Save our brains: how dangerous is sport?

You're listening to the conversation. Where I live in Melbourne, Australia, this is the sound of our weekends. [Screaming] This is Australian Rules Football, and kids play it from when they're six or seven years of age. But a few weeks ago, it took a tragic turn. A much loved Melbourne Football player remains on life support this morning after a heartbreaking injury during a match. The 27-year-old was playing for Epping's reserves team in Laylaur on Saturday. Ayer has died in hospital after suffering catastrophic injuries in a free clash during a game in Melbourne's north. Nathan Fitzgerald copped three hits to the head during a tackle. He was only 27 years old when he died. It's prompted a reckoning about the sport we treat like a religion here. He's at Safe, shoot our kids play, and what kind of duty of care do we owe the players who take to the field every weekend? I'm Neil C. Wang, sports editor at The Conversation, a news and analysis platform, partnering journalists with academics. Welcome to The Conversation Weekly, where experts explain how we ended up here. The Conversation Weekly, where we ended up here. Alan Pierce, as a neuroscientist, you've been researching sports-related concussion for more than two decades. When you first started working in this space, how much do we know about the risks of head knocks and concussion and CTE? We had known about concussion in particular for quite some time. Concussion is a single traumatic brain injury. I get on my high horse here and I hate the term head knock because it's more than a head knock. It's a brain injury. You see the signs and symptoms straight away after a concussion. There was a fair amount of research around concussion in particular, but not necessarily from a longitudinal aspect in terms of players later in life and retirement. And certainly not around chronic traumatic encephalopathy or CTE. Footy legend, Polly Farmer has become the game's first player to be posthumously diagnosed with the crippling brain disease known as CTE. The first case of a degenerative brain disease linked to constant head knocks in a New Zealand professional rugby player has been confirmed. There's been a lot of work in the last ten years now and that is because we do have good evidence coming through from the brain banks around the world showing pathology evidence. Good strong evidence that CTE is a real disease and it's also relating to repetitive head impacts rather than concussions per se. There has been quite a bit happening, but we've still got a long way to go here. So what exactly is CTE and what do we know and not know about its causes? CTE is what we call a neurodegenerative brain disease. Not unlike other dementias, but it certainly has very specific characteristics that differentiate it from other dementias like Alzheimer's or vascular dementia or frontal temporal dementia. And if we compare it to Alzheimer's, for example, where it starts in the deeper part of the brain, CTE is very specific around the outer part of the brain. And where it first starts is at what we call the valleys. So you have the lumpy, bumpy look of the brain and it's sort of filled with hills and valleys. And at the very bottom of those valleys is where we start to see the early stages of CTE. Because what we see is a, I guess a relationship to physical trauma. And so unlike other dementias or even diseases like motor neurone disease, where it can start spontaneously, it's age-related, it's family-related as well. CTE is really very much starting because of physical trauma. And it's not just in old people. We see this in young people as well. So that's probably the biggest difference. So we find that players, athletes, military, unfortunate domestic violence, where the person has never been concussed but has received hundreds and thousands. And in some cases, tens of thousands of repeated impacts diagnosed with CTE. And then on the flip side, you have people who have had 50 concussions in their career aren't diagnosed with CTE. So it's one of those things that we're still finding out, but the evidence is pointing towards repetitive head impacts. We've seen a slew of former AFL and rugby players come out recently about their experiences with brain injuries. From the age of probably 42, starting to deal with memory loss and stuff. When it impacts you through everything, your ability to work, your ability to sleep, you know, go headaches every day. How would you describe your health now? It's pretty ordinary. It's my life. Just crap. I've made a joke of it. I try to be as happy and as positive as I can about it. But my independence is gone. Things I take for granted are gone. We are surprised by that. I've been doing this research now for nearly two decades. So I wasn't necessarily surprised to hear that because I've been hearing these stories now for a very long time. And it's probably only in the last sort of five or so years, maybe 10 at the very most. But more like, you know, close to five is that we do have more and more players now becoming public about their impairments, cognitive impairments, mental health issues, even some with movement disorders, who sort of came through with the, I guess, the evolution of professional sports. And this is where the players were starting to train full time. There was much more input into sports science. They're getting stronger, fitter, more powerful. And so the game has really ramped up. And so for me to start seeing a lot of these players now starting to come through, personally hasn't been surprising. But I can certainly appreciate from the wider public that they're sort of concerned about the number of players now coming forward publicly. So have our heads been in the sand with CTE and concussion? Concussion, something that everyone's been talking about. I suppose in some respects you've hit the now on the head there with CTE and that we have been keeping our heads in the sand because I guess what has been happening is the fact that when we have announced a case of CTE and in Australia, the Brain Bank's been going since 2018. So when we've been announcing N Rugby players, football players, a case of CTE, what has happened is that the discussion has been turned back into a concussion issue. So everyone has been assuming that CTE is related to concussion. So when we try and talk about CTE, the sports or people involved in sports say, "Oh, we've got concussion protocols. We have mandatory stand-downs for concussion." And we've got to try and explain that that is not the aspect of what we're worried about with CTE. CTE is a disease of repetitive sub-concussive impacts. You don't have to show any signs or symptoms. It's just those repetitive hits that is lead in towards CTE. So in some respects, there has been a lot of misinformation around that and we're desperately trying to change that conversation back into the fact that CTE is related to repetitive sub-concussive impacts. Is it inherently risky then to play these high-contact sports like AFL and Rugby? A lot of these sports just like any other sports have inherent risks as well. I think what we need to be addressing is accepting those risks, but how do we actually modify and reduce the risk element of it? And so we can still enjoy the physicality of these games. I hope this is not taken the wrong way, but the occasional concussion may occur. But what we can do is actually reduce the exposure risk for CTE in particular. So things like reducing the amount of contact in training can be one way of reducing exposure. So children and young adolescents to about 14 years of age, if we modify these sports and I want to be really clear when modifying, we're not banning anything. But when modifying these sports to non-contact version, so in rugby, it could be touch rugby, in Australian football they call it AFL 9s, where there's much more of a running and flowing element to it than the collision aspect. And so we can reduce the risk of CTE quite significantly if we take out the first six to eight years of a child playing these sports without contact. Hello, we'll hutten here from former leaders. I think your podcast is particularly timely. To leading thinkers, we have lots of academics who've looked at this in real detail. I've gathered some of the best minds in social science to help me explore the research, evidence and policies that could shape the world around us. You have to be prepared to take risks. So why don't join me as I discover the big ideas that could shape the way we live. This has been extraordinary. Subscribe to the Wii Society now on Spotify, Apple and all good podcast platforms. Welcome back. Alan, it feels like the noise around CTE in particular has been growing in recent years. It feels like sporting codes are reluctant to really address it. Why is that? I think one of the things that the sports are most worried about is what could this issue of CTE do to the sport generally because it's all about the physicality. And so this is something that could basically be an existential threat to the sports. The best they can do at the moment is to drive. concussion because it's something that is potentially solvable through better rules, policies, mandatory stand-downs, things like that. But it's really hard to address something like CTE when you can't necessarily pick it up because there's no obvious signs or symptoms, right? So I think one of the things that we've got to be kind of aware of is allowing people to understand what those risks are. We've known about the risks of boxing since 1928 in the modern era of science. I suppose you could say, you know, and boxing is more popular than ever in certain respects and this huge prize money and people are still doing it on a recreational basis. So I don't think it necessarily means that these sports are going to end. If people know what they're going to get into and we're doing what we can to try and reduce the risk of children and adolescents, I don't think there'll be any threat to sports at all. Increasingly, we're seeing players both amateur and professional wearing helmets on the flu field. Do they work? Short answer is no. No, they have no effect at all. And it's a question I get asked a lot. It's a bit counter-intuitive for people to understand that helmets don't protect against concussion because, you know, they sit over the top and they're protecting your head. But what people don't understand is that helmets can protect the skull from fractures and lacerations, but it doesn't stop the brain tissue from moving. People have to understand that brain tissue is like silken tofu inside your brain. You know, it's not what you will find at a butcher's or when, you know, the brain bank do the work on analyzing the brain. What has to happen first is you have to fix the brain and so it becomes almost a solid tissue. Whereas a non-fix brain, it's very delicate and it doesn't take much to move the tissue, which means that you'll be stretching and sharing the brain cells and that's kind of what we concerned about. And so helmets, while they can protect the skull bone, the force is still going through to the brain tissue. Even with concussion, you don't need to be directly hit to the head to be concussed. You can be hit in the shoulder and the force comes through to the brain and moves the brain tissue. So helmets have absolutely no effect when someone gets a heavy bump, for example. Do you think there are any answers in technology? We've seen inventions like mouthguards with impact sensors. Do we have any idea how useful they are? The sensors that we find in helmets and, you know, the mouthguards as well are really there for surveillance. So they're not necessarily there to protect against, you know, harm for the brain, rather they're more there to, I guess, give some information on what load is going through potentially to the brain, but certainly the head during matches and during training. So while they can't be used in a preventative fashion, what they can do is they have value in providing information that player A has taken 200 G's worth of force this week. Let's, you know, rest him or her, get them just to do some light training and use it in that sense rather than, you know, they took a 80 G hit, are they concussed or are they not concussed? Because there's just no correlation to that. Some players will be concussed on 15 or 20 G's and then another player can keep running on after a 60 G hit. So, you know, that's where we have to be using the technology appropriately and responsibly. So if not that, what will work? What's the solution here? The solution is not necessarily glamorous. It's not tecrolated, it's not sexy. It basically is reducing the exposure. And, you know, when you sort of suggest that we've got to maybe think about modifying our sports, particularly for kids and adolescents, but also, you know, in training, we've got to cut back on the collisions as much as possible. You know, people look at you like, you're just this negative nilly. And I think we've come to the point now where we can't afford to keep saying, oh, isn't it sad that player X or Y or Z has passed away with CTE? Oh, it's so terrible. What a terrible thing. And then four days later go and watch the game and expect the players to be essentially destroying each other on the field or expect their training sessions to be harder than ever because that's what, you know, real athletes do. There's got to be some compromise here. And unfortunately, it's not going to be tec, it's not going to be anything flashy. It's just going to be common sense and what the science tells us in reducing that exposure risk. This might sound like a blunt question, but do you reckon kids should be playing contact sports at all? They think to be playing a modified form of contact sports. So they can still learn how to kick a ball, mark a ball, catch a ball, pass a ball, evading an opponent, dealing with psychological resilience of of winning and losing and dealing with difficult teammates. There's a lot of good stuff in sport. We've still got to be able to enjoy these sports, but just modifying them. Just for juniors, other sports do a lot of modifications as well. Like tennis, they have modified nets and modified rackets to reduce chronic injuries to shoulders. And, you know, there are limits on how many times a kick can ball or pitch in baseball because, again, they want to reduce chronic injury. They're just modifications that we're suggesting in terms of these sports as well to protect the brains of our future athletes. Alan, it's been great chatting with you. Thanks very much. That's it for this week's episode of The Conversation Weekly. We've been reporting on head knocks, CTE and concussion for years now, and you can read all our stories on our website. We'll link some of them in our show notes. This episode was written and produced by Isabella Padwinski. Sound mixing is by Michelle McLean, and our theme music is by Nita Syle. The conversation is a nonprofit news outlet dedicated to sharing the work of academic experts with a wider audience. If you like what we do, please support us at donate.theconversation.com. Thanks for listening.