Updated concussion statement ‘game changing’

Matt Woodley

16/06/2023 3:16:14 PM

The guidance lays out ‘best practice’ on concussion’s prevention and treatment, but an omission has also sparked controversy.

Doctor performing concussion test on AFL player
The AFL has announced a $25 million study into the long-term effects of concussion and head trauma. (Image: AAP)

More than 100 researchers have released a consensus statement on concussion, bringing together 10 systematic reviews to outline the existing evidence around preventing and treating the condition in both professional and amateur sport.
The report was compiled after the International Conference on Concussion in Sport in Amsterdam last October and involved a review of 23 different studies in an effort to cover all aspects of concussion management.
Professor Gavin Davis, a neurosurgeon at the Murdoch Children’s Research Institute, said the findings will change how concussion is viewed across sporting codes, recreational sport and within medical clinics and emergency departments.
‘Concussion is among the most commonly occurring injuries in sport and results in a variety of symptoms and functional difficulties that can impact school, work, sport and recreation,’ he said.
‘Fortunately, most concussion symptoms will resolve within the initial weeks following injury. However, up to 30% will report persisting symptoms beyond 30 days.
‘Our wide-ranging research will be game-changing with improved early concussion assessment criteria and diagnostic and management tools, improved exercise and rehabilitation methods and upgraded return-to school and return-to-sport protocols.
‘Advances in biomarkers and emerging technologies will also guide future research and injury prevention.’
Key findings across the studies include:

  • the creation of five new diagnostic and management tools covering the acute (first 72 hours post injury) and subacute periodan updated definition of sport-related concussion to now emphasise the cause of the concussion, the physiological impacts and the evolution of symptoms/signs
  • new ‘return to learn’ and ‘return to sport’ strategies spanning rest, exercise and rehabilitation:
  • strict rest until symptom resolution was not effective for sport-related concussion
  • mouthguards were associated with a 26% decrease in sport-related concussion in collision sports, while headgear was linked to lower rates of concussion in soccer
  • no unintended consequences were reported in reducing bodychecking in contact spots, while neuromuscular warm-up programs in rugby saw a drop in the concussion rate of up to 60%
  • advanced neuroimaging, fluid-based biomarkers, genetic testing and emerging technologies were sensitive to the acute effects of sport related concussion and tracking neurobiological recovery
  • critical progress has been made towards validating advanced technologies for concussion management, but clinical relevance is yet to be confirmed.
The research found that continuing to play after sport-related concussion was associated with athletes taking longer to become symptom free than previously reported. 
However, they could not find any current evidence to support exact timing on when an athlete should retire or discontinue sport. Instead, decisions should involve clinicians with expertise in traumatic brain injury and sport, and consider the psychosocial, injury-specific and sport-specific factors, as well as any persisting symptoms.
The statement also found that studies linking repeated concussion with chronic traumatic encephalopathy, which relied on data from brain banks, was not rigorous enough to be included in their review – an omission criticised by some researchers.
Extended recovery times needed for younger athletes
Separate research, conducted by the University of South Australia, has also suggested that extended recovery times may be needed for youth athletes suffering from head trauma, after they found that a concussion can increase future injury risk by 50%.
The world-first study tracked and evaluated the long-term impact of concussion and subsequent injury risk of 1455 sub-elite junior Australian rules football players.
Tracking injuries over a seven-season period, researchers found that football players who suffered a concussion were also about 1.5 times more likely to be reinjured in the future when compared to players who had never been injured.
This increased risk was the same as for players returning from upper and lower limb injuries.
The finding comes ahead of the Australian Senate’s report into concussion injuries – for which the RACGP made its own submission – and follows the AFL’s announcement for a $25 million study into the long-term effects of concussions and head trauma.
In junior elite football, as well as AFL and AFLW, the guidelines for concussion say that the earliest a player can return to play post-concussion is 12 days after the injury, after following the graded progression through a return-to-play program.
However, the UniSA paper’s lead researcher Dr Hunter Bennett, says the significant and elevated risk of injury after a concussion suggests a longer recovery period is required for some players to better recover before returning to play. 
‘The current recommendation of 12 days post-concussion may not be sufficient to allow full recovery in elite under-18 footballers,’ he said.
‘Concussion is a common injury in Australian rules football that can lead to impairments in balance, coordination, reaction time, and decision making – and these impairments can increase the risk of other injuries if an athlete returns to play before being fully recovered.
‘When we know that athletes have a greater risk of another injury post a concussion, it suggests we need unique and careful rehabilitation strategies to monitor when an athlete is fully recovered and ready to return to play.’
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Dr Elizabeth Dorothy Hindmarsh   20/06/2023 9:10:34 AM

This is important research but it also needs to look at and include the victims of family and domestic violence. These people are also experiencing head injuries and traumatic brain injuries and the effects on the brain from strangulation

Dr John Maxwell Hollingsworth   20/06/2023 11:08:21 AM

There are many other variables that result in concussion recurrence. Poor tackle technique, height and size of the player, has a mouthguard been used, player aggressiveness ,medications. Before accepting recurrent head injury is related to management of the first head trauma other reasons must be ruled out.