Sports related concussion has been very topical over the last few weeks. This has been highlighted by the recent ‘Four Corners’ program on the ABC. This outlined a condition know as chronic traumatic encephalopathy or CTE. This condition has been described in some Ex-NFL players at autopsy, and is suggested to be due to the effects of repetitive concussion.
Whilst head injury in sport is an important topic, there are at present many unknowns with respect to this condition. There are only case reports and certainly no controlling for other factors such as associated recreational drug use, anabolic steroid use or familial or genetic factors. It should also be remembered that American football is a considerably different game to our football sports where the helmet (and head) is regularly used as a battering ram. Our understanding of this condition is also limited as there is no diagnostic test sensitive enough to pick up CTE in the living athlete.
The general consensus of the world experts in concussion management is that if the concussive episode is well managed, and complete resolution of the episode has occurred before return to play, then the risk of long term consequences is low (see Zurich consensus on concussion management). This would include removing any concussed player from the field of play for medical evaluation, not allowing a concussed player to return to play on that same day and following a stepwise protocol for return to sporting activities. This includes monitoring for post-concussive symptoms, neuropsychometric deficits, and balance loss. Once all of these factors have completely resolved then a safe return to play can occur. It is also important that all codes are reviewing the rules of the game to reduce dangerous contact to the head.
The links below are to the Zurich Concussion Consensus, a copy of the SCAT 3 concussion assessment tool and to a recent article in the Medical Journal of Australia entitled ‘Does Football Give You Brain Damage’ which is a rational look at the current concussion debate.