“Landmark” senate report recommends sport concussion overhaul

An Australian Senate committee has called on the federal government to lead changes to the way head impacts are managed – and prevented – at all levels of sport.

Following four hearings held across the eastern states at the beginning of the year, the cross-party Senate Community Affairs References Committee heard scientists, health professionals, sport governing bodies, lawyers, athletes and their families describe an uneven approach to concussion identification and care at all levels of sport.

Inconsistent management protocols between and within major codes were repeatedly identified as a significant area of concern.

The report handed down by the committee has been described as a “landmark” document by observers. Among its recommendations, it calls for the government to:

• Establish a national sports injury database to quantify all injury causes and incidence rates across sports and levels of participation.
• Increase independent research and funding models for ongoing research into sports-related head trauma.
• Improve education and awareness training for medical professionals, first responders and the community at large.
• Develop binding return-to-play protocols.

It recommended governing bodies to consider how they support athletes affected by head trauma, to ensure adequate insurance coverage for participants, and called for further rule modifications to prevent and reduce head trauma impacts, particularly at junior levels.

The inquiry was called in response to what its chair, Greens Senator Janet Rice, described as a “simmering” issue in Australian society. She hopes the report will lead to broad reform into the way Australians respond to head injuries in sport.

“The committee decided that [head trauma in sport] was something was really worth our while looking into,” Rice tells Cosmos.

“And that was absolutely the case.

“The level of evidence that we heard, the level of interest in what the impacts of concussion are, I think really underlines the fact that this report was really worthwhile, and is really a landmark report, I think, in terms of bringing together both the impacts of concussion, the extent of concussion.”

Opportunities exist to boost scientific understanding

Evidence increasingly connects repeated head trauma to neurodegenerative diseases such as chronic traumatic encephalopathy (CTE), although research is still in its earlier stages. It can also only be fully diagnosed post-mortem, offering little help to those who may be experiencing the disorder in life (though some clinicians do offer likely diagnoses).

Scientists, including those who appeared before the inquiry, welcomed the committee’s findings, particularly the prospect of improving research into the connection between sports head trauma and neurodegeneration.

The national database put forward by the committee is also seen as a valuable tool for researchers.

Associate Professor Fatimah Nasrallah, a neuroscientist at the Queensland Brain Institute, says the establishment of a database would advance understanding of head injury prevalence, potential biomarkers, and improve protocols and injury management policies.

“The cream on the pie here is the national database,” Nasrallah says.

“They’ve called clubs, they’ve called all [sporting] institutions to provide data and be transparent about the data they have. That’s the only way that you’re going to be able to make change by having more transparency around the number of concussions, the type of concussions so that policies and guidelines can be implemented.”

She, along with others, welcomed the prospect of a new or existing entity developing long-term research to “identify clinical features, progression, and interventions” related to head trauma in sport.

“Australia is well-positioned to instigate holistic research programs that centre on advanced imaging techniques combined with cognitive clinical assessment,” says Professor Trevor Kilpatrick, a neurologist at the University of Melbourne.

“Concussion research needs consistent dedicated funding to progress into sizeable studies that will have lasting benefits for people engaging in both community and professional sports.

“All levels of sport, from grassroots clubs right up to elite professional sporting bodies can better understand, prevent and respond to concussion and repeated head trauma.”

Culture reform required

Beyond recommending investment in research and tools to understand the connection between brain injuries and sports, the committee identified disconnects between sporting culture and appropriate participant care.

In conversations with community-level sports participants, Cosmos has found there to be inconsistent approaches to concussion identification, management and return to play, even where governing bodies provide protocols or frameworks.

While efforts to develop diagnostic technology for sideline use show promise, few athletes have access to reliable, peer-reviewed or approved technology that can clearly identify and dictate brain injury management. 

Compounding this, athletes appearing at the inquiry repeatedly described ingrained cultures where athletes ‘play through’ injury, or feel that concussions are not treated seriously amid ‘win at all costs’ attitudes to sport.

While Rice expects cultural change to take time, she is hopeful that it could be achieved in tandem with other measures recommended in the senate report.

“It’s not going to happen overnight,” Rice says.

“But I think if we have really good quality community awareness and community education – and we’ve got binding protocols about when people are able to return to play – that will begin to change that culture.

“I think at the moment, [the community] like us in the inquiry, are learning a lot about what the impacts of concussion are. Across the wider community, there’s not that awareness about it.”