Pressure to play 'jeopardises long-term health'

Many sportspeople returned to the field too early after concussion injuries, David Lamb, CEO of underwriting agency Sportscover Australia, told the AILA conference.

“The post-injury approach is a dog’s breakfast. There is pressure to play, and people are going back much too soon,” he said.

“I’m an insurer; I write the cheques. Concussion will be to sport what James Hardie is to asbestos.”

He said the problem with the sport concussion assessment tool (SCAT3), outlined earlier in the session by Prof Jeffrey Rosenfeld, director of neurosurgery at The Alfred Centre, Melbourne, was that players could memorise the required responses.

Prof Rosenfeld said the test was a standardised tool, administered by qualified health professionals, and now used in the Australian Football League and other leagues to determine the injury level.

But Mr Lamb said SCAT3 was not always administered. “Clubs have learned how to get around the rules.” There was peer pressure and ‘warrior syndrome’; players did not want to be tested, they just wanted to get back on the field. Clubs were complicit when star players were involved. “There’s a conflict of interest in asking sport to self-regulate.”

He said sideline testing was “strong and professional at the top level, but drops away at the lower levels”.

“A lot of elite sports bodies spend time and money on research, but it may not get to the grass roots level. All players deserve the same protection as the $10 million marquee players.”

Mr Lamb called for baseline pre-season brain testing, but said many sporting clubs could not afford it. “We have a culture that invests in cure not prevention.” He said it should be mandatory in collision sports.

He also wants education programs to tell players they need two to three weeks off after a concussive brain injury and independent doctors on the sideline to conduct tests, not team doctors.

“Player welfare must come first. If a comprehensive concussion program were in place, it would encourage more people to play sport.”

Mr Lamb said Australia should be worried about US litigation trends being adopted. “We have plenty of plaintiff lawyers out there willing and able to sue.” Australians play “a lot of sport — 60%-65% of Australians play organised sport. We have a high level of collision sports, and we play without a lot of padding.”

Athletes were getting bigger and faster. “If you were six foot, you used to be a ruckman in the AFL; now you’re a rover.”

Prof Rosenfeld the diagnosis of concussion was complex and not all concussions resulted in a loss of consciousness or convulsive symptoms. It was “a default diagnosis once other conditions are ruled out”.

H warned that “second impact syndrome” could trigger malignant cerebral swelling, which could result in death. “It can be prevented by taking a player off after the first incident.”

He said players should rest both their body and their brain until all acute symptoms resolved, then have a gradual return to school, social activities and, eventually, sport.

Sports Medicine Australia recommended 5Rs – recognise, remove, refer on, rest and finally return.

Prof Ronenfeld said traumatic brain injuries (TBI) were a risk factor in developing Alzheimers disease and inflammation could continue in the brain for years after an injury.

“If you have repetitive hits of mild TBI, no one knows the impact.”

Meryl Lieberman, a lawyer with the New York firm Traub Lieberman Straus & Shrewsberry, detailed US litigation against sporting bodies.

Mehr v FIFA was a class action seeking proper concussion management and return to play guidelines. She said it was dismissed last July, because the judge said the class was too large; the risk of injuries was assumed in playing soccer; there was no legal duty to change the rules of the game; and no claim that anyone had actually suffered an injury.

The US National Football League had reached a settlement with almost 5,000 retired NFL players for a range of concussion-based injuries and diseases. It included an uncapped monetary award fund, estimated at more than $US750 million; a $US75 million assessment program and a $US 10 million education fund.

Ms Lieberman said litigation focused on allegations that defendants:
• Knew or should have known about long-term injury from concussive and sub-concussive hits
• Failed to enact reasonable measures to prevent concussive injuries
• Encouraged injuries for economic gain
• Misrepresented the risk of concussive injuries and the long-term effects.

Potential defences were:
• Lack of duty
• Assumption of risk
• No causation
• Release/waivers
• Medical knowledge is still evolving
• Statute of limitations
• Jurisdictional limitations.

“If the law is ahead of the science, there’s a lot of money being paid that shouldn’t have been,” Ms Leiberman said.

She said concussion management was still at an embryonic stage. There was no bellwether case, so the field was uncertain and no defendant had been found liable.

Chronic traumatic encephalopathy (CTE), a progressive degenerative brain disease found in athletes with a history of repetitive brain trauma, including concussions and subconcussive hits to the head, was “a true wild card” in sports litigation.