages conveyed by this document, the authors acknowledge that the science of concussion is incomplete and therefore management and return-to-play decisions lie largely in the realm of clinical judgement on an individualised basis”.
I have been involved in this game almost all my life. One must admire the wonder of its resilience and its capacity to unite people of every denomination and culture. It provides those who play and have played with a treasury of nostalgia and a plethora of friends for life. This does not always happen in a life less lived and challenged. Rugby league understands and embraces gender equality, and accepts that there is always the element of risk in participation which in itself draws one to participate .The cultural power of rugby league particularly in New South Wales and Queensland is part of the glue that binds us as a nation, and State of Origin is an Australian heritage.
The concussion era is another challenge, one which would not have such a high media and medical presence if rugby league was not the contributing story line. All will benefit from research, not just the sport itself which ensures the continued growth of the game whilst increasing the safety of those who participate and the enjoyment of those that appreciate the athleticism of the performers.
Paul Broughton OAM