OVER the past decade, sport-related concussion has become a major public health concern. The discovery of severe acute and long-term effects of these injuries on the brain have launched concussion into the spotlight across the globe.
Scientists and league administrators in sports such as rugby, boxing, American football, Australian Rules, and ice hockey have collaborated to address this problem. New strategies and guidelines have been introduced to reduce the incidence and severity of concussion, and ensure that cases are accurately diagnosed and optimally managed.
The GAA has shown commitment to player welfare, hosting various concussion training events and publishing the Concussion Management Guidelines for Gaelic Games. These guidelines recommend that all players suspected of concussion be removed from play pending a standardised medical assessment. However, very little research exists on whether this is actually occurring on the pitch.
A recent study led by two medical students at University College Cork, under the supervision of Professor Conor Deasy (Consultant in Emergency Medicine, Cork University Hospital), Dr Gregory Tierney (University of Leeds, School of Biomedical Sciences), and Dr Michael Cusimano (Consultant Neurosurgeon, St Michaels Hospital, Canada), used a video-analysis methodology previously applied to professional soccer to investigate the incidence and assessment of Potential Concussive Events (PCEs) during the 2018 and 2019 inter-county Gaelic football seasons.
Two reviewers reviewed 111 matches and identified all PCEs, defined as any event in which a player was unable to resume play in a meaningful capacity within five seconds of a direct and visible head contact. Each event was analysed to determine whether an assessment occurred, the duration of that assessment, subsequent return-to-play (RTP) decision, and visible signs of concussion.
The study found that although most players were assessed following a PCE, 88.6% of assessments were under two minutes in duration and only 5% of players were removed from play. It is important to note that the standardised concussion assessment tool (SCAT-5) recommended for use by the GAA and international bodies takes at least 10 minutes to perform. Our findings suggest that this assessment is rarely being completed, if at all.
However, the most important finding was the proportion of players who returned to play following a PCE that resulted in visible signs of concussion. An international consensus study published in 2019 indicated that there are six observable signs on video analysis that indicate a high probability of concussion. The authors of this study recommended that if a player displays even one sign, they should be immediately removed from play and professionally assessed for concussion.
Our study determined that 61 (25.2%) PCEs resulted in a player with one or more signs. However, only nine (14.8%) of these players were removed from play. This suggests that assessment of PCEs in elite men’s Gaelic football may not always be in accordance with best practice, and is placing players at risk. The same methods have been applied to elite inter-county hurling, and a paper detailing this research is currently under review at the Irish Journal of Medical Science. The assessment and RTP findings were almost identical to those in Gaelic football, suggesting that this is a widespread issue that exists across the entirety of the Gaelic Games.
TO date, it appears that the GAA’s efforts to improve concussion care have had a limited effect.
The authors offer the controversial recommendation that the GAA take action to improve the identification and management of head injury, through strategies such as sideline video analysis, external concussion spotters, and concussion substitution rules.
Over the past few years, sporting leagues around the world have begun to implement such measures at varying rates. American Football and rugby have been leaders in the space, while soccer is known to be well behind the curve.
Recently, following a violent head clash between Raul Jimenez and David Luiz, a massive public and media outcry has led to the English Premier League committing to trialing a new concussion substitution rule in 2021. While this is a step in the right direction, we should not wait for a dangerous and controversial event like this to occur in Gaelic games before initiating change.
The GAA must endeavour to standardise concussion assessment and RTP protocol across the league, at all levels of play. Ongoing training, education, and quality assurance programmes may be necessary to ensure that stakeholders appreciate the importance of concussion management, thereby promoting a more informed safety culture when it comes to head injury. A survey published in 2019 found that over 90% of adolescent GAA players and parents would value further education on sport-related concussion. Perhaps it is time that we addressed this gap in knowledge.
For decades, players of all ages who found themselves dizzy, confused, or shaken following a big collision were told to ‘shake it off’ and get on with it. We have only recently realised the danger of this behaviour. The public must be made aware that a concussion is not like a sprained ankle or a bloody nose.
It is an ‘invisible injury’ that is easily missed, placing players at risk of further damage that may compound over time. Furthermore, it affects a part of the body that is indispensable. While there are surgeries and therapies available for damaged knees or shoulders, there is no procedure that can reverse post-concussive syndrome or dementia.
As players get bigger and stronger, concussion risk may be increasing, and while concussion cannot be eliminated from the game entirely, we must ensure that players suspected of having sustained a concussion are receiving appropriate care. If this is not happening at the elite level, it is most likely not occurring in youth leagues. We hope that the public will recognise this public health issue, and will take an active role to boost awareness and advocate for change at all levels of play.
The current study is the first of its kind in Gaelic games. It is hoped that this new information will encourage a collaborative effort from the GAA, team doctors, managers, players, and other stakeholders to facilitate increased concussion awareness and adherence to guidelines. The key to moving forward is a collective effort between both the GAA and the community to make the game safer for all.
The goal is not to change the way sports are played, but rather to strike a careful balance between preserving the parts of sport that we hold dear, and protecting the well-being of the individuals that participate for years to come.
- The paper can be found at the following link: https://rdcu.be/b7V6y.
To date, it appears the efforts to improve care for concussion in the GAA have had a limited effect