Is the debate on sports-related concussions coming to a head?

It happened 50 years ago, but the memory of former Gaelic footballer Pat O’Neill’s first concussion hasn’t faded.

He was then just another kid with dreams. He crashed into another player. Went off. Came back on. The usual. Smacking his head again, after an ill-timed bout of hi-jinks in the school swimming pool, didn’t help.

It wasn’t until he went to class and began work on maths that he vomited. Only then was he sent to the infirmary, where the only medical attention was 48 hours spent under the watchful eye of a Sister Camillus.

Seven years later, it happened again. Another collision. Came off second best against a retired Tipperary hurler, during the 50th anniversary commemorative game for the Bloody Sunday atrocity at Croke Park.

He ended up in the wards on Jervis Street after that one. O’Neill, whose public life has been defined by the twin pillars of medicine and sport, shared those experiences with a few hundred people in Croke Park last Saturday, at the National Concussion Symposium, and they raised a fair few chuckles.

What became clear as the symposium progressed was that we still know all too little about concussion and that so much of the little we do know is either wrong or debatable. It made for a sobering day’s education.

The word ‘concussion’ stems from the Latin to ‘shake violently’, but it was 2001 before the first international conference on the issue was convened, in Vienna, and it’s just a decade since the term started to enter the wider public discourse.

The spiralling web of stories about high-profile former athletes suffering from chronic traumatic encephalopathy (CTE) — a neurodegenerative disease that can lead to dementia, memory loss and depression — has changed everything.

There are an estimated 3.8m sports-related concussions every year in the US. Half of those happen to adolescents, and parents are getting jittery about putting little Johnny or Jane in harm’s way.

Sports bodies have come to fear concussion every bit as much. Laws have been trialled and changed, lawsuits threatened and filed. The overriding emotion, on all sides, has been fear.

“Concussion is the bogey man,” as one speaker put it in Dublin. Another to contribute last week was Dr Mickey Collins, an internationally renowned expert in the field of sports-related concussions, and a founder member of the UPMC Sports Medicine Concussion Program, in Pittsburgh.

He has treated children, and high school and college athletes, as well as professionals, and has advised organisations as diverse as the Pittsburgh Steelers and Cirque De Soleil.

What he said last weekend was extraordinary. “This is a treatable, manageable injury,” he said. “It’s gone from ‘how many fingers am I holding up’ to one of mass hysteria. It’s worse than we thought, but it’s not as bad as it’s made out to be. We can normalise this injury by treating it properly.”

Dr Collins hasn’t just started saying this. Articles, journals, and interviews stretching back three years show that the fourth-generation Irish-American has been preaching this gospel for some time. “Concussion,” he said in one interview, back in 2013, “is not cancer.”

This is game-changing stuff, if true.

Concussions, after all, are proving to be terminal for more and more sports careers. Last week, Connacht and Ireland prop, Nathan White, was just the latest well-known rugby player to have to retire because of them.

Concussion has been a life’s sentence for some, a death sentence for others.

Dr Collins, whose UPMC clinic sees up to 20,000 cases per year, has rarely reached for the switch that shuts the door on someone’s playing career and he has gone on record to say that people don’t need to fear turning out like Junior Seau.

A Hall of Fame linebacker in the NFL, Seau shot himself in the chest two years after retiring from pro football, in 2010, and subsequent, postmortem tests showed definitive signs of CTE brought on by repetitive head trauma.

Can all that be avoided with the right treatment? Dr Collins is adamant that it can and argues that the answer is to stop approaching concussion as one big, bad, homogenous concept and start breaking it down into its many component parts.

“If there are 30 different types of knee injuries, why do we think there is one type of concussion?” he asked, rhetorically. “The brain is infinitely more complex. There are several different types of problems that can occur after a concussion.”

The folk at UPMC have broken these problems down into six categories, which means that a concussed patient experiencing, say, balance issues will be attended to differently to one experiencing undue stress and anxiety or migraines.

Personal and family medical histories are taken into account, one-to-one interviews are held, and tests carried out, and only then is a course of treatment decided upon.

Some patients may still require peace and quiet and black-out blinds, as is the commonly-held view, but others are rehabilitated through exposure to stimuli long before the symptoms of concussion have receded completely.

Dr Collins compares it to a mechanic starting a busted car to see how it is working.

“We need to move beyond sitting in a dark room, taking away all the computers and all the phones, don’t let kids go to school or socialise with their friends, unplug them and hope that rest will take care of it.

“Well, it doesn’t, a lot of times.”

Dr Collins was one of 37 field experts who gathered in Pittsburgh, last October, to construct a framework for concussion treatments. Opinions are still scattered as to the next step, but over 95% did at least agree that the problem was treatable. Yet even that gathering came with an asterisk.

For a start, it was funded by the NFL, who have considerable skin in this game. Questions were asked about the absence of some voices previously critical of the league, and the media was kept away.

Dr Bennet Omalu, whose discovery of CTE in NFL players did so much to bring the subject under the microscope, and whose story was portrayed by Will Smith in the film, Concussion, has been among those questioning the benefits of treatment.

“No physician should tell a parent that it is safe for your children to receive repeated blows to the head, because we can treat them,” he has said. “That has no reasonable scientific basis. It is wrong to state that concussions can be treated and cured.”

Collins’ and Omalu’s opinions sit at extreme ends of a spectrum replete with them. To paraphrase one expert: you can have a heart attack in Dublin or Cork and be treated the same way. You can’t say that for concussion.

These conflicting views, and more besides, will all be aired at the latest consensus conference, in Berlin, at the end of this month and, with research into concussion jumping by 150% in five years, theories are being tackled all the time.

The flight to Dublin, this time last week, offered Dr Collins plenty of scope to read back over the the first four consensus documents. The most recent was agreed upon in Zurich, in 2012, and one perceived anomaly jumped out at him, time and again.

According to the Zurich document, 90-95% of patients were getting better within seven to 10 days. Dr Collins, and the rest of the staff at UPMC, apparently weren’t seeing any results to back that up and subsequent tests confirmed their suspicions.

In a study of high school and college athletes — who take longer to recover than adult professionals — symptoms were found to linger for three to four weeks, with females taking longer to recover than males.

“The seven-day thing resonates, because a lot of games are played every seven days, right? The reality is that the brain doesn’t work that way. If it takes ten, sixteen or nineteen days, do not put these kids back to play until they are recovered.”

Pat O’Neill is still a consultant in orthopaedic and sports medicine at the Mater Private Hospital and Cappagh National Orthopaedic Hospital, but his days as a player, a team doctor, and a manager with Dublin, are long behind him.

When he looks down from the stands now, he marvels at the kaleidoscope of high-vis jackets that scurries towards injured players and thinks back to his days playing and managing the Dubs, when he had to double as the lone team doctor. Different times.

He was intrigued by the brighter future Dr Collins presented. By the new hope it offered.

“It’s a very interesting concept, that concussion is not homogenous, that symptoms can overlap and then this active, managed (recovery), as well. It is the first time that it has been applied to the brain.”

The UPMC approach may be the answer and it may not.

It may be that there is no answer. All we can be sure of is that our attempts to understand and deal with concussion, today, will raise the same disbelieving chuckles in the future as O’Neill’s tales last weekend.