Tick-tock goes the concussion clock
In September 2023, the Australian Senate tabled its Community Affairs Reference Committee’s (Committee) findings in respect of traumatic brain injuries (TBI) sustained in contact sports. Of course, a welcome step in the right direction for the broader Australian sporting industry given the strong prevalence of TBI across sporting codes. But whilst the report is generally informative and provides some broad recommendations, there are particular areas that warrant further consideration.
Redefining the ‘promotion’ of sport.
The inquiry and subsequent report acknowledged and recommended that further (and more ongoing) support ought to be provided to professional and amateur athletes affected by TBI. Notably, the Committee noted that ‘there are significant disparities in the support available to professional athletes, compared to players in the broader community. The Committee is of the view that the lack of support available at community levels must be addressed…and sporting organisations can (and must) play a key leadership role in supporting these individuals’.
In terms of disparities themselves, there is naturally a stark contrast in TBI recognition at professional and amateur level given the wealth of resources available, and continued fixation on high-performance moving toward 2032. A continued fixation on high performance programs, naturally, leaves the amateur programs in the lurch when it comes to issues such as TBI. This issue is seemingly so prevalent that it has warranted the Committee’s strong recommendation for a shift in focus - following Neuroscientist Professor Alan Pearce’s recognition of the distinct lack of any support arrangements at community level, and correlation to a growing class of retired athletes continuing to ‘suffer in silence’.
The Committee’s view is particularly interesting, noting that sporting organisations’ governing documents largely follow a similar ‘company limited by guarantee’ structure in that they provide a series of targeted objects based on fostering the development and promotion of sport at their respective community levels. To develop and promote sport is not purely a recruitment drive exercise. It is more than an Auskick or Junior Rugby program targeted at promoting participation from children. In light of recent findings, it then begs the question - what is it to develop and promote a sport?
A question ultimately left for administrators to answer, but in light of the Committee’s findings and understanding of the nature of collison sports both at a high performance and amateur level, it is difficult to see a better form of development and/or promotion of a respective sport than by actively rolling out community based solutions and support to athletes affected by TBI.
In light of the Committee’s comments, it is clear that some further thought ought to be given by what exactly ‘promotion’ means at a community level. One would expect that following such findings - consultation, guidance and promotion of mitigation (and rehabilitation) programs to youth and amateur athletes suffering TBI, is firmly on the cards.
The need for a unified approach
In addition to the above, the Committee also noted that ‘[in the current Australian sporting landscape] there exists a strong incentive to win. Coupled with compelling social, normative and economic factors that influence decision-making’. In considering these observations, which are relatively well known to the majority of industry proponents, it is unsurprising to note that return-to-play protocols for TBI vary from sport to sport - given the industry’s continuing commercialisation. After all, money talks in this industry.
Equally well known among industry proponents by now, are the damaging effects a premature return to play from a TBI can have on an athlete. It is therefore important that administrations and government liaise to formulate tighter protocols around return-to-play to ensure the longevity and holistic wellness of athletes. Steps have already been taken in this regard - with the Australian Institute of Sport’s formulation and release of their ‘Australian Concussion Guidelines: For youth and community sport’ aimed at providing a series of overarching concussion management guidelines for community sports. In a centralised and global move, the Australian Institute of Sport’s new guidelines have been formulated largely in collaboration with the United Kingdom’s Department for Digital, Culture, Media and Sport, and New Zealand’s Accident Compensation Corporation. Whilst moves such as these put Australia’s governing body at the forefront of a global movement to establish sound and unified rules with respect TBI - it is merely one of the many steps required.
“What could be of higher priority...than looking after the individuals on whose shoulders the success of the game now stands?”
Boardroom mitigation
Put simply, TBI is a governance issue as much as it is an athletic issue. Whilst on-field mitigation is an obvious answer to the TBI problem and media continually criticise players in error (who, by in large actively mitigate but are subject to accidental collisions), players need to be given the tools and environment to succeed without the growing threat of TBI. Total elimination of risk in collision sports is simply not feasible. No one is suggesting it is. But what is feasible, is an acknowledgement and demonstration by administrators to protect players through rule changes and the like. After all, as the Committee heard from Mrs Anita Frawley, widow of AFL great Danny Frawley - ‘What could be more of higher priority for the competition than looking after the individuals on whose shoulders the success of the game now stands?’
To effect real change, the aforementioned is a question administrators must ask themselves in almost every decision. It is what has driven rule changes by Rugby Australia regarding tackle height, and introduction by the NRL mandatory sin-binning for egregious head-high conduct. Rule changes are substantive measures - encouraging players to be cautious in contact, isn’t.
The new school of thought
Whilst the inquiry was welcome for industry generally, and has provided useful recommendations and highlighted several key obstacles administrators and athletes must overcome in the fight against TBI, the reality is - without workable solutions that actively negate (or at least mitigate TBI), industry is left with the same problem, but now with more data. Interestingly and notably however, technological advancements out of the United States seem to suggest that the sports-tech industry is actively taking steps toward solutions, through the inception and promotion of wearable devices such as the Q-Collar. The Q-Collar, a non-invasive, wearable device, is designed to nullify the brain’s ability to move inside the skull when the subject of impact. With well over 20,000 athletes actively using the technology in the United States, the innovations around wearable sports-tech appear (at least initially) to be leading the charge in terms of providing industry with workable solutions in response to the senate inquiry.
The need for a unified approach in trial and implementation of sports-tech solutions such as the Q-Collar, has never been more important considering the rapidly expanding breadth of TBI sufferers. No longer reserved for rugby players or combat athletes, studies are starting to suggest that over the past three to five years, female athletes - particularly footballers - have become at a heightened risk of suffering a TBI. The prevalence of the ‘concussion gender gap’ and sustained growth of female sports following the successes of events such as the FIFA Women’s World Cup 2023 and Women’s Rugby World Cup 2021, (where athletes from competing nations sported wearable tech aimed at TBI mitigation) only compounds to the necessity for swift and resolute action in promoting wearable sports-tech.
Industry is in agreement that technology needs to be appropriately trialled and examined before it is made available to athletes. But rather than assuming a quasi-pessimistic approach about all sports-tech advancements in the TBI mitigation sub-group, administrators ought to be continually pushing for developments. With respect to athletes, we think that athletes should find some comfort in the inquiry’s findings especially those at a semi-professional or community level given the potential availability of TBI management resources. With respect to professional athletes, we think technological advancements ought to provide some level of comfort that the sports-tech industry is actively working toward real mitigation solutions for TBI in 2024 and beyond.
There should be no questions about the Committee’s findings, nor the Australian Institute of Sport’s active response to the findings. The establishment of globalised concussion management protocols, are a welcome and essential step toward TBI management. But the establishment of a unified return-to-play approach and recommendation for a ‘concussion officer’ to be present at all community fixtures, is hardly paving new ground toward a continued life of high performance sport. For the latter to occur, there needs to be rapid action utilising the power of expanding sports-technology. At least, that is the way we see it.