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Touchline • Issue 18 • 13
we then look at that concussed group:
there’s 10% of those - 1 in 10 - who have
what’s called a difficult concussion: a
complex recovery outcome. That can be
a catastrophic brain injury. In an inquiry
that I was involved with in 2006 for an
18 year old rugby union player, he had
approached the scrum, he packed down,
he lay down and he didn’t get up again.
The family switched off the life support
machines the next day. He had had a
concussion the previous week. Why was
he playing?
And then at the other end of the
spectrum there’s that group who get
the post concussive prolonged system
recovery that is significantly disabling
and often not recognised because of
the subtle psychological and social
impacts that it has on work, school life,
relationships, performance at sport even.
Secondly, a lot has been said about
prevention in the media. It’s bandied
about. Sometimes I’m not actually quite
sure what is meant by it, but if we look
at prevention: there’s primary prevention.
These are strategies that are put in place
before the event happens - concussion
in this context. They are there to try and
reduce the incidence and prevalence
of this particular condition, so what
evidence is there? In ice hockey with
age group players, if you eliminate body checking: you reduce
concussion. The limited interchange rule in rugby league has
also shown to reduce concussion.
Interestingly in an education program with the New
Zealand Rugby Union, which just involved giving coaches,
sports officials and referees an
information card on concussion,
they were able to actually reduce
the concussion injury claims and
cost to New Zealand Rugby Union
significantly and they worked
out that there was a return on
investment of 12 dollars for every dollar spent.
At this point there is no evidence that protective equipment
reduces the incidence or severity of concussion. Head gear,
mouth guards etc.: there isn’t anything. In fact we don’t know
at this point what effect legislation has on changing the rates
of concussion.
In America the landmark Lystedt law that was instituted in
Washington State in 2007, was launched in New Orleans and
I was at that conference and got to meet Zachery Lystedt.
The Law has really snowballed and dominoed to involve 42
states throughout America. The essence of that particular law
involves three key principles. Number 1 – any key player who
is concussed or suspected of concussion should be removed
from the field of play and not returned to play or practice
that day. 2 - that player has to seek medical attention and
be formally diagnosed and managed, and 3 - have written
clearance to return to sport. That is law.
The final point: there’s no prevention strategy here that can
eliminate concussion. Clearly you can have the best road
traffic rules in the land but you’re still going to have road
traffic accidents, but we accept that it does happen: it’s an
accident. I treat concussion cases in diving, rowing (because
they do road cycling), and swimming (an Olympic swimmer
may slip on the side of the pool). Accidents happen, so this
last point really relates to the discrepancy in the availability
and accessibility of concussion resources.
Hans Westerbeek:
This might be a good point to go to
firsthand experience and ask Elton to tell us a little bit about
your playing history, as well as how and why your career
ended.
Elton Flatley:
Yeah sure, thanks for having me here today.
I was lucky enough to play just on 10 years of professional
rugby for the Reds and the Wallabies and had no issues with
concussion till about mid-career, and towards the end of my
career where I copped two quite severe concussions. From
those times, there was a real drop off from the physical
effects of the games which would cause me to get another
concussion. I’d look on the video tape when we would do a
team review of the games and after those big hits the ones
previous didn’t look so big. My body got to a stage where it
couldn’t stand up to the rigours of professional rugby. That
was when I was about 27 or 28 years old, and I tried to
continue on for a period of time. I was very lucky that I had
the doctors at the Queensland
Rugby Union and also at the ARU,
who were absolutely fantastic.
They put me in front of all the
leading specialists in the field.
I went down to Melbourne
and saw one of the leading
specialists down there.
I got to age 28, and I remember the game where I retired. I
got a little bit of a slight concussion: I had a bit of blurred
vision in my eye. I had to go into the contact situation and I
hesitated, then I hesitated again. I walked off the field and I
had a chat to the doctor, and said “I think I’m going to retire”.
He told me to sit down and we would have a discussion about
that on Monday. It was a pretty emotional time. Only about
