Long-term failure to reduce the risk of brain injury in sport criticised in British report

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"What is astounding is that when it comes to reducing the risks of brain injury, sport has been allowed to mark its own homework."
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Urgent action is needed by the British Government and sporting bodies to address a long-term failure to reduce the risks of brain injury in sport, an inquiry by a parliamentary committee has concluded.

The Digital, Culture, Media and Sport Committee set out to examine links between sport and long-term brain injury. It considered scientific evidence of links between head trauma and dementia, and how risks could be reduced.

The MPs heard evidence from scientists, former athletes, chief medical officers, players’ unions, and national governing bodies for various sports, and received written evidence from a wide range of interested parties.

In its recently released report, the committee said there was no overall responsibility within sporting organisational structures to mandate minimum standards for concussion and head trauma, or to assess whether protocols are followed.

It said the government should establish a nationwide minimum standard definition for concussion that all sports must use and adapt for their own codes.

Committee members said health and safety officials should work with the national governing bodies of all sports to establish a national framework for the reporting of sporting injuries.

Efforts should be made to raise awareness on the dangers of concussion effectively.

The nation’s high-performance sports agency, UK Sport, which invests in Olympic and Paralympic sport, should pay for a medical officer at every major sporting event with the responsibility to ensure the safety of participants and the power to prevent athletes at risk from competing, the MPs concluded.

Committee chairman Julian Knight said members were shocked by evidence from athletes who suffered head trauma, putting their future health on the line in the interests of achieving sporting success for Britain.

“What is astounding is that when it comes to reducing the risks of brain injury, sport has been allowed to mark its own homework.

“The Health and Safety Executive is responsible by law, however, risk management appears to have been delegated to the national governing bodies, such as the FA (Football Association). That is a dereliction of duty which must change.

“The failure by these sporting organisations to address the issue of acquired brain injury is compounded by a lack of action by Government. Too often it has failed to take action on player welfare and instead relied on unaccountable sporting bodies.

“As concerning is grassroots sport with mass participation, where we’ve found negligible effort to track brain injuries and monitor long-term impacts.”

The report concludes there is no overall responsibility to mandate minimum standards for concussion and head trauma, with each sport left to decide on correct protocols.

The present system allows sports to be funded as long as their protocols look good on paper, with no effort put into assessing how they might work in practice. When funding depends on excellence and achievement, the focus of athletes, clubs and governing bodies on the safety of athletes can easily be lost.

Because concussion does not occur at high frequency within the elite sport community, little effort is made to drive numbers down even further, with some preventable brain injuries occurring, carrying the potential for long-term consequences for individuals, according to the MPs.

The inquiry heard evidence that the lack of any statutory requirements to report injuries could have led to under-reporting. Sports Minister Nigel Huddlestone voiced concern to the inquiry that he was “not at all convinced” there was accurate recording of all concussion injuries at present.

The report finds the absence of scientific certainty should not be a prerequisite for changing sporting rules to improve safety. It recommends a more precautionary approach with a greater proportion of the money spent on elite sport to be focused on protecting the athletes who are at the core of Britain’s success in sporting endeavours.

Although scientific research could not yet demonstrate a causal link between dementia and sporting activity, it was undeniable that a significant minority of people would face long-term neurological issues as a result of their participation in sport, the MPs said.

Notable cases include the 1966 World Cup-winning squad, with five former players diagnosed with dementia.

The FIELD research study, joint-funded by the Football Association and Professional Footballers’ Association, established a strong correlation between a career in football and a significantly increased incidence of dementia in later life.

Risks for former footballers were found to be five times greater for Alzheimer’s disease, almost four times greater for motor neurone disease, and two times greater for Parkinson’s disease.

The inquiry was told that a focus on the term concussion was potentially unhelpful because though one of the most obvious symptoms of brain injury, long-term impacts of acquired brain injury might occur in absence of historic concussions. Many sports injuries result in impacts sufficient enough to cause brain injury, but not severe enough to cause concussion.

The report criticises the Football Association and the Professional Footballers’ Association for failing to fight hard enough within the broader football community or publicly enough to address the issue of concussion. Instead, the committee said it had been left to campaigning by organisations such as the Jeff Astle Foundation and former footballer Chris Sutton to keep the issue in the public eye.

Though a vast number of people participate in grassroots sport, there was evidence of a lack of awareness of concussion and its potential long-term consequences among participants and those facilitating sport. The inquiry heard repeatedly that the National Health Service (NHS) was not properly equipped to deal with the issue.

The report makes recommendations to improve NHS knowledge and treatment, as well as data collection on concussion and concussion-related brain injury.

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