Head in the game.
Team sports are working hard to protect athletes from the short, and potentially, long-term effects of concussion. Scottish Football banned professional players from heading the ball on the day before and after a match, whilst for under 12’s heading the ball has been banned altogether. Australian Football, Rugby League and Rugby Union have all implemented changes to their rules to try and eradicate contact with the head, slower than some medical experts would have liked, and with mixed responses from current and former players. The Australian Sports Commission published guidelines for managing concussion in youth and community sport suggesting a 21 day break from competitive sport following a suspected concussion.
In Australia this weekend, Nelson Asafa Solomona will miss the Rugby League Grand Final for a tackle he made last Friday. The player he struck, Lindsay Collins, would have been ineligible to play in the final should his team, the Sydney Roosters, have won. Why? Because the contact was deemed to be a ‘category 1’ which carries with it a mandatory 11 day stand down. Contrast this with Isaac Heeney and Logan McDonald who both played in the Australian Football League Grand Final for the Sydney Swans carrying injuries. Heaney had been playing through the finals series (three games) with a stress fracture to the ankle. So why are clubs forced into managing some injuries in a certain way, and not others?
Some will argue that strict rules for managing concussion are needed because of the serious nature of issues it can cause in later life. There is a growing body of research linking repeated head trauma, such as that experienced in contact sports, with early onset dementia and neurodegenerative conditions. An analysis conducted by the Global Spine Journal found professional athletes prone to repetitive head or neck trauma, such as those with a contact element, were eight times more likely to develop motor neurone disease than the general population. Such medial issues are serious and have significant implications for one’s health, so too, however, does arthritis and other musculoskeletal conditions athletes carry with them into retirement.
The risk of legal action is likely at the forefront of mind for governing bodies. There have already been high profile cases where athletes have sued their sport for diagnoses that may have been linked to previous injuries or head trauma sustained when playing. At a time when athlete welfare is so important, litigation should not be the driving force behind these changes, rather a commitment to making sport as safe as possible irrespective of how an injury occurred or which part of the body it affects.
I recall a lecture given by Prof. Greg Whyte in which he detailed why, in fact, sport is not good for you. Training is often of an intensity and volume that renders athletes at higher risk of illness, whilst the nutritional status of athletes in some events has been linked to medium term health issues, particularly in female athletes. Contact sports require athletes to repeatedly suffer impact trauma, few rugby players will progress though their career without some form of shoulder injury that requires surgery. This is a risk all athletes accept when they choose to train and compete. Even if clubs and national governing bodies cannot make their sport safe, they can implement measures to better care for athletes when recovering from injury.
First, pain killing injections could be banned. The use of injections is more common than many fans may think. They are used, as the name suggests, to dull pain and allow athletes to train and compete whilst injured. The downside is that they sometimes result in more serious injury when already compromised musculoskeletal structures are pushed beyond their limit. If sport is serious about protecting the long-term health of athletes, allowing pain killing injections seems at odds with this aim.
National governing bodies could implement an insurance scheme that protects the wages and/or opportunities of athletes injured at the end of their contract. In Football or Rugby Union, as an example, players may feel more pressure to play through injury in the final year of their contract. If national governing bodies were willing to insure players so that they were remunerated for the period of time they were injured, even after their contract ended it may reduce, if not remove, the pressure to play injured. Governing bodies could take this a step further and require clubs to retain the services of players injured in the final year of their contract if the injury results in a period on the sidelines of more than 25% of the regular season. This percentage may not be appropriate however it is a starting point. Governing bodies could institute studies that look at how many athletes get injured in the final year of their contract, how long they miss of the regular season and how many find themselves without a club the following year. Both measures would result in athletes and the medical staff who support them to experience less pressure to rush the rehabilitation process.
Finally, mandatory return to play protocols could be implemented. For example, following an injury that required them to miss at least two games, players would need to take part in at least four squad training sessions before being introduced back into competition. This would prevent clubs from rushing players back into games before a reasonable amount of training had been completed. They could go further and suggest a minimum return to training period following injuries of varying lengths. For example, if an athlete misses a month of competition then a return to training period of 10 days may be applied. For injuries that required a longer period of time on the sidelines, a more graduated return to training would be implemented. Clubs will already have their own version of this, however, it is not mandated nor enforced by the governing body and so players deemed of higher importance (or of less value) are likely to be rushed back earlier than medical advice would suggest is best practise. There is no safety net for athletes whose career is cut short because of an injury sustained in a competition they should not have been taking part in.
The improvements in how athletes are protected and rehabilitated from concussion are positive steps. Yet it does raise the question of whether such measures should be implemented for all types of injury sustained in sport.
