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Do we need a massive paradigm shift regarding the management of concussions? ~ Dr. Chris Bradshaw

This post is the second part of a two-part series on concussions and sports medicine.

The management of acute concussive episodes in sports people has been the topic of much debate in sports medicine circles over recent years, forcing constant assessment of the way concussion is managed and diagnosed, leading to significant refinements to the guidelines governing sports medicine practitioners who deal with such athletes in both team and high velocity sports.

Running in parallel with these refinements in the treatment of concussion has been the growing concern regarding the phenomenon of Chronic Trauma Encephelopathy (CTE).

This has been of big concern in the United States and specifically in the National Football League, highlighted by the suicide of Dave Duerson, a former professional footballer who committed suicide and left instructions for his brain to be donated for scientific research. He was subsequently found at autopsy to have CTE.  To-date upwards of thirty past and current players have been found to be suffering CTE at the time of their death.

There have also been concerns regarding CTE linked with boxing and with soccer. Much more recently there has been some concern about the long-term effects of repeated concussive episodes in Australian Rules Football.

Australian Rules Football - Photo by markehr. Used with permission. All rights reserved. Source: flickr

Australian Rules Football – Photo by markehr. Used with permission. All rights reserved. Source: flickr

That having been said, there is a marked difference between the sports of American Football or Gridiron, and Australian Rules Football.

Gridiron players wear helmets and have become accustomed to using their heads, protected by their helmets, as a weapon, and as such they practice blocking many times a week. This micro trauma may be accumulative, with many hits per week spanning a career of many years.

In contrast, many Australian Rule Football players go through their entire career without any concussive episodes. The concern in Australian Rules Football is focussed on those participants who suffer multiple, or severe, concussive events. Current research regarding these individuals involves the performing of dynamic MRI scans of the brain, and monitoring these in a serial ongoing manner.

With respect to Australian Rules Football, much of the focus is on managing any concussive episodes correctly, and many of the guidelines regarding this suggested at the Zurich conference will be adopted. This will be administratively be difficult for the medical officers and indeed for the coaches and administrators, but until the long term consequences of concussion are better understood, this conservative approach is definitely the way to go. The other focus is identifying those individuals who have had multiple or severe concussions, and monitoring them with the long-term consequences in mind.

With respect to American Football, or Gridiron, the solution to the problem of CTE is probably to remove the helmets from the players, making minor head hits more painful and therefore less desirable. It would be a massive paradigm shift for the culture of the sport, and is unlikely to happen, but in a counter-intuitive way it would probably dramatically decrease the incidence of CTE in those playing the sport.

Chris Bradshaw is a Sport and Exercise Physician with the Olympic Park Sports Medicine Centre based in Geelong. Since 2006, he has been the head medical officer for the Geelong Football Club. Bradshaw has also experience with the Premier League with Fulham from 2003-2005, and was the Australian Track and Field Doctor from 1997 to 2000, culminating in the Sydney Olympics. He was also with Richmond Football Club from 1992 to 2003. 

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