Concussion and CTE

1 May 2024

Concussion and chronic traumatic encephalopathy continue to make headlines in Australia. The Queensland Brain Injury Collaborative (QBIC) spoke to a range of experts on the evidence linking the two, and what can be done to minimise the risk of long-term damage from repetitive head trauma.

For more than 10 years, since a class-action lawsuit was raised against the US National Football League, concussions have loomed large in the public conscience, sparked by concerns that repeated head trauma might lead to progressive, irreversible brain damage in the form of chronic traumatic encephalopathy (CTE).

Now, the spectre of CTE hangs over some of Australia’s most popular and most profitable sports. But is media hype getting ahead of the scientific and medical evidence? Or is all the attention helping to drive meaningful change in how we manage concussions?

One of Australia’s leading proponents of the link between repeated traumatic brain injury and CTE symptoms in life, neurologist Dr Rowena Mobbs , advocates for a much greater effort to address the issue. While she acknowledges a lack of understanding as to exactly how clinical progression relates to pathological changes, she points out that one of the world’s most reputable health organisations has acknowledged a clear link between head injuries and CTE. “The link is causal according to the National Institute Neurological Disorders and Stroke (NINDS), part of the US National Institutes of Health (NIH)”, she says, referring to a 2022 statement . “I for one will not be volunteering to sustain repeated exposure to brain impacts and the community deserves a precautionary approach”.

The need for longitudinal studies

Professor Karen Barlow , Chair in Paediatric Rehabilitation at The Queensland Children’s Hospital, reiterates the NINDS view that a link between repeated head trauma and CTE pathology is real, but stresses that a robust clinical diagnosis foretelling CTE pathology does not yet exist. She says people who sustain multiple head injuries could have a range of genetic or lifestyle that might contribute to CTE. “We need to be able to dissociate factors like drugs, alcohol and genetics from the actual damage head injuries are doing to a person. Most importantly, we need to remind people that as a profession, we do not yet have agreed clinical criteria for the diagnosis of TES in living people. We need to encourage people to see their doctor about neurological changes and stop them from assuming they have probable CTE.”

Professor Barlow is far from a lone voice on the need for longitudinal studies. In February 2024, the newly formed Concussion and CTE Coalition – consisting of Dementia Australia, the Brain Foundation, Connecters Australia, The University of Queensland, and Dr Mobbs – released a position statement on concussion and CTE. In it, they recommend longitudinal research on people at risk of TES and CTE “to ensure a better understanding of the long-term impacts of brain injury between the in-life experience and the symptoms and development of CTE-related dementia.” Submissions to the recent Senate Inquiry into Concussions and repeated head trauma in contact sports likewise requested longitudinal studies, as well as support for brain banks that allow for pathological analysis of post-mortem brain tissue.

Improving education

All this momentum for research is positive. But research is a slow-moving beast, and more immediate gains can be made. A prime concern of both Professor Barlow and Dr Mobbs is the low level of public awareness and limited education provided on the issue. Although sports concussions and CTE have reached the public conscience, a deeper understanding of the nuances is missing.

This gap in knowledge and awareness is close to the heart of Brendan Swan , CEO of Concussion Australia Ltd. As a teenager, Mr Swan was a competitive Thai boxer who had a series of concussions during training. Over a decade later, these still cause symptoms and impose limitations on his daily activities. Aiming to create meaningful change, he now spearheads Concussion Australia alongside a host of medical, legal and lived-experience experts. The organisation aims to educate grassroots communities about concussion, and advocates for mandatory concussion education amongst elements of the sporting community – including coaches, first aid officials, and players – as well as school teachers, parents, GPs and emergency doctors.

A practising lawyer, Mr Swan also wants to see changes to workers’ compensation for paid athletes, and a legislated requirement for sporting clubs to hold adequate public liability insurance covering head injuries. These are complex issues that require big, slow, moving parts to come together. Still, Mr Swan sees hope for change in the current climate and is doing all he can to help.

Clearly, plenty can be done to improve how Australia approaches the issue of concussion. Many of these gaps – the need for research, public education, training of health professionals, changes to athlete insurance coverage – are addressed in recommendations of the Senate Inquiry. As of mid-April 2024, the government response to the recommendations is pending. In the meantime, experts are using their voice to push for meaningful changes in how concussion research, education and clinical management are handled.

Last updated:

21 May 2024

QBIC