Concussion in sport Contents

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1The problem of concussion and sport

1.The back pages of newspapers are the traditional place for sporting headlines, tracking successes and failures on the field of play and attracting an enormous amount of commentary and opinion. More recently there have been an increasing number of articles on the growing evidence of a link between playing sport and developing dementia in later life.

2.The media’s key focus, like much of its sports coverage, has been on football and rugby. This is despite the condition, Dementia pugilistica, being first associated with boxing, and jockeys having the highest sporting incidence of head injury and concussion. It is unclear from the press attention whether this issue is more prevalent among football and rugby or simply more newsworthy due to the high profile of these sports. It is, however, quite clear that the focus has been on professional sport rather than the wider sporting community or the vast number of people that participate in sport across the UK.

3.We sought to examine the issue of concussion and sport more broadly, to determine whether the issue was back page drama or a problem requiring Government intervention. We have spoken to scientists, former athletes, chief medical officers, players’ unions, and National Governing Bodies for various sports, and received written evidence from a wide range of interested parties.

The value of an evidence-based approach

4.There is a tension, apparent throughout this inquiry, between the certainty among campaigners and the press that sport has a problem and the uncertainty in the science of what is causing that problem. The progress of scientific information is often slow, and our current scientific knowledge does not demonstrate a causal link between particular sporting activities and later development of dementia. In the meantime, sportsmen and women are presenting with the signs of early dementia in numbers that are increasingly shown to be above what would be expected among their contemporaries (the risk to former footballers was five times greater for Alzheimer’s disease, almost four times greater for motor neurone disease and two times greater for Parkinson’s disease). The most iconic list of sufferers comes from the World Cup winning squad of 1966, of which five have been diagnosed with dementia.1

5.We have also heard that a focus on the term concussion is potentially unhelpful.2 Concussion is one of the more obvious symptoms of brain injury but the long-term impacts of acquired brain injury may occur in the absence of historic concussions.3 Many incidents during sports fixtures result in impacts that are sufficient to cause brain injury but not severe enough to cause concussion.4

6.The response of both sporting bodies and scientists has been to engage in research to provide a better evidence base as a foundation for proposing changes to the rules of sports where there is perceived to be greater risk. There is a forum, established in 2001 and funded by professional sport, which considers the research on this issue and, roughly every four years, issues a Consensus Statement on Concussion. This kind of symposium is an important part of scientific discourse and useful in identifying the gold standard of research progression. Witnesses to this inquiry have, however, questioned its value in deciding changes to sporting activity5 as its insistence on the best science and its aim of a consensus essentially precludes it taking a precautionary approach to advice on concussion in sport.6

7.The UK Government’s mantra since the 1999 White Paper on Modernising Government, especially relevant in midst of a pandemic, has been evidence-based policy.7 Ministers confidently present policies that are based on the best current evidence or on the current scientific advice. The question then becomes whether that should preclude policy being made in areas where the science is not settled or delay policies where a decent evidence base is being established and precautionary action may result in improved life outcomes for those affected. We were interested in exploring where there might be justification for governing bodies or the Government taking a more precautionary approach to mitigating the possible contribution of sport to the development of dementia among participants.

Risk versus reward

8.The touchstone study for those seeking change in sport is the FIELD study, joint-funded by the Football Association and Professional Footballers’ Association, which established a strong correlation between a career in football and a significantly increased incidence of dementia in later life.8 While this study clearly demonstrates that something needs to be done, it provides no clear direction of what should be done. The research also showed that, apart from this terrible downside, “all-cause mortality was lower in a cohort of Scottish former professional soccer players than in a control cohort of adults from the general population who were matched to the players on the basis of sex, age, and degree of social deprivation”.9 The benefits of sport sit at the heart of the Government’s sport strategy which highlights the “physical wellbeing, mental wellbeing, individual development, social and community development and economic development” that result from sporting activity.10

9.Despite the need for acquired brain injury to be taken seriously by sport, the detail of which we will come onto later in this Report, both written and oral evidence to this inquiry support the health benefits to people through mass participation in sporting activity. An active lifestyle promotes overall good health, including reducing the risk of dementia in later life.