Health: Concussion in Sport

Baroness Grey-Thompson Excerpts

Thursday 27th February 2014 Grand Committee

[Baroness Grey-Thompson (CB)]

My Lords, I thank the noble Lord, Lord Addington, for tabling this timely debate. The issue of concussion has been gaining momentum over recent months. The journalist Anne Peters has written extensively about it and it comes on the back of the announcement last August of the case of the NFL in the USA, where 4,500 athletes took a class action suit and sued the league. The league agreed to pay out a total of $765 million to fund concussion-related compensation, medical exams and research.

I am very pleased that the noble Lord, Lord Moynihan, raised the issue of “Head Games”. Unfortunately, I cannot make the premiere next week, but I have read the book instead. It makes stark reading in terms of the information it lays in front of us. Who can forget the tragic case of Ben Robinson who died in 2011? He was a young man who died after being concussed on the pitch three times. I spoke to Ben’s father Peter this morning. It was very emotional. It is hard enough reading about Ben’s case, but it is incredibly powerful listening to a man talking about his son who died playing the sport he came to love. It is probably fair to say that Ben was not a natural rugby player, but he was really good at the sport and was one of the best players on the team. The hardest part was listening to Peter say that Ben’s mum Karen had been at the game and she realised that something was not right, but did not feel that she had any power to stop the game going ahead. When she did try to intervene, she was told to “calm down”.

This is a powerful argument in making us realise that we have to involve many people and governing bodies in the discussion. I absolutely do not want to stop children playing sport, because the benefits are greater than being inactive. Peter told me that Ben received advice on nutrition, training and absolutely everything except concussion. Peter also said that he has a younger son who does not play rugby, but he would let him if he felt that he could do so safely.

There is a lot of information out there, but would I have gone out and looked for it had I not been taking part in this debate? The answer is no, because I would have assumed that concussion would not be an issue in most sports that my daughter and I are involved in. Some of this comes back to how we educate people. Sport Scotland has issued a really good leaflet highlighting the issue of concussion and what you have to do if you see it in a young player. At the launch of the leaflet, Dr Willie Stewart presented a huge amount of information. He had interviewed 300 schools from the south-west of Scotland. The good stuff was that 90% recognised that concussion could be fatal. However, 30% of the schools said that they would still leave a child with suspected concussion on the field of play. Curiously, virtually all the 30% who would have left the child on the pitch would have then informed the parents that they thought the child had concussion, so there is a bit of a mismatch in terms of how young people were being treated. The survey also made it very clear that there was a need for a physical test in the first 24 hours after injury, but there was not the understanding that it was important for the brain to rest as well—that is a really important part of rehab.

It is also interesting that well known rugby players like Will Greenwood have spoken out on this matter and the need to take it seriously. However, it is really difficult for current players to speak out, because it is their career. How much time they spend on the pitch affects their sponsorship, media coverage and future contracts. So I think it is important that we engage retired players and, I hope, encourage more competing players to think about this.

Over the weekend, I was told the story of a professional club player who was very clearly concussed but refused to leave the pitch. The good news is that the referee refused to carry on. That might be easier to do at club level and it should be hugely applauded. But at a lower level, where there is a lot of pressure from parents and the children themselves who want to play, we should not be asking the children, “Are you okay to play on?”.

I have had a lot of help with preparing for this debate. The RFU has showed me a lot of information. Rupert Moon, a great Welsh rugby player and also a friend of mine, put me in touch with a lot of professional people within the sport who are trying to filter the information down. But we have to do so much more than we currently do. We have to recognise that, while there are many stories about rugby, the problem is about so much more than rugby. Yesterday, in the New York Times, there was a story about a young man, a 29 year-old former soccer player who died from chronic traumatic encephalopathy. He is the first named player to have died from this condition. On a four-point scale of severity he was considered to be at stage 2.

Part of all this is education and getting people to think about the issue, no matter whether it is lacrosse, hockey or any other sport we can think of. We also have to recognise that sport is dangerous. There were a number of concussion injuries during the recent Winter Olympics, while Maria Komissarova was injured during ski cross training. She has undergone a number of operations on her spine. My own husband broke his back cycling, and indeed many of my friends are in wheelchairs due to playing sport. I have twice been hit by cars while out training. By the end of my career I also knew that, despite all the benefits of doing sport, I would probably end up with some severe damage to my back, neck and shoulders, which has happened. But I still believe that the benefits far outweigh the risks.

I was trying to find some kind of context for this. Stories about sports injuries will obviously hit the headlines in lots of media outlets, but it is a question of trying to figure out what the comparable data are. Statistics from Headway using data extracted from the NHS show some massive figures for head injuries. During 2011-12, 213,752 people were admitted to hospital. There has been a 33% increase in UK head injuries over the past decade. The number of severe traumatic brain injuries is running at between 10,000 and 20,000 per year in the UK. Interestingly, men are twice as likely to sustain a brain injury as women, and if we look at the target groups, it is 15 to 24 year-old males and people aged over 80. Those figures are important in terms of putting the issue in context and showing how many people are injured. However, it is hard to find data for the UK, so measuring data is an area in which we need to do more work.

Mortality rates due to blunt trauma in the USA among athletes aged under 21 in organised high-school and collegiate sport show that there were 261 trauma-related deaths, 1,139 cardiovascular deaths and 427 deaths from other causes. If those numbers are broken down by sport, American football is responsible for 56.7%, track and field 10%, baseball 6.9% and then gymnastics at 1%, hockey at 1% and weightlifting at 0.4%. The average number of deaths per year is nine. Again, comparing these figures against deaths in the general population, some 12,000 are killed in road traffic collisions, there are 6,000 homicides, 2,500 young people die of cancer and, bizarrely, 50 are killed in lightning-related incidents, which is interesting. That is why we need some context in the UK.

I am also very conscious as a mum whose daughter plays a lot of sport that the temptation is to stand on the sidelines and say, “Come on, you are all right”. My daughter has never hit her head playing sport, but when they skid across the hockey pitch one says, “Come on, darling. Give it a bit of a rub and you’ll be okay. Get back out there”. That is because there is pressure on people to carry on playing, and that is much more the case for boys. We have a culture where it is cool to be a sporty boy but not so cool to be a sporty girl. I think that that kind of pressure on boys is huge.

I have received some interesting information from a colleague of mine, David Sutton, who is the strength and conditioning coach at Northants Cricket. He has worked in numerous sports. He sent me some information on fencing, which I had never considered to be a sport where there was a risk of traumatic head injuries. What is looked for is the natural position of the arms following concussion. Immediately after moderate forces have been applied to the brainstem, the forearms are held flexed or extended, typically in the air, for a period lasting up to a few seconds. It is interesting that there is a lot of work in this area through fencing. David Sutton said that this ultimately comes down to three simple things. We need to educate our PE teachers and coaches. We need to be unafraid of running a SCAT score in order to check whether a young person has been injured. It is not enough just to say, “Are you okay?”. We also need much more training through accident and emergency departments and GP surgeries so that health workers understand the realities of concussion.

I am really pleased that we are discussing this subject in a debate and I hope that we will return to it again in the future.