World scientists update position on sport concussion

A panel of international neuroscientists, researchers and clinicians have released their new consensus statement on concussion in sport.

It comes amid an unprecedented focus on the consequences of head injury in recreational activities and professional sporting codes, with athletes across the globe seeking compensation for injuries sustained during their playing careers.

The statement, published today in the British Journal of Sports Medicine, contains updated recommendations on athlete care and calls for better concussion management through rule and policy measures like mandatory removal from play when concussion is observed or suspected, and medical clearance processes for athletes to return to competition.

Education for participants, coaching staff and parents is also emphasised, which they say is associated with reductions in repeat concussion rates.

The statement – delayed by two years due to the COVID-19 pandemic – represents the agreed state of knowledge on concussion science from the International Conference on Concussion in Sport held last year, compiled from 10 systematic reviews of existing research.

Cosmos series on sport concussion

Among some of the changes made are recommendations for implementing on-field neuromuscular training as part of warm-ups. When completed three times a week, lower rate of concussion were observed in Rugby Union competitions.

New assessment tools and updates to the Sports Concussion Assessment Tool (SCAT) for clinicians and Concussion Recognition Tool (CRT) for non-professionals were also released in conjunction with the statement.

A greater emphasis on mental health in athlete evaluation was also included, as well as recommending multidisciplinary assessment where concussion symptoms persist after a month.

Professor Vicki Anderson from Murdoch Children’s Research Institute, who is a member of the International Concussion in Sport Group, welcomed the rigour of the systematic review process but acknowledged that where evidence is limited, it may not yet be considered as part of the statement.

Ultimately, as a consensus statement, it marks a position of what is agreed, rather than what experts suspect or debate might relate to concussion injuries.

“It’s a very rigorous systematic review process,” Anderson told Cosmos.

“Systematic reviews are the best level of evidence, but in a field where there’s not a whole lot of trials for example, around what is useful, then what happens in a systematic review is that there will be a lot of papers that are not eligible.

“The results of those systematic reviews are put together by a series of scientific panels, and that’s the information that goes to the expert review group.”

Based on the review process, the statement currently finds there to be no increased risk between amateur male American footballers, soccer players and other athletes from mental health or neurodegeneration compared to the general population. However, professional soccer and gridiron players were found to have greater mortality from neurological disease and dementia.

The statement also calls for increased research into the impacts of sport concussion across different demographics, such as those on the basis of age, sex, gender and cultural contexts as well as geographical locations outside of North America.

Of 342 conference participants to submit their recommendations for future research, 3 in 5 called for emphasis on long-term effects of concussion, and half want increased focus on prevention and rehab.

Professor Alan Pearce, a neuroscientist from Latrobe University in Melbourne who was not involved in the paper, has carefully watched the public discussion around concussion in sport unfold in Australia.

He told Cosmos the consensus statement was the biggest in terms of content he had seen, but that it would be left up to sports bodies to determine which recommendations they would implement.

He also suggests non-professional competitors would benefit from increased research looking at concussion impacts at amateur level.

“Sports that are now being represented by this group need to step up and dedicate good research funding and support for independent research at the [community] club level, so we don’t just keep talking about the elite leagues,” Pearce says.