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28 May 2016

Transcript: AMA President Professor Brian Owler, AIS Chief Medical Officer Dr David Hughes, Doorstop, National Convention Centre, Canberra, 28 May 2016

Subjects: Release of AIS/AMA Position Statement and website on Concussion in Sport 

 BRIAN OWLER: Thank you for coming out this morning. It is indeed a great pleasure to announce the launch of the Concussion in Sport website. It's a project developed jointly between the Australian Institute of Sport and the AMA. 

Let me say firstly, thank you to David Hughes for the work that's been done by the Institute. And it's certainly been a pleasure to collaborate with the Institute on behalf of the AMA. It is a very important resource that we're launching today. 

The message is: if in doubt, sit it out.

Concussion is something that occurs on the sporting fields. It's not just something that occurs for professional athletes. And so this resource is really designed for those coaches, trainers, teachers, parents - those people that are dealing with these injuries that do happen on sporting fields on Saturday mornings or during school days as well. 

It's not something that we should be afraid about. It's an important medical consideration. I don't think we should shy away from it. It's really something that I think people want more information on, and I'm not just talking about the coaches and parents; I'm talking about medical practitioners as well. So this resource,, is a website that people can go to and find this sort of information. 

There are videos that are recorded by experts from the sporting world, but also GPs, emergency doctors, and myself as a neurosurgeon. It shows the important things that people need to look out for, but also gives some pretty clear instructions on how to manage concussion in terms of return to training and returning to sport, returning to play.

So I hope that parents and coaches, in particular, can use this resource. It gives them some reassurance, and we can get some better management of concussion and make sure that we avoid some of the problems that can come along if people don't pay enough attention to it. Maybe if I hand over now to David?

DAVID HUGHES:  Thanks very much Brian. And I would like to start by thanking Professor Owler and the AMA for their collaboration on what I think is a very unique and important initiative in Australian sport, and in Australian health. It brings together two peak organisations, the AIS as Australia's peak sport performance agency, and the AMA as Australia's peak body representing doctors and medical students. 

I think it's important to point out that there has been a lot of good work going on in concussion in Australia. We have some of the world's leading researchers. We have published some landmark papers in Australia, and I pay tribute to the doctors and researchers in Australia who have contributed to world knowledge on concussion. 

This product brings together the latest, most reliable, evidence-based information on concussion and, as Professor Owler has pointed out, it is tailored specifically on the website to different groups, including athletes, parents, coaches, teachers, and medical practitioners. I've been in sports medicine for 25 years, and I have to say that I still find each case of concussion challenging. So I therefore assume that my colleagues in medicine find concussion a challenging issue, and I certainly know from my discussions with athletes, parents, and coaches that concussion is an issue that causes a certain amount of anxiety and concern, and rightly so. It's an important issue, and it's a safety issue for those who want to participate in sport.

I want to make it very clear that this Concussion in Sport position statement, and the supporting website, is not about alarming people or putting people off sport. We know that sport is very important for the physical, psychological, and emotional health of individuals, and there's a multitude of evidence supporting those facts. 

We want people to play sport, but both the AMA and the AIS have a clear and unequivocal focus on keeping everybody in Australian sport safe. And this product is about ensuring the safety and welfare of all of those participating in sport in Australia. So I would encourage all of those who are involved in sport who wish to know more about concussion to go to the website and to download the usable resources that are there. 

And we hope that, by ensuring that the Australian public and all of those involved in sport are better informed about the issue of concussion, we will reduce the concern and anxiety about this issue and we will also ensure that everybody involved in sport is receiving world's best care in terms of dealing with the important issue of concussion in sport. Thank you very much.

BRIAN OWLER:  Any questions?

QUESTION: When you're recommending two weeks that kids sit out from the sporting field after any sort of sign of concussion, where did that figure come from? Why two weeks?

BRIAN OWLER:  Look, there are a number of recommendations that are around. We've erred on the side of caution. No-one is going to have ill-effects from sitting out two weeks of sport. But we know that if people go back too early, then they risk having more concussion, and it's the compounding effects of concussion that can actually end their playing career. And we see that happen in some of the, I guess, more high-profile cases. So, it is erring on the side of caution. 

I've got to say there is a lot of research that still needs to be done in the area of concussion. There's still, I think, a growing understanding of what concussion actually is, and the effects that actually take place on the brain. But the two week figure is essentially erring on the side of caution on the best evidence that we have available to date.

DAVID HUGHES:  And I think, if I could just make a point there, that there certainly is good evidence and growing evidence that children are more susceptible, and take longer to recover from concussion. It's not the most conservative policy in the world. I know that there's one group in Scotland, I think it's the Scottish Institute of Sport or something similar, which has recommended four weeks. We don't think the evidence is there to support such a long period of time out of sport. 

This policy is actually quite closely aligned with World Rugby's current policy on children in sport, and we certainly feel strongly that children should not be treated the same way as adults when it comes to concussion in sport, because of the evidence that is out there about the greater susceptibility and the longer time to recovery.

QUESTION: You've probably dealt with junior athletes in the past. Can you appreciate the difficulty in keeping them off the sporting field for two weeks?

DAVID HUGHES: We certainly deal with a lot of young athletes at the AIS. A lot of our athletes are under the age of 18 at the AIS, and we certainly appreciate the difficulty with keeping people off the field for a long period of time. No-one likes to miss out on their sport. 

But we want to make sure that when they go back to sport, they go back for good, and that they do not suffer further concussion injuries. And I also think that around children's sport there is a growing awareness amongst parents and coaches, and teachers, who are responsible for these young athletes, that concussion is a serious issue and those individuals do not want children going back and being hurt again. So they want clear guidelines that ensure that those children, when they go back to sport, do so in a safe manner.

QUESTION: I understand in some countries and states have legislated in this area; do you see a need for that?

BRIAN OWLER:  I don't think it's something that needs legislation. I think it's something that we've certainly changed a lot of attitudes around. You know when people used to get concussions, they'd be praised as being brave if they went back out on the sporting field. And we now know that that's not the right thing to do. 

So I think we've actually shifted the culture and the attitudes a long way in professional sport and some of the commentary that goes around it, and I think now we need to start to shift some of that culture and attitude that still remains in some of the amateur sports as well, to make sure that they treat the problem in the way that is most appropriate. 

So I think this is more of an educational program, and that's what this resource does, is provide education. 

I deal with patients that come to my office sometimes, young people, they're sometimes playing sport at a fairly high level and they've had a concussion. They don't need to see a neurosurgeon, but somehow they find their way to my office and are asking for information. I'm usually very impressed, I've got to say, by the understanding that young people actually have about many of these issues now. 

And when you actually explain to them what the issues are, sure they're disappointed, but most people I think have a much greater understanding of the importance of actually making sure that they take the time to recover. They understand that process of going back to training and then before they go back to play. 

So I think we are changing some of the culture and attitudes that are around concussion through this education, and I think this resource will be part of that process.

QUESTION: How serious is the risk to young brains from concussion, and repeated concussions?

DAVID HUGHES:  There's no such thing as a good concussion. So every concussion is something that we don't want to have, but we accept the reality that in some sports they do occur. In the vast majority of cases, the vast majority of cases, people will recover from a concussion within 7-10 days, with children perhaps up to two weeks, without any medical intervention, with just observation, keeping an eye on them, and then having a very careful, graduated return to sport, which is outlined in our position statement. 

But there does seem to be a case where some individuals, having suffered a first concussion, seem to become more susceptible. And that's why people need to see a medical practitioner, because every case needs to be treated on its own individual circumstances and the facts surrounding that particular case. 

There’s something that I do when I'm lecturing on concussion at conferences - I'll say to people, how many people in this room have played a contact sport for greater than five years at some stage in their life? And, you know, half the room will put up their hand. And I'll say, now put your hand down if you've never been concussed. And most of the hands stay up. 

So concussion is something that does occur, unfortunately, in contact sports, and people who play contact sport for a long period of time are likely, at some stage in their career, to experience concussion. However, the majority of those people make an uneventful recovery if they're treated appropriately, and I think that's the important thing and the thing that we're trying to emphasise here - that concussion can, if managed appropriately, can be managed safely and we can safely get people back to sport. 

But as Brian mentioned, I think it's very important - the change in culture from that attitude that somehow it was tough to get concussed or knocked out, be briefly assessed, and then pushed back out on the field after that. Those days are gone. I think we've seen great advances from across all sports, certainly in Australia, over the past five years, and now I think people clearly understand that that's not appropriate. 

So concussion is a serious issue but, if managed correctly and if managed according to the principles outlined in this position statement, we believe that we can minimise harm, and hopefully return people safely to sport without having further concussive episodes.

QUESTION: So you're confident that Australian sporting bodies that regulate junior sport are taking concussion seriously at this point?

DAVID HUGHES:  Absolutely. I want to be very clear that the AMA and the AIS are not trying to tell sports what to do in Australia. This policy complements the great work that's already happened over a range of sports over the past five years. I think if you look at every one of the football codes in Australia, you'll see that there's been significant shifts in the concussion policies over the last five years, because there's a concerted effort and a growing recognition by administrators of the sport, because they've got their own anxieties about concussion, that we need to take this problem seriously and that nothing should come before athlete safety and welfare.

QUESTION: Can you suggest an age, a minimum age, for contact sport for kids?

DAVID HUGHES:  A minimum age? What I think you'll find is that all the sports have variations of their own code for younger groups. So you'll have kids as young as seven starting playing contact sports, but usually the rules are modified to make them less contact, and so it's sort of, as I understand it, a phased approach to contact sports these days across most of the contact sports with safer rules for the very young groups.

BRIAN OWLER:   And I'd just like to emphasise the point that was made before about physical activity. The AMA has a separate program to encourage young people in particular to take up sport. We have a problem with childhood obesity. We need to get people up, playing sport. And the AMA wholeheartedly supports people playing sports, including body contact sports. 

So this is not trying to tell people not to play, or to scare anyone. They fact of the matter is that concussions do occur. They tend to occur, I think more frequently, as the games get more physical as probably people get a little bit older and bigger, but we just need to know how to manage it. And what this does is provide some reassurance, provide some facts that people can use, and shows them what resources are also available. 

So I want to be clear that we actually want to get people out playing sport. We want to get people moving; we want to get people fit. But this is a problem that does occur, in terms of concussions, and I think we just need to make sure that people have the information available to them.

28 May 2016
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Published: 28 May 2016