Researchers say Australia’s concussion guidelines in sport are ‘manifestly inadequate’.
Contact sports should be banned in Australia for all children under the age of 14, because of the risk of complications from repetitive head injury, says a researcher who has been studying brains donated to the Australian Sports Brain Bank.
And Associate Professor Michael Buckland, a neuropathologist at Royal Prince Alfred Hospital (RPA) and the University of Sydney, described the nation’s current concussion guidelines for professional and amateur sporting codes as “manifestly inadequate” when it comes to the prevention of chronic traumatic encephalopathy (CTE).
CTE is a neurodegenerative condition caused by repetitive head injury, and is associated with a range of neuropsychological problems, including mood and behavioural symptoms, cognitive impairment and dementia. It can be definitively diagnosed only post-mortem.
“Every sporting organisation should have not only a concussion policy, but also a CTE policy. And that CTE policy should be founded on two basic principles: reducing lifetime exposure to repetitive head injuries and delaying the onset of exposure to repetitive head injury,” he said.
“I don’t think there should be contact sports for children under the age of 14 years. They should be playing modified games.”
He told The Medical Republic he wanted an independent review into Australia’s concussion guidelines, and that a broader range of medical professionals should be involved, not just those connected to professional sports. He wants GPs to be among those who are part of the review.
“All we’re asking is that we don’t hit children in the head a lot. It’s not actually that unreasonable.”
Professor Buckland
“There is room for an overarching guideline for sport in general,” he said. “But the ones we have at the moment, when it comes to CTE, are manifestly inadequate.
“There is no doubt that the issue of CTE is downplayed, and the evidence for an association between repetitive head injury and CTE is downplayed or dismissed.”
The calls follow a research letter published in the Medical Journal of Australia in which Professor Buckland and his colleagues released findings from the first three years of the Australian Sports Brain Bank (ASBB).
“All 21 donors had participated in sports with risks of repetitive head injury, including 17 who had played in football codes,” they reported.
All but one donor exhibited some form of neurodegeneration, and 13 had two or more neurodegenerative pathologies. The most frequent neuropathology was CTE – 12 donors had pathognomonic CTE lesions.
Professor Buckland and his colleagues set up the ASBB in 2018, in partnership with the Concussion Legacy Foundation in the US. The MJA letter detailed their examination of 21 brains donated up to March 2021, and Professor Buckland said the results were deeply concerning.
“The first finding is that, in this population of people that have exposure to repetitive head injury, the most common pathology we have identified is CTE,” he said.
“More than half (12) of our donors had CTE pathology in their brain. That is remarkable. I think it is alarming that there’s definitely CTE here in Australia, and it’s not hard to find when you go looking for it. The other finding is that three of the 12 donors with CTE were under the age of 35.
“They had played sport recently, under modern concussion guidelines, including the current Australian Institute of Sport concussion guidelines, and that hasn’t protected them.”
Professor Buckland said the findings supported his position that contact sport should be banned for children, although he conceded this was likely to be a contentious issue.
“I think it does need to be minimum age and whether that’s 12, 13, 14 or 15 could be open to discussion,” he said.
“We can maintain all those positive physical benefits, and mental and social benefits of team sports. All we’re asking is that we don’t hit children in the head a lot. It’s not actually that unreasonable.”
Professor Buckland said while CTE could not be diagnosed until after death, GPs should have a “degree of suspicion” in patients with a history of repetitive head injury, such as athletes in contact sports.
“It’s important not to jump to CTE straight away,” he said. “But if there are people who seem to have a progressive deterioration, it should be considered. And they should be referred to either a psychiatrist or a neurologist that has an interest and some expertise in this area.”
TMR made several attempts to seek specific comment from the Australian Institute of Sport, but was directed to a media release from October 2021, in which it welcomed $340,000 in Australian Government funding for The Concussion and Brain Health project 2021-24, which “will contribute to the evidence and understanding of sport-related concussion and continue to prioritise the health of Australian sport participants”.
As part of the initiative, the AIS will work with medical experts and researchers to update the Concussion in Sport Australia: Position Statement, a concussion management resource launched in 2019. Additionally, the AIS is collaborating with the Hunter Medical Research Institute (HMRI), the University of Newcastle and the University of Canberra on a research program that will assess the brain health of retired elite level athletes.
Medical Journal of Australia 2022, online 10 February
Concussion in Sport Australia Position Statement, updated February, 2019
