A key document shaping sports policy on concussion says it is “reasonable to consider” that there is a potential association between repetitive impacts to the head and the development of chronic traumatic encephalopathy.
Last month it was announced that three other former Football League players – Jimmy Conway, Jim Fryatt and Jimmy Gabriel – had been posthumously diagnosed with CTE, a progressive and fatal brain disease.
The findings nearly doubled the number of publicly confirmed diagnoses within English football, following cases involving Jeff Astle, Rod Taylor, Billy McEwan and Nobby Stiles.
Now, the latest Consensus Statement on Concussion in Sport, a document that has in the past played a key role in shaping how sports governing bodies establish their concussion policies and protocols, states: “It is reasonable to consider an exposure extensive to repetitive impacts to the head, such as that experienced by some professional athletes, potentially associated with the development of the specific neuropathology described as CTE-NC (CTE neuropathologic change).”
Concussion has become more of an issue in professional sports in recent years.
Sports such as football and rugby have made changes in recent years to provide greater protection against the risk of impact with concussion and subconcussion, for example restrictions on head training at all levels of football and trials to lower the height of the tackle in rugby.
The new Statement says that studies to date on the effects of concussion and repetitive head impacts on the health of athletes in old age have been “limited.”
The 2019 FIELD study found that professional soccer players were three and a half times more likely to die from a neurodegenerative disease than age-matched members of the general population, raising concerns that their increased exposure to the impacts of concussion and subconcussion were behind the increased risk.
However, the Declaration, the first to be published since 2017, says much more work is required to firmly establish any link.
“Studies, to date, are methodologically limited because most were unable to examine or adjust for many factors that may be associated with the neurological outcomes of interest,” it said.
“Studies examining cognitive decline and neurological outcomes did not examine genetic factors and generally did not consider or control for factors known to be important for brain health in the general population, such as educational level, socioeconomic status, smoking, hypertension and cardiovascular disease, diabetes, sleep apnea, white matter hyperintensities, social isolation, diet, physical activity or exercise.
“To establish a clear causal association between sports participation early in life and cognitive decline or dementia later in life or to quantify that association, future well-designed case-control and cohort studies, including as many confounding factors and individual risk modifiers as possible are needed.”
The Statement recommended the creation of a new working group, which would seek funding for further research on the potential long-term impacts of brain injury and “continue deliberations on these issues in the interest of athlete care.”
In a briefing in connection with the report’s release, the Statement’s joint first author, Dr. Jon Patricios, said soccer must operate at a “low threshold” for suspected concussion if it wishes to proceed with brief evaluations at the field.
Head injury activists, the global players union FIFPRO, the Premier League and Major League Soccer in the United States called for a trial of temporary concussion substitutes earlier this year, which would allow for an off-field assessment of 10 minutes for a player suspected of concussion.
The game’s legislative body, the International Association Football Board, rejected that proposal in January and work continues on the existing additional permanent substitute concussion trial, which includes a much shorter on-field evaluation.
Dr. Patricios said: “Three minutes is enough to suspect a concussion (but) if you only allow a three minute period, your threshold for removing that player should be very low.”
“If there is a suspicion (they have suffered a concussion) they should retire and not play again if there is not enough time to do a proper evaluation.”
Dr Patricios, as part of the Concussion in Sport Group coordinating the Consensus Statement, wrote to the IFAB in February in support of calls for a temporary concussion surrogate trial.
Work on this latest Statement began in 2018 and is based on results discussed by more than 100 medical experts at the Concussion in Sport Conference in Amsterdam last October.
The Conference is funded and organized by sports bodies such as FIFA, World Rugby and the International Olympic Committee.
The CISG’s work has faced criticism in the past from some head injury advocates for being too protective of sports organizations, but the Declaration’s joint first author, Dr. Kathryn Schneider, says the group has “The process has evolved and it has been inclusive.” in creating the latter paper, published in the British Journal of Sports Medicine.
Elsewhere in the Statement, clinicians are encouraged to recommend early return to light physical activity that does not exacerbate symptoms within the first 24 to 48 hours of sustaining a concussion, finding that strict rest until complete resolution of concussion-related symptoms “is not beneficial.” “.
Limited screen time in the first 48 hours after injury may also aid recovery, according to data reviewed by the doctors who prepared the Statement.
