We need to change the rules

By Dr. Helena Popovic, Medical Doctor, International Speaker and leading authority on improving brain function
October 2022

If you knew that doing something you loved — I mean really loved — could give you dementia, would you still do it?

What if that ‘thing’ was playing your favourite sport? For instance, boxing, ice hockey, American football (gridiron or NFL), soccer, Australian Football (AFL), rugby league (NRL) or rugby union (RU)?

Would you let your children participate in these sports if you knew that it raised their risk of developing dementia later in life?

What happens when sport clashes head on with medicine?

In 2014, the first Australian case of chronic traumatic encephalopathy (CTE) was diagnosed in Manly Rugby Union player Barry ‘Tizza’ Taylor who developed problems with memory, cognition and violent outbursts in his 50s. CTE is a type of dementia caused by repeated blows to the head, with our without loss of consciousness. Over time, this leads to accumulation of abnormal proteins in specific regions of the brain together with brain shrinkage and loss of mental functioning. Barry’s symptoms became progressively worse until his death at the age of 77.

Decades ago, doctors believed that only boxers were at risk of dementia due to repeated concussions. We now know that all impact sports predispose players to CTE and the risk increases with:

  • more frequent and severe head knocks
  • the shorter the interval between knocks
  • the longer they’ve been playing the game.

In response to the alarming number of sportspeople coming forward with CTE, Associate Professor Mark Buckland established the Australian Sports Brain Bank (ASBB)* to accelerate research and provide support for patients and their families.

A few weeks ago, I was privileged to attend the launch of a new initiative by the ASBB called The Concussion Legacy Foundation (CLF). One of the CLF’s first projects is to raise awareness of an international campaign called ‘Stop Hitting Kids in the Head’. The campaign aims to eliminate repetitive head injuries in children as a result of playing sport. One effective strategy is to replace tackle football with touch or flag football. In flag football, instead of tackling, the defensive team must ‘deflag’ or remove a flag from the player with the ball. It’s a much safer sport with limited contact between players. Another proposal is to ban heading in soccer for children under the age of 12.

Mitigating head injuries in sport is a complex issue. Playing sport enriches our lives — physically, mentally and socially. However, if we don’t set guidelines that ensure the safety of players, the harms will undo the benefits. To their credit, the AFL has amended the rules to reduce the number of dangerous tackles and high collisions. In 2019, rugby union lowered the legal tackle height worldwide and immediately saw a significant drop in concussions. Protocols for managing head injuries have also been tightened. These reforms are moving AFL and rugby in the right direction but it’s only a start. Another critical issue is the culture of the game. Mental and physical bravery are carved into a player’s DNA. Team members fear being seen as weak if they admit to feeling unwell. They believe it’s an occupational hazard and the game must go on. No one wants to let the team down by staying off the field after a ‘minor’ knock. However, symptoms are sometimes delayed for several hours, and continuing to play would make the player sicker later. We need to redefine ‘minor’ and ‘bravery’. Bravery shouldn’t mean playing on after an injury. Wouldn’t it be braver to talk about injuries so that sport could be made safer for everyone? To quote Samuel Johnson: Courage is the greatest of all virtues, because if you haven’t courage, you may not have an opportunity to use any of the others.

When the rules of soccer and contact sports were created, we were unaware of the consequences. Now that we know, we need to reconsider the rules. Science is full of research that yields answers we don’t like. Life is filled with events that force us to change. COVID-19 has demonstrated that the world is capable of massive — previously unimaginable — change. Surely, so is sport.

The first step is raising awareness. Your voice can make a difference. Start a conversation today.

*To further our understanding of not only CTE but all dementias, the ASBB studies posthumous brains donated by sportspeople and members of the public, with or without a diagnosis of brain disease. If you’re interested in pledging your brain to the ASBB, visit brainbank.org.au for an information pack. You can change your mind at any time if you no longer wish to participate.

*If you would like to learn more from Dr Helena Popovic or buy her books, please visit: drhelenapopovic.com


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