‘Getting your Bell rung’: Is concussion the Death Knell for Contact Sports? – RCSIsmj senior staff writer Daniel O’Reilly
We have been treated to a glut of sporting festivities over the last several months- Rugby World Cup, Football European Qualifiers and World Championships in Boxing that have all had strong Irish representation. However, an issue that has surrounded all these contests is the occurrence of concussion, a type of mild traumatic brain injury (mTBI).1While some sports have recognised the effect repeated blows to the head can have on an athlete’s long-term health for quite a long time now (notably boxing), others are only recently appreciating the risk.2
Chronic Traumatic Encephalopathy (CTE, formerly known as Dementia Puglistica) has unfortunately been described in a number of athletes.3 It has been shown that the likelihood of boxers developing this condition is related to number of rounds boxed.2 A case study was also recently published describing a high level amateur rugby player afflicted by the same condition.4 More worrying still, it has been shown that it mightn’t be the concussions that are doing the real damage but the low level neuronal trauma that results from multiple sub-concussive blows.1
So should we ban contact sports? Unfortunately at present there is no clear-cut answer. Although there seems to be a high risk of CTE in those who have suffered repetitive mild traumatic brain injuries during sporting activities, there is no clear threshold at which the risk of CTE may outweigh the psychological and physical benefits an athlete may derive from their chosen activity.5 When one remembers the stark reality that 1 in 4 children in this country are overweight or obese, this is not a trade-off to be taken lightly.6 As both spectators and medical professionals, the best we can achieve is reducing risk by following the best available evidence, identifying concussed players early and removing them from the field of play before a second injury has a chance to occur.7 Unfortunately, from my own experience both as an amateur sportsman and as a spectator, this is not yet the case.
Increasing awareness of concussion is a first step in the prevention of future cases of sports-related CTE. The fact that there is a highly anticipated film about to be released on the topic of concussion is testament that concussion is garnering more interest than ever before.8 However, whether that translates to better care of athletes remains to be seen. Without a change in attitudes to concussion, many of the sports we enjoy today will have an irreparably damaged reputation in the eyes of future generations.
1.Gavett, Brandon E; Stern, Robert A; McKee, A. C. Chronic Traumatic Encephalopathy: A potential Late effect of Sport Related Concussive and Subconcussive Head Trauma. Clin. Sport. Med. 30, 179–ix (2011).
2. DeKosky, Steven; Ikonomovic, Milos D; Gandy, S. Traumatic Brain Injury-Football, Warfare and Long Term Effects. N. Engl. J. Med. 363, 1293–1296 (2010).
3. McKee, A. C. et al. Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury. J. Neuropathol. Exp. Neurol. 68, 709–735 (2019).
4. Stewart, W., McNamara, P. H., Lawlor, B., Hutchinson, S. & Farrell, M. Chronic traumatic encephalopathy: a potential late and under recognized consequence of rugby union? Qjm 1–5 (2015). doi:10.1093/qjmed/hcv070
5. McCrory, P., Meeuwisse, W. H., Kutcher, J. S., Jordan, B. D. & Gardner, A. What is the evidence for chronic concussion-related changes in retired athletes: behavioural, pathological and clinical outcomes? Br. J. Sports Med. 47, 327–30 (2013).
6. Heinen, M., Murrin, C., Daly, L. & Brien, J. O. The Childhood Obesity Surveillance Initiative ( COSI ) in the Republic of Ireland : Findings from 2008 , 2010 and 2012. (2014).
7.Aubry, M. et al. Zero tolerance: the future of head injury in sports. Br. J. Sports Med. 47, 249 (2013).
8.Anderson, E. Did Sony Make Changes to ‘Concussion’ to Avoid Clashing with the NFL?