Brian O'Driscoll has been a high profile victim of concussion in recent years. INPHO/Ryan Byrne

Limiting impacts in training key to cutting concussions - Dr. Michael O'Brien

The head injury specialist feels training time would be far better spent working on skills.

IF YOU PLAY sport, you know that training can be just as painful as it is fun, especially when you play contact sports such as rugby or American football. Tackling drills in particular are a nightmare, especially on cold, wet Irish days.

But aside from making you uncomfortable, teams may actually be putting their players at unnecessary risk if they’re engaging in too much contact training warns the associate director of the concussion clinic at Boston Children’s hospital, Dr Michael O’Brien.

“I was talking with some of the professional rugby players about this and I don’t think hitting every day is needed, even in contact sports like rugby, if your goal is performance,” O’Brien told at the recent Brain Injury and Sport conference organised by Acquired Brain Injury Ireland.

“If [a coach] is not properly instructing players and giving them feedback on the right way to do things, all they’re doing is increasing exposure to injury and if you’re not giving feedback on the correct way to tackle, what are you doing with your time?

“You increase soft tissue damage, increase the number of sub-concussive hits – a head injury that doesn’t result in concussion symptoms —  generally just fatigue the player and therefore negatively impact performance and increase the chance of a single concussive event.

“Therefore, I think it’s wise to limit the number of training collisions and number of impacts in training because I know for a fact it will increase performance if they substitute that with well-designed, scientifically based training.”

O’Brien, who by the nature of his position in Boston Children’s Hospital works with high-school kids who suffer sports related head injury, has particular concern over the long term exposure to head injury kids face by playing multiple sports, many at the same time.

He argues that professional and elite athletes reach the top of their chosen contact sport not just because they’re better and fitter than their counterparts, but also because they are pre-disposed to be less likely to succumb to injury, including head injury.

Children though, aren’t as fortunate:

“I do worry about children playing contact sport, differently than I do for professional or top college players. Just before you started recording this interview we were talking about sub-concussive collisions which have been measured in the hundreds and even thousands in college American football players.

“For top athletes, they have an unusually high threshold for concussion, but that doesn’t mean the brain isn’t experiencing multiple impacts and I think there are a lot of them who don’t either get or report concussion symptoms but that doesn’t mean they’re not experiencing hundreds of these sub-concussive collisions.

“It’s not just their speed and skill that get them to the top of their game, it’s something else so the folks with average threshold for injury are really going to be weeded out.

“So with young people, I don’t worry about Chronic Traumatic Encephalopathy — a disease that is being found in increasing numbers in top level athletes who have played contact sports — though it has been discovered in athletes as young as 17,  but where we just talk about concussion, the more hours of exposure, the bigger the risk.”

“In the States, we have kids who play football in the fall, hockey in the winter, basketball and all sorts of sports at the same time increasing their risk of injury.”

O’Brien admits that one solution could be to introduce the concept of rolling substitutions, as in American sports, into rugby, the GAA and even soccer where there is, he asserts, increasing evidence that repeated heading of the football is leading to long term brain injury.

“I’m no expert but I am a fan of rugby, of the nature of the game, of it’s toughness and I don’t think that rolling substitutions would take away from the beauty of the game, but I do accept that it would change the fundamentals of the game enormously.

“If you look at the NFL, where they have rolling substitutions, players only play one way on offence and defence — it’s news when someone plays both sides of the football — so perhaps while rolling substitutions might help limit the impact of concussions, it might be too much of change for the folks who know and love rugby better than I do.”

He argues though, that just because you’ve always done something a certain way, doesn’t mean you have to continue to do it that way in the future, particularly when the benefits of change outweigh the consequences of retaining the status quo.

“When I was a kid, nobody wore helmets when riding a motorbike, now everyone wears them. Same with banning smoking in restaurants, that was strange for a while and now if you travel somewhere that allows smoking it’s just shocking. At the time, people complained but in retrospect you look back and ask ‘why was there even debate’?”

“I’m not in favour of change just for the sake of change but if it makes sense, then we should do it.”

With regards his own field, sports-related head injury in children, O’Brien is unsure as to the future:

“In 100 years time time we’ll either be saying to ourselves, ‘boy that was a curious time when we were over-protective’ or we’ll be saying ‘boy that was a brutal time, how could we be so barbaric with our kids’.”

“The mounting evidence says it might be closer to the latter.”

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