Sports leagues’ concussion guidelines must be broadened as brain health concerns rise

Recently, the Australian Football League (AFL) was rocked when it was revealed a Geelong player with a history of concussion had been asked to waive his legal rights to claim for any future brain trauma.

It was the latest in a series of concussion issues the AFL has had to address in recent years.

But the focus on concussion is problematic. Indeed, concussions are not necessarily the most pressing issue in contact sports when it comes to brain injuries.

The bigger concern should be chronic traumatic encephalopathy (CTE).

What is CTE?

CTE is a neurodegenerative brain disease that has been linked to contact sports such as Australian football, rugby league, rugby union and soccer.

It often strikes later in life but has been diagnosed in athletes as young as 20 in Australia.

It can only be diagnosed posthumously.

CTE develops after repetitive brain trauma—research indicates concussions may not necessarily be the primary cause. Instead, repeated subconcussive impacts to the brain pose the actual risk.

These subconcussive impacts, which rarely cause any symptoms, can occur during normal gameplay from actions such as tackling or bumping.

It is the accumulated damage from these repeated subconcussive impacts that can lead to CTE.

Encouraging action on concussion

In the past decade or so, the AFL and other contact sports have made changes to mitigate the impacts of concussion through rule changes aimed at minimizing head contact, rigorous concussion assessment protocols and mandatory “stand-down” periods following concussion.

These measures should be acknowledged.

However, research is increasingly suggesting the biggest risk comes from subconcussive impacts.

So, what have Australia’s sporting codes done to address this risk?

The answer is somewhat surprising.

The main cause of CTE is barely acknowledged

I recently analyzed the community concussion management guidelines from some of Australia’s major sports.

What I found was concerning.

In the AFL’s guidelines, it is apparent what the focus is: “concussion” is mentioned 264 times in 36 pages. The measures outlined are focused on concussion prevention, diagnosis and management.

However, a search for “subconcussive” shows no mentions. The term “repeated head impacts” (or similar) is used 11 times but usually in conjunction with concussion or to minimize the issue of such impacts. For example, on Page 5, it states:

“While head trauma poses a higher risk, not everyone who experiences repeated concussions develops CTE, and it is uncertain to what degree repeated head impacts increase the risk.”

Yet researchers are now confident subconcussive impacts play a significant role in the development of CTE. The AFL’s emphasis on “uncertain,” then, is interesting phrasing.

Only once, on Page 4, is the phrase “repetitive nonconcussive head impacts” used, but even then, the term is not defined or explained:

“Head trauma, either as a single concussion, repeated concussions or repetitive ‘nonconcussive’ head impacts, also appears to be associated with an increased risk of brain degeneration later in life.”

Similar issues arise in other sports.

In rugby league, the Australian Rugby League Commission guidelines mention “concussion” 126 times in 15 pages, but “subconcussion/non-concussion” is not mentioned once.

There are also no mentions of “repeated/repetitive head impacts.”

Again, these guidelines deal only with concussion prevention, diagnosis and management.

In soccer, Football Australia’s guidelines mention “concussion” 52 times in eight pages, but again there is no mention of “subconcussion” or warning of the risk of repeated subconcussive impacts. This is despite the strong link between repeatedly heading the ball and a higher risk of developing CTE.

In rugby union, Rugby Australia’s guidelines mention “concussion” 153 times in 20 pages, with “subconcussion” again not mentioned at all.

What should be done?

It would be simple to explain the dangers of subconcussive impacts in these guidelines. The leagues should update them to include references to subconcussive impacts and more information about the risk as soon as possible.

Other information—such as the potential value of mouthguards with built-in sensors to monitor contact forces—could be included.

Contact restrictions at training—which the NRL and World Rugby have already introduced, with the AFL reportedly following suit soon—should also be formally recommended, and the age of “first exposure” to contact should be raised.

Such measures would inform athletes, families and officials about the seriousness with which sports need to approach participants’ brain health.

It’s more than just concussion

At the moment, many people who play contact sports may incorrectly think sports governing bodies have already dealt with the “concussion issue.” Dozens of pages in the guidelines arguably do this quite well.

However, the failure to explain the risk posed by repeated subconcussive impacts—and to warn those who play they may develop a devastating brain disease even if they never suffer a concussion—is concerning.

Who’s behind this story?

Swati Mestri

Swati Mestri holds a bachelor’s degree in Electronics Engineering and has worked as a content editor since 2019. She has experience editing research documents across technology, health care, and materials science, and has a particular interest in technology and space.

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Andrew Zinin

Master’s in physics with research experience. Long-time science news enthusiast. Plays key role in Science X’s editorial success.

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This article is republished from The Conversation under a Creative Commons license. Read the original article.