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Brain injury just not sport

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The sight of footballers and other athletes being knocked out on the playing field should no longer be accepted as the price of playing sport, according to one of the world’s leading health institutions.

The United States’ Centers for Disease Control and Prevention (CDC) has identified concussions and other brain injuries acquired in the course of playing sport and other activities as a serious public health problem, and urged much greater focus on preventing them occurring.

In a statement released last month, the CDC called for a substantial improvement in surveillance systems to identify instances of such injury and provide information on how best to prevent it in future.

“TBI (traumatic brain injury) is an important public health problem that requires more attention, societal engagement and research,” the CDC said.

Its call follows alarming reports, both in the United States and Australia, of serious brain damage suffered by professional footballers.

Former Australian Rules Football player Greg Williams, who had an illustrious career playing with Carlton and Sydney, earlier this year went public with his belief that being concussed numerous times on the playing field had contributed to increasing memory loss.

In the United States, alarm bells were rung after a study found 40 former National Football League players suffered progressive brain disease.

The finding has helped spur a multi-billion-dollar lawsuit that has been filed against the NFL on behalf of more than 4000 former gridiron players and their families over claims they suffered life-long brain injuries as a result of the playing the sport.

The CDC has called for improvements in injury surveillance systems in the United States to better understand the epidemiology and long-term outcomes of such injury.

Acting head of the CDC’s Health Systems and Trauma Systems Branch Arlene Greenspan told amednews.com that improving knowledge was vital to devising the best ways to prevent such injuries occurring.

“There are things we know that we can do about TBIs that aren’t uniformly being carried out,” she said.

In Australia, the professional football codes have introduced rules that penalise players that hit the heads of opponents, and that require any player who suffers some loss of cognitive function on the playing field to be tested for concussion, and to be prevented from returning to play if concussed.

But Monash University brain injury expert Professor Mark Stevenson has warned that such practices were not being emulated at lower levels of these sports, putting the health of players at risk.

Professor Stevenson, who has previously worked at the CDC, conducted a study involving 3000 Sydney school-grade and suburban rugby union players aged between 15 and 48 years for between one and three seasons.

The research found a high incidence of concussion among players – 7 per cent sustained a concussion within 10 hours of play, and the incidence doubled to 14 per cent with 20 hours of play.

Players who sustained one concussion were twice as likely to sustain a second, and those with a lower body mass index were 10 per cent more likely to sustain a concussion, and those who trained for less than three hours a week were 20 per cent more likely to be concussed than those who spent more time training.

Alarmingly, Professor Stevenson said, many of those who suffered concussion risked exacerbating the injury by returning to play early,

In a column in the Sydney Morning Herald on 27 February, Professor Stevenson said the study found 48 per cent of players who sustained a concussion returned to play in the same game, and 34 per cent did not leave the field at all.

This was despite a recommendation from the International Rugby Union Board, supported by the Australian Rugby Union, that players who suffer a concussion take a three-week break from training and play.

He said only 22 per cent of players identified as receiving a concussion in the study reported receiving any return-to-play advice. And 75 per cent of those players did not comply with the three-week stand-down period.

“Not one player in the study who received the recommended post-concussion advice complied,” Professor Stevenson said. “Eighty-seven per cent of concussed players returned to either training or competition within one week, and 95 per cent had returned within three weeks of injury.

“So it’s not just a lack of awareness of the rules regarding concussion – the rule itself is seen by the players as largely meaningless.”

Adrian Rollins