Sporting organisations across the country and the world have began to implement concussion policies, along with a myriad of rules and regulations to ensure the effects of head injuries are mitigated.
Recently, the PFA has worked with Preston Lions to provide support for former Socceroo Warren Spink – who suffered a life altering brain injury playing for Australia in the 90s – raising money to help manage his wellbeing and financial situation. The two held a fundraiser last month at BT Connor Reserve, where a documentary about Spink was shown to help raise awareness of his condition, concussion, and head injuries.
The PFA have also enacted a number of initiatives on concussion and head trauma, including an expert education program on how to respond to head injuries that’s been developed in collaboration with FIFPRO for A-Leagues players.
This includes a partnership with the Concussion Legacy Foundation Australia (CLFA), whose helpline is available to all PFA members who are struggling with the outcomes of repeated concussions, brain injuries, their lingering symptoms, and help those who are concerned about suspected CTE.
In order to continue bringing further awareness around the risks associated with concussions and brain injuries, the PFA posed a range of questions to Dr Alan Pearce – who works with both the CLFA and Australian Sports Brain Bank (another PFA partner).
Q: Are you able to provide a clear differentiation between a concussion and brain injury?
AP: When we think of “brain injuries”, we tend to picture the individual who has had a moderate or severe brain injury that includes quite obvious signs where the skull has been fractured or that the individual has clear obvious injuries. Concussion on the other hand, is still a brain injury (it falls within the mild traumatic brain injury), but the signs and symptoms appear more subtle.
This doesn’t mean that it is any less serious, indeed a concussion can be catastrophic, and for some people they may take months or years to recover.
Q: What are the main symptoms of a concussion/brain injury and how long does it take to properly evaluate?
AP: There is, what we call, a “constellation of signs and symptoms” associated with concussion. These can also differentiate quite significantly between individuals, so two people can be concussed and have vastly different symptoms. However, in saying that, more obvious signs and symptoms of concussion include confusion, dizziness, dazed, headaches, nausea and/or vomiting, lack of coordination, unaware of surroundings, blurred vision, slurred speech, difficulties in concentrating, being emotional (sad or crying), and fatigued.
Loss of consciousness (being ‘knocked out’ only occurs in about 10% of cases). However, it’s important to note that these signs or symptoms need to be happening following an observed or suspected physical impact to the individual. Further, someone does not need a direct impact to the head to cause concussion.
A concussion can happen to someone who has had an impact to the body, with the force travelling to the brain tissue. Finally, a concussion is an ‘evolving injury’ a player may not show symptoms immediately, but could show signs 5, 10 or even 30 minutes after the collision. Therefore it is important with a suspected concussion to bring a player off and let them rest for 10 minutes prior to starting the assessment to ensure any symptoms masked by adrenaline may show up.
Q: What are some of the measures players can take when they feel they have sustained a concussion?
AP: This is a little tricky because in many situations a concussed player, being dazed and/or confused may not even realise that they are concussed. So we need team mates to look out for each other, and if a team mate (or opponent) is seen to be “not quite right” after a collision, then they should call for a trainer and get the player off the field to be assessed. Remember the lines “recognise and remove” and “if in doubt, sit it out”.‘
Watch FIFPRO’s advice on concussion for footballers: watch
Q: What needs to be done to provide greater education to football (soccer) teams to be prepared for instances where they may be a concussion or brain injury?
AP: Just like CPR, all soccer teams and clubs should have annual concussion education updates. This is to remind not only players, but coaches and officials what the signs and symptoms of concussion are, and what should be done. It could save a life.
Q: Do you think enough is being done in the football space when it comes to recovery and education?
AP: I think right across the board we can all improve when it comes to encouraging proper recovery after a concussion (do not be too quick to try and return to play). We need to have not only education but also a cultural change to concussion. We can no longer afford to accept that a concussion is a “badge of honour” to illustrate athletic toughness, or not disclosing having a concussion for fear of not being selected to play. As I have said in the Australian football (AFL) and rugby space, an extra couple of weeks recovery and rehabilitation, can extend a career by many years.
Q: Should teams (at an elite level) start to incorporate brain scans as part of their medical?
AP: This is an interesting question. Routine clinical brain scanning (i.e. MRI and CT) do not have the resolution to detect subtle changes in the brain following concussion or even repetitive physical trauma. There are more advanced techniques, but currently they are being used in an experimental setting until we can get more information on their clinical capacity. While brain scanning may not be quite ready as yet, all clubs can, as part of their preseason screening, include baseline data which could be as simple as doing some elements of the Sports Concussion Assessment Tool V6 (such as the working memory and concentration components).
Clubs should also try and actively reach out to a local medical practice and physiotherapy practice that could be their preferred medical/physio clinic for clearing players to return to contact training and matches.
Q: Is there a clear link between dementia/brain disease and professional footballers?
AP: We have seen over the years, starting with the late Jeff Astle [former English footballer], that there is a link between repetitive brain trauma exposure and risk of diseases including dementia, in particular chronic traumatic encephalopathy (CTE), but also Alzheimer’s disease, motor neurone disease and parkinsonism.
However, while we need to be aware, we should not allow ourselves to be alarmed. We can reduce the risks quite significantly by reducing both exposure to repetitive physical trauma to the brain (through excessive heading of the ball), but also providing proper assessment and recovery/rehabilitation protocols following a concussion.”
Q: What is CTE and how does CTE occur?
AP: CTE stands for chronic traumatic encephalopathy. It’s a neurodegenerative disease that is linked to repetitive physical trauma to the brain. While the majority of cases that have been published have been in the football codes (American, Australian rules and rugby) there have been growing number of cases in soccer, including female soccer players recently published by Boston University.
CTE occurs when physical impacts to the brain release a protein called tau. In normal situations, tau helps maintain structural integrity of the brain cells (neurons) but when its released from repetitive physical trauma, it becomes toxic and kills the brain cells that then affect an individual’s cognitive, behavioural, and movement functions and subsequently mental health.
Q: How much of an impact does heading the ball have?
AP: This is something we are still currently researching. The first study to really look at this was Dr Tom Di Virgilio from Stirling University who, in 2017, showed that after a series of repeated heading of the ball, as someone may do in practice, there were physiological changes in the brain, as well as temporary memory impairments, for 24 hours. Since then, there have been supporting studies leading to the IFAB trial to phase out heading at youth levels in some countries.
