I realize it has been a few weeks since my last post, 2016 has started out with a bang and it’s only getting busier! I am very excited to start a new chapter and begin my PhD at Wilfrid Laurier this fall focusing on advanced concussion assessment and management. My hope is to improve clinical guidelines to ensure that athlete’s return to play safely to prevent the recurrence of injury. This will be one of many articles on concussion that will focus on current trends, research and education for management and prevention!
Concussions are definitely a hot topic lately. More often than not, people still don’t fully understand what they really are, how to recognize them and what to do if you or someone you know sustains an injury. For those who are unfamiliar, check out the video below. “Concussions 101” is from Parachute Canada and is a great resource for making sense of concussions for parents and youth.
During an interview last month for TeamUp Laurier’s 3rd Annual Concussion Symposium, I was asked, “Why are we seeing so many more concussion injuries these days?”. My answer is that concussions are not increasing in their prevalence, it’s the increasing awareness and recognition that is bringing these injuries to light. More and more athletes are asking questions and aren’t afraid to admit when they’ve sustained an injury or are having persisting symptoms. The stigma that surrounded these invisible injuries has been removed and the old mentality that an athlete has “had their bell rung” or being told to “just shake it off”; is no longer acceptable.
Within the past year, there has been an ever-expanding media spotlight placed around the issue of concussions in sport. Will Smith’s role as Dr. Bennet Omalu in the “Concussion” movie certainly created a buzz in the general public about the kind of devastating consequences that these injuries can have. In December 2015, Ontario became the first province in Canada to propose legislation to improve education and management of concussions with 49 recommendations under Rowan’s Law. The initiative is dedicated to Rowan Stringer, a 17 year-old who passed away after sustaining two concussions within one week of playing high school girls rugby in Ottawa. It is unfortunate that it took a tragic loss to fuel change but in doing so I hope that it leaves a legacy to prevent this from happening again in youth sport. It has also helped to develop Rugby Canada’s new initiative that was launched in February 2016 called “Play Smart”. This program was created to reinforce that education is a necessity for those involved with the welfare of athlete’s playing rugby across the country. And most recently, on March 14, 2016, an NFL official FINALLY acknowledged a link between playing football and a risk for chronic traumatic encephalopathy (CTE). CTE is a neurodegenerative condition that is a result of cumulative concussion injuries that results in symptoms such as depression, personality changes, impulsivity, and Parkinsonism.
I think this growth of interest surrounding concussion and sport is fantastic. It’s finally turning into something that can be discussed amongst the general public in a way that makes sense. Although with this increase in attention, there has been controversy. Some feel that body contact should be removed from sport in general. In my personal opinion, I think that making sports safer by limiting contact to the head and being more stringent about unsafe tackling or body checking is a better idea to reduce the occurrence of injury. I don’t believe that the benefits of removing certain aspects of a sport are greater than the benefits that youth can gain by participating in organized sport. There is increasing evidence that there is a greater risk for mortality from a sedentary lifestyle than there is for participating in organized sports, such as rugby.
In a recent press release, World Rugby responded to a call for banning tackling in rugby in the UK,
“Physical inactivity is one of the biggest public health challenges of the 21st Century. Stats from the Lancet show that approximately 5.3 million people die each year from physical inactivity, and that’s more than 80 people each day in the UK. We need to do all we can to encourage people to take part in sport and physical activity, and also look at how we can make sport as safe as we can. Stopping children playing this form of rugby is in my view counterproductive.” Dr Andrew Murray, General Practitioner and a consultant in Sports and Exercise Medicine at the University of Edinburgh
The current initiatives are focused on keeping sport safe for young athletes by continuing to educate everyone involved. Education is not meant to be a scare tactic or deter athletes from participating in sport, but to inform them about the risks that could potentially occur. There are risks with simple activities we do everyday such as driving a car, riding a bike, and duties at work. As mentioned above, inactivity is our biggest risk. So there’s no sense in trying to eliminate what has a greater benefit.
There is still a lot of research to be done and I’m looking forward to joining the academic community. My goal for the future is to improve concussion guidelines for clinical assessment and management by establishing a better connection between the research and clinical practice. The literature continues to evolve as we learn more about recovery from concussion injuries and my hope in the long-term is to establish a safer return to play guideline to prevent recurrence of injury.
There will be a new consensus meeting this fall 2016 in Berlin, Germany, that will most likely lead to revisions in the current assessment and management guidelines. This is going to be a very exciting year for development and education, stay connected and keep yourself informed!
Parachute Canada. http://parachutecanada.org/concussion
Play Smart. Rugby Canada. www.rugbycanada.ca/playsmart
Hay, J., Johnson,V.E., Smith, D.H. and Stewart, W. (2016). Chronic traumatic encephalopathy: The neuropathological legacy of traumatic brain injury. Annual Reviews. http://www.annualreviews.org/doi/pdf/10.1146/annurev-pathol-012615-044116
Response to ‘Ban on Rugby tackling’ petition in the UK. World Rugby. http://www.worldrugby.org/news/142105