The Senate has tabled its report on concussions and repeated head trauma in sport, including 13 recommendations for addressing the issue, including improvements to data collection on sports injuries, additional research pathways, and increased education for the community and healthcare practitioners.
Australia has long prided itself on being ‘a sporting nation’ and more than 90% of Australian adults have an interest in sport, with 13 million adults and 3 million children taking part in sport each year.
However, contact sports such as ‘Aussie Rules’ and Rugby are also highly popular, and in recent years there have been increasing reports and concern, both in Australia and internationally, about the growing evidence of the link between sport-related concussions and the short and long-term impacts on athletes’ health, including neurodegenerative diseases such as Chronic Traumatic Encephalopathy (CTE).
“Evidence to this inquiry has clearly highlighted that the link between concussion, repeated head trauma and contact sport is a contentious issue and space, with sporting organisations, medical, research and legal professionals, governments, the media and the community alike, all grappling with its evolving complexities and evidence,” the report said.
“The committee heard of former athletes suffering from anxiety, depression, psychosis, hallucinations, dizziness, and brain fog, and how those closest to them watched their rapid decline.”
The Senate committee also heard that GPs were often the first point of contact for social, amateur, and professional contact sport players who have a suspected concussion, and the RACGP explained in their submission that doctors could assess and manage concussion injuries in a variety of settings, including sporting matches.
The Australasian College of Sport and Exercise Physicians (ACSEP) also highlighted that community sports participants with suspected concussion were often referred for medical assessment in the public system under Medicare and in public hospitals.
A key focus was the need for increased training and education within the medical community to improve how the acute and long-term effects of concussive injuries were dealt with in the health system, with many patients reporting problems when seeking advice and treatment.
Shine Lawyers, one of the legal firms dealing with compensation claims, said that the experience of many of their clients was that “If they did report their symptoms, very few people believed them, let alone provide appropriate referrals to providers who specialise or understand mTBI [mild traumatic brain injury] symptomology.”
“The experience of these individuals is one of being unheard, gaslit and exhausted, and GPs who identified the symptoms were often at a loss as to where to send their patients for treatment,” Shine’s representative said.
“Additionally, the greatest concern for our clients is the lack of treatment options available when they are desperate for help, and we recommend the use of specific multi-disciplinary concussion or traumatic brain injury centres to help deal with the complexities of these injuries.
“Currently there are very few people or places that individuals can go to, or that GPs know to refer to, for concussions, mTBI, or CTE rehabilitation.
“These injuries are complex with a constellation of symptoms and require wholistic treatment by a range of specialists, and for this reason, it is strongly recommended that multi-discipline concussions or TBI centres be set up in all capital cities in Australia.”
Professor Melinda Fitzgerald, from Mission for Traumatic Brain Injury, similarly highlighted the importance of educating clinicians on these matters, as well as appropriately resourcing them.
“Even research on educating our clinicians is important. I’ve been involved in some studies where we’ve asked clinicians—GPs in particular—whether they feel comfortable managing someone with concussion, and over half of them don’t,” she said.
“They’re not resourced sufficiently to be able to manage people with concussion in community, and evidence-based guidelines are not adequately disseminated to health professionals, leading to unnecessary or inappropriate concussion management.”
However, as evidence from the RACGP highlighted, Australians should be encouraged to undertake regular physical activity but the safety of people who participate in sports, especially junior players, was of utmost importance.
“The committee agrees with the RACGP that widespread participation in sporting activities will only be achieved if sports are made safe and are also perceived to be safe,” the report said.
“Even though the committee recognised that sports in Australia are largely governed by private organisations and businesses… given the significant public health issues involved, the committee considers that there is still a pivotal role for government to play in this space.”
The committee also called for increased funding and support from the Australian Government and sporting organisations to coordinate research efforts into the long-term effects of concussion and repeated head trauma incurred during participation in sport.
Dr Chidozie Anyaegbu, a Research Fellow in Neurotrauma at Curtin University and The Perron Institute for Neurological and Translational Research, explained that a key element of the research drive would be the establishment of a National Sports Injury Database.
“Increased funding will enable us to identify clinical features, progression, and interventions to prevent development of CTE, and allow scientists to understand whether there are different risks and trajectories for children, women and Aboriginal or Torres Strait Islander peoples,” she said.
“However, comprehensive prospective and longitudinal research tracking the development of these neurological conditions in a living brain is necessary to establish causation.
“I commend the Senate committee’s recommendation of a national database, as this will be a crucial resource for such longitudinal research: by collecting various biological data from people that have experienced a concussion overtime, researchers will be able to identify early diagnostic markers of neurodegeneration and targets for treatment.”
Finally, the committee acknowledged that concussion did not just occur in sports and other recreational activities but was a significant concern for other groups including victim-survivors of domestic violence, other physical assault victims, defence force personnel and veterans, and those involved in car accidents.
“Whilst concussions that occur in these contexts sit outside the scope of this inquiry, the committee acknowledges that concussion should be prevented and responded to in many different contexts and believes the insights from this inquiry have application in terms of the importance of prevention, better management, and response to these injuries regardless of their cause,” the committee said.
The 13 recommendations made by the Senate Committee were:
- That the Australian Government establish the National Sports Injury Database as a matter of urgency…
- That professional sporting codes collect data on concussions and identified sub-concussive events…
- That the Australian Government consider establishing independent research pathways, including through a newly created body or through existing bodies, such as the National Health and Medical Research Council, that is dedicated to supporting and coordinating research…
- That the Australian Government and sporting organisations continue to fund research into the effects of concussion and repeated head trauma on at-risk cohorts…
- Encourage Australians, in the event of their death, to donate their brain to a brain bank for scientific research…
- That the Australian Government consider a coordinated and consolidated funding framework for ongoing research…
- That the Department of Health and Aged Care in consultation with relevant stakeholders, consider how best to improve community awareness and health led education regarding concussion and repeated head trauma…
- The committee recommends that the Australian Government, in partnership with state and territory governments consider how best to address calls for:
- the development of standardised, evidence-based, and easy-to-access concussion and head trauma guidelines for GPs;
- suitable general practice consultations for people with concussion, repeated head trauma and other complex care needs; and
- increased training for first aid responders at sporting venues that focuses specifically on treating concussion and head injury.
- That national sporting organisations in Australia explore further rule modifications for their respective sports.
- That the Australian Government, in collaboration with medical experts, develops return to play protocols, adaptable across all sports, for both children and adults…
- That the Australian Government consider developing a national strategy to reduce the incidence and impacts of concussion, including binding return to play protocols and other rules to protect sport participants from head injuries…
- That professional sporting codes and players associations consider ways for a best practice model to provide ongoing support, financial and otherwise, to current and former players affected by concussions and repeated head trauma…
- The committee encourages professional sports organisations to ensure their athletes have insurance coverage for head trauma. The committee also encourages state and territory governments to engage with professional sporting organisations to explore how the general exclusion of professional sports people from various state and territory workers’ compensation schemes could be removed….