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See how Fergal O’Brien’s yard is leading the charge with cutting-edge concussion testing and a renewed focus on athlete welfare.
See how Fergal O’Brien’s yard is leading the charge with cutting-edge concussion testing and a renewed focus on athlete welfare.
By Sam Peters, author of Concussed.
It is often purported that the growing band of brothers and sisters championing the need for improved athlete welfare through a more caring culture in professional sport are blind to its number one imperative: winning.
Those of us in rugby who have spent decades calling for greater protections for players as the sport’s risk profile has sky-rocketed have been labelled ‘soft’ or ‘not rugby people’ while the mere mention of ‘player welfare’ is snarled at in certain quarters as evidence of an invidious woke culture creeping into the game.
It is, of course, utter tosh. But that does not stop those whose interests are best served by ignoring the long-term health and wellbeing of those we cheer on from the stands parroting the same old tired lines.
Call for change and be prepared to be shot down by some uneducated but very loud voices. Such is life today, I suppose.
Professional sport is a tough world. Anyone who has been within a cricket ball’s throw of a sports dressing room or training ground knows that. No quarter is ever asked, let alone given.
In the wrong hands, it can be a world where machismo reigns, bullying can fester and being honest about emotions or personal health can be sacrificed on the altar of protecting a contract or your place in the starting line up. Short-termism reigns. The future? It can wait.
Meanwhile, in schools sports, players and parents themselves can be their own worst enemies when pushing for faster return to play times.
Medics can also be pressured into burying their morals by coaches and owners more interested in today than tomorrow while those calling for improved workplace culture are dismissed as romantics who don’t understand the cold, hard reality.
Brain health inevitably suffers as concussions are denied and mental-health problems hidden.
And there are few sports where the participants have traditionally been expected to ‘suck it up’, ‘grin and bear it’ or ‘take one on the chin’ more than in professional horseracing where the owner is king and young, vulnerable jockeys compete for rides.
In a sport where concussion is an everyday risk for jockeys and stable staff tasked with moving the horses around their yard and the country, the temptation to hide symptoms of concussion or mental health concerns is ever present.
“There’s times in my career and I think every jockey has had times where they know and you go into the instant mode where you’ve always got to beat the doctor,” explains Max Kendrick, a seasoned jump jockey with almost 500 rides in the past five years.
“Yeah I think you have to break it down and understand the sport if you think about like every single lad in that change well most lads in that change room are self-employed so I mean if you’re stood down, it’s not like you’re playing for Arsenal or Chelsea if you’re injured.
“There is insurance so you’re getting paid for but you know you miss rides you might not get back on the horse the next day. So automatically the mentality is straight away no matter what the injury is not just head – whatever it is – can I get away with riding. Yeah, so in that sense like I think the power has got to be kind of taken out of the jockey’s hands because like I don’t think I can see a world where you’re ever gonna shift that mentality.”
Kendrick is speaking with me on a crisp December day outside the office of the Grade One National Hunt trainer Fergal O’Brien’s yard in the stunning surrounds of his Ravenswell Farm in the heart of the Cotswolds.
We are in racing country, where tradition and hierarchy are prized. But here, at one of the most successful and well-known yards in the land, there is a real sense of change in the air. Progress even.
I’m here at the invitation of Your Brain Health, an Australian owned company on a mission to improve the education of medics and physiotherapists around the world about the importance of better concussion management, brain health awareness and improved brain function.
Critically, they are seeking to take the guesswork out of return to play protocols following a concussion, where historically decisions have been made either by the subsistence of demonstrable symptoms, or even worse, on the athletes word.
“When we’re treating an athlete with a hamstring injury there are tests we perform so we know precisely when it has returned to full function,’ YBH’s chief operations officer and current Welsh Fire physio David Bartlett tells me.
“Just because the patient is symptom free does not necessarily mean that hamstring has recovered. The same is true of brain injuries but historically we haven’t treated them with the same levels of objectivity and reasoning as other parts of the body.”
Bartlett and his YBH team, include experienced physiotherapists Simon Shepard and Emma Edwards, a chartered physiotherapist and member of the jockey injury management team which looks after professional jockeys on the racecourse, have been invited to the yard by Dr Simon Gillson, a close confident of O’Brien’s founded Concierge Medical and has worked at the yard for nine and a half years.
Gillson describes the concussion risk in racing as ‘an occupational hazard’.
“It would basically be impossible for a jockey to go through their career without sustaining a concussion,” Dr Gillson explains.
“I think the stats on fallers have changed over the years. It used to be one in 10 races you expected to fall off as a race rider. I think that might be down to one in 20. They’ve (authorities) have improved jumps safety and other things which is great and there’s improved equipment but you are still having rotational injuries, you’re falling at speed, horses are rolling on top of you, being kicked in the head, the neck, the chest.
“So your chances of getting through any lengthy career without having a significant head injury and concussion are, I would say, a zero. I mean, absolutely zero.”
Edwards nods in agreement.
“When it comes to testing for concussion so much has been based on some fairly basic orientation questions. As a physiotherapist something I’ve looked at is eye movements, as being something that even when someone’s denying having a concussion, you can pick up on eye movements. It provides an objective measure to tell a jockey, ‘this is what I’ve seen, do you think you’d be safe, seeing the stride to the fence, and making the right decision in that split second?
“More often than not they’ll put their hand up and go, ‘actually, now you’ve said that, I’m not really feeling 100%’.
“They’re not stupid. They know their every move is being scrutinised. They just want to perform well.”
The plan, with O’Brien’s blessing, is for all 37 of his yard staff to undergo a ‘multimodal’ baseline screening of their brains by the Your Brain Health team, with tests ranging from balance, and reaction times to a digital evaluation of the vestibular ocular motor system.
From force plates to measure balance, to a reaction mouse, to the use of a VR headset, the key thing seems to be the use of technology to provide better quality data.
“With multiple functions the brain is a complex organ and what we are doing is not going to cover everything.’ said Shepard. ‘However, put this data alongside other tests and clinical examination, and it may well lead to better understanding, better decision making and a personalised approach to care.”
The tests are carried out in a highly professional but light-hearted manner, which puts the jockeys and yard staff at ease and encourages them to take a full part in the testing. The participants seemed genuinely interested in both the testing and the reasons that sit behind it.
I undergo the tests myself and am pleasantly surprised to read the graph afterwards which shows my eye tracking to be in pretty decent order.
Much more importantly, the presence of the YBH team indicates a shift in mindset which is looking to place the brain health of staff far higher up the priority list than it has been historically in horse racing. It is forward thinking in every sense.
It also has the added benefit of potentially improving the performance of jockeys who after all, need great balance, great eyes and great decision making, if they are to optimise their performance and that of their prized equine assets.
“It’s been shown in cricket there is a correlation between certain helmet strikes and a drop in batting averages,” Bartlett explains.
“By generating more objective data, and adding a ‘gamification’ element, not only do we see better compliance than with historic testing, but we are also being able to identify individuals function, and as such ensure a return to performance, rather than trying to ‘beat’ the system and return before they are ready.”
Improved athlete welfare and improved performance. Now that really is something worth going the extra yard for.
Your Brain Health is proud to partner with CONCUSSED Media to bring the inaugural Ahead of the Game event, to be held at St Paul’s School in London on February 12, 2025.
This highly anticipated evening, created by award-winning author and concussion campaigner Sam Peters, promises a powerful discussion about the future of sports. Featuring a world-class lineup of speakers, the event will unite guests for panel discussions, networking, and debate centered on how to ensure sports remain both safe and accessible.
World-Leading Speaker Lineup
Ahead of the Game will bring together an extraordinary panel of experts, including:
The event will be co-hosted by Sam Peters and former Mail on Sunday sports editor Alison Kervin OBE, who together spearheaded the paper’s Cudlipp Prize nominated concussion campaign. The pair will lead the evening’s discussions with their unparalleled expertise in sports journalism and safety advocacy.
Former professional rugby players Nick Greenhalgh and Sam Smith will join Kervin for the second panel of the evening, alongside current Welsh Fire Physiotherapist David Bartlett and professional cricketer Tom Kohler-Cadmore.
What to Expect
The event will feature two engaging panel discussions addressing the challenges and opportunities facing grassroots and school sports today. Topics will include:
Following the panels, attendees will have the chance to ask questions and contribute to the discussion during an extensive Q&A session.
Networking and Exclusive Access
Guests will also enjoy unique opportunities to network with the speakers and fellow attendees, fostering connections and collaboration. As a special highlight, attendees can purchase a signed copy of Sam Peters’ award-winning book, Concussed – Sport’s Uncomfortable Truth, which has been instrumental in raising awareness about concussion in sports.
Join Us to Shape the Future
Whether you’re a parent, coach, athlete, educator, or policymaker, this event is your chance to join a critical conversation about the role of sport in schools and the measures needed to make it safer for everyone who plays.
Event Details:
📍 Venue: St Paul’s School, London
📅 Date: February 12, 2025
🕒 Time: 1815-2200
Tickets are limited, so reserve your spot today to be part of this landmark event. Together, we can help shape a brighter, safer future for school sports.
By Associate Professor James McLoughlin.
I have been asked recently my opinion about disappointing recent research with regard to the effectiveness of neurocognitive and VR eye-tracking tests in diagnosing concussion.
I could rant on about research methodology, types of tests, samples sizes and patient selection criteria. However, the answer to this complex question is simple – bad research questions!
Unidimensional Diagnostic Clinical Concussion Tests Are Doomed to Fail.
Picture this: you’re on the sidelines of a soccer game, and your friend—who just got bonked on the head by an overzealous defender—is getting asked a series of questions by a medical professional. The questions go something like, “What is your name?”, “What venue are we at today?” and “Who did we play last week?” Your friend squints at you, thinks for a second, and says, “Adelaide?” The medic gives them a thumbs-up, and suddenly they’re cleared to play again. Hooray?
Yeah, nah. Unidimensional tests, the one-trick ponies of concussion diagnosis, are hilariously doomed to fail. Let’s dive into why these outdated methods are less effective than using a paper umbrella in a rainstorm.
Concussions Are Like Bad Roommates: Complex and Unpredictable
Here’s the thing about concussions: they don’t fit neatly into one little box. They’re like that roommate who leaves dishes in the sink, hogs the bathroom, and sometimes mysteriously vanishes for days. They mess with your mood, memory, motor skills, and just about everything in between. So, expecting a single question like, “Do you know where you are?” to capture the full scope of this chaos is a bit like trying to catch some spilled soup with a strainer
Concussions mess with multiple dimensions of your brain. They affect your ability to think straight, your sense of balance, your visual processing, and—let’s not forget—your mood. If you try to diagnose that whole symphony of confusion with one simple test, you’re just going to miss the tune. And probably most of the instruments too.
The One-Test Wonder: Not So Wonderful
Imagine trying to determine if someone is drunk based solely on how well they can say the word “pineapple.” Sure, it might work for the extreme cases, but most people are going to skate by with a “pineapplish” that sounds about right. Concussion tests that focus on just one aspect—like memory recall or a basic visual task—are like this “Say pineapple” trick. They’re simplistic, easy to beat, and maybe not reflect the types of brian injury. I think sometimes sports are more concerned with convenience than accuracy.
The brain is far too crafty for these kinds of “gotcha” questions. A concussed person might nail the “What’s the score?” question but still struggle to walk in a straight line or remember why they went into the kitchen five minutes ago (and okay, to be fair, the latter could just be normal).
Multidimensional Problems Need Multidimensional Solutions
Here’s a radical idea: if concussions affect your brain in multiple ways, maybe—just maybe—we should assess them in multiple ways. Crazy, right? A strong concussion evaluation should involve balance tests, cognitive tests, eye tracking, and even mood assessments. It’s like forming a crack team of experts to tackle a complicated heist. Each one has their specialty, and together, they might just figure out what’s going on.
Plus, let’s be real: the stakes are high. A misdiagnosed concussion isn’t just a “fail” on the medical professional’s part—it could mean a person goes back out into a contact sport, takes another hit, and ends up with serious long-term damage. Concussions aren’t something we can afford to get wrong.
Let’s Leave Unidimensional Tests in the Past
The unidimensional test is the medical equivalent of trying to solve a Rubik’s cube by just staring at one side. Spoiler: it’s not going to end well. Concussions need a more nuanced approach—something that acknowledges the fact that the brain is not a simple machine but a symphony of electrical chaos, prone to occasional weird, delayed or subtle signs and symptoms. And all our brains are different before a concussion, with our own individual levels of eye movement control, skill, processing speed, headache symptoms, anxiety, sleep and memory. This is why multidimensional concussion baselines can be so useful.
Blood and saliva tests that confirm some brain damage are almost upon us, and symptoms and symptom provocation remain the cornerstone of the most sensitive tests following injury, with a mixed bag of physical, cognitive and psychological signs of injury. Currently symptoms carry the most weight in current concussion diagnostic tests and symptom resolution defines recovery! However multidimensional objective signs guide better decision making and gives everyone greater confidence moving forward.
If we’re serious about keeping athletes, children, and anyone else who takes an unfortunate knock to the head safe, we need to start treating concussion assessment like the complex issue it is. Please, no more research of these one-dimensional tests to confirm diagnosis. To be honest, the brain deserves more respect.
In an exciting development for physiotherapy and neurological rehabilitation, Your Brain Health, has partnered with innovative tech firm HeadX to introduce HeadX Kross to the healthcare market. This collaboration centers on a new, state-of-the-art, head-mounted laser system designed specifically to enhance and support physiotherapists in their rehabilitation programs.
The new laser technology aims to revolutionise the way therapists can work with patients recovering from neurological and musculoskeletal injuries, including concussion. The HeadX Kross head-mounted laser device, offers precision targeting and hands-free operation through a cross-haired laser, providing therapists a novel tool to target both the brain and cervical spine.
Designed with input from academics, engineers, and rehab specialists, the device integrates a head-mounted wearable cross-haired laser, opening new doors for hands-free, real-time applications during physiotherapy sessions.
Assoc Prof James McLoughlin, Co-Founder of Your Brain Health said:
“Feedback of head position in space using head torches or lasers has become an integral part of our vestibular and cervical rehabilitation. Standard head torches and lasers provide useful positional information in the pitch (up and down) and yaw (rotational) planes of head movement. However, the new HeadX Kross also gives feedback in the roll (lateral tilt) which adds a new dimension to our ability to train head and neck control. Feedback of movement in the roll plane helps us retrain lateral head stability which is incredibly important for functional gaze needed for accurate perception of size, verticality, motion and depth of objects. It also activates specific neck and trunk movement strategies for balance and postural control training. This includes everything exercises to improve performance in sports, to rehabilitation from neck pain, headache, concussion, dizziness and balance/falls!”
The HeadX Kross head-mounted laser device, offers precision targeting and hands-free operation through a cross-haired laser, providing therapists a novel tool to target both the brain and cervical spine.
The introduction of this laser technology offers promising benefits:
As the global need for effective, efficient rehabilitation solutions grows, the partnership between Your Brain Health and HeadX signals a promising leap forward. For patients recovering from serious injuries, surgeries, or neurological conditions, access to such advanced technology offers hope for faster and more effective recoveries.
Your Brain Health’s commitment to clinical excellence, paired with HeadX’s innovation in wearable tech, is likely to create a ripple effect in the field of rehabilitation. The companies are optimistic about the head-mounted laser’s potential applications in both in-clinic settings and remote rehabilitation, providing accessible and adaptable solutions to support various therapeutic needs.
Richard Wheatley, Founder of HeadX said on the collaboration:
“HeadX Kross is a testament to the power of collaboration between technology innovators and clinical experts. Our partnership with Your Brain Health united us around a shared commitment to addressing real, clearly defined clinical needs, propelling us from concept to launch in just three months. And this is only the beginning—with aligned goals and complementary strengths, this collaboration marks the start of an outstanding partnership, poised to bring groundbreaking technology to the clinical neuroscience sector and transform brain health care for clinicians and patients alike.”
Currently in the pilot testing phase, this device is expected to launch widely within the next year. With trials underway, Your Brain Health and HeadX are confident that this technology will set new standards in physiotherapy and neurorehabilitation.
For therapists interested in the launch of HeadX Kross, they can join the waiting list here. UK Therapists can also pre-order at a discounted rate!
As the medical community continues to push the boundaries of rehabilitation science, partnerships like this pave the way for innovative therapies that can profoundly impact patients’ lives. The future of rehabilitation is here, and it looks brighter than ever.
Do you understand BEST practice when it comes to concussion management?
We think we do.
That’s why we’ve come up with our BEST practice model of concussion care.
Watch the video to find out why it matters!
Persistent symptoms
Many people will experience symptoms after a concussion beyond 4 weeks. These are ‘persistent symptoms’ that will require help from health professionals. Up to 25% of people still experience symptoms at 3 months(Polinder et al. 2018), and with those who attend hospital after concussion, nearly 12% of children and 31% of adults experience symptoms beyond 3 months, with more than 50% still report some symptoms at 12 months(Machamer et al. 2022).
We estimate that 36,000 people in Australia
90,000 people in the UK
And 470,000 people in the US will experience persistent symptoms each year!
Academic Performance in schools.
1 in 5 children will suffer a concussion by the age of 10.
What about employment?
We have removed time and cost limitations by designing fast and cost-effective multimodal screens that focus on key measures monitored and compared at an individual level to inform best care following a concussion.
We have developed a world class programme of three critical courses for anyone involved in concussion management. From parents and teachers through to medical practitioners wanting evidence-based updates. Knowing the most up to date developments saves lives.
We facilitate support by providing opportunities for global networking within our custom designed online community of experts. Knowledge around concussion continues to evolve rapidly from the fields of neurology, vestibular, musculoskeletal and sports rehabilitation. Collaboration and sharing are key to innovation and best practice moving forward.
We are at leading the way in the selective use of the very best technological advances. From specific software, apps, virtual reality, eye-tracking, balance, movement, heart rate and cognitive testing devices, we know what people need and when.
Avedesian, Jason M., Tracey Covassin, and Janet S. Dufek. 2020. “The Influence of Sport-Related Concussion on Lower Extremity Injury Risk: A Review of Current Return-to-Play Practices and Clinical Implications.” International Journal of Exercise Science 13 (3): 873–89.
Daneshvar, Daniel H., Evan S. Nair, Zachary H. Baucom, Abigail Rasch, Bobak Abdolmohammadi, Madeline Uretsky, Nicole Saltiel, et al. 2023. “Leveraging Football Accelerometer Data to Quantify Associations between Repetitive Head Impacts and Chronic Traumatic Encephalopathy in Males.” Nature Communications 14 (1): 3470.
Fitzgerald, Melinda, Jennie Ponsford, Natasha A. Lannin, Terence J. O’Brien, Peter Cameron, D. James Cooper, Nick Rushworth, and Belinda Gabbe. 2022. “AUS-TBI: The Australian Health Informatics Approach to Predict Outcomes and Monitor Intervention Efficacy after Moderate-to-Severe Traumatic Brain Injury.” Neurotrauma Reports 3 (1): 217–23.
Fralick, Michael, Eric Sy, Adiba Hassan, Matthew J. Burke, Elizabeth Mostofsky, and Todd Karsies. 2019. “Association of Concussion With the Risk of Suicide: A Systematic Review and Meta-Analysis.” JAMA Neurology 76 (2): 144–51.
Gaudette, Étienne, Seth A. Seabury, Nancy Temkin, Jason Barber, Anthony M. DiGiorgio, Amy J. Markowitz, Geoffrey T. Manley, and TRACK-TBI Investigators. 2022. “Employment and Economic Outcomes of Participants with Mild Traumatic Brain Injury in the TRACK-TBI Study.” JAMA Network Open 5 (6): e2219444.
Ledoux, Andrée-Anne, Richard J. Webster, Anna E. Clarke, Deshayne B. Fell, Braden D. Knight, William Gardner, Paula Cloutier, Clare Gray, Meltem Tuna, and Roger Zemek. 2022. “Risk of Mental Health Problems in Children and Youths Following Concussion.” JAMA Network Open 5 (3): e221235.
Lystad, R., A. McMaugh, G. Herkes, G. Browne, T. Badgery-Parker, C. Cameron, and R. Mitchell. 2022. “The Impact of Concussion on School Performance in Australian Children: A Population-Based Matched Cohort Study.” Journal of Science and Medicine in Sport / Sports Medicine Australia 25 (November): S36–37.
Machamer, Joan, Nancy Temkin, Sureyya Dikmen, Lindsay D. Nelson, Jason Barber, Phillip Hwang, Kim Boase, et al. 2022. “Symptom Frequency and Persistence in the First Year after Traumatic Brain Injury: A TRACK-TBI Study.” Journal of Neurotrauma 39 (5–6): 358–70.
Polinder, Suzanne, Maryse C. Cnossen, Ruben G. L. Real, Amra Covic, Anastasia Gorbunova, Daphne C. Voormolen, Christina L. Master, Juanita A. Haagsma, Ramon Diaz-Arrastia, and Nicole von Steinbuechel. 2018. “A Multidimensional Approach to Post-Concussion Symptoms in Mild Traumatic Brain Injury.” Frontiers in Neurology 9 (December): 1113.
The autonomic nervous system can be complicated, which sort of makes sense as it is often responding to the complex challenges of life!
From heart rate to hormone, blood pressure to breathing, this is the part of the nervous system that unconsciously recognizes, reacts and regulates so many systems in our body. A conductor of our physiological orchestra, where the sympathetic nerves are activated at times of stress and demand, and the parasympathetic branches are key drivers for recovery and restoration.
However, for all of its nuances, there is increasing evidence that highlights the importance of understanding the autonomic system and how it can be disrupted following an mTBI. Whether it is due to stretching and shearing of axons, inflammation, a change in the levels of neurotransmitters such as adrenaline, noradrenaline and acetylcholine it is not uncommon for patients, who remain symptomatic at 3 weeks, to be experiencing an autonomic component.
So, what to look out for?
If we think of what the autonomic nervous system controls these are the things that can go out of kilter. And whilst the following symptoms may be triggered from other systems, it is worth considering
Cardiovascular: Changes and fluctuations in blood pressure or heart rate
Gastrointestinal: Nause, vomiting, bowel disturbances, loss of appetite
Sleep: Insomnia, excessive sleep, ineffective, non-restorative, sleep
Thermoregulation: Changes in body temperature and sweat response
Eyes: Unequal pupil size (anisocoria), sensitivity to light
How to assess?
Aside from clinical questioning there are a whole host of tests that can be used to help form judgement. Here are three that you may find useful.
Buffalo Concussion Treadmill Test: This test can also be done on a static bike and looks at how heart rate, perceived exertion and symptoms vary with a graduated increase in physical demand. The outcome is a modified heart rate threshold that is relevant to a patient at that moment in time and this allows for greater accuracy in exercise prescription.
NASA Lean Test: A useful way to evaluate excessive changes in heart rate that can be seen with patients who are experiencing postural orthostatic tachycardia syndrome (POTS). If POTS is detected interventions may include medication, nutritional (fluids), compression garments and graded exercise.
Firstbeat Lifestyle Assessment: This brings together physiology and context. A monitor is used to collect changes in heart rate variability and whilst the monitor is worn the patient will keep a diary of actions / feelings. A report is produced that details intra-individual changes in autonomic response and these are mapped, minute by minute, against a timeline. This data is useful in understanding the demands of daily life and lead to lifestyle interventions.
How to Treat?
I have already touched on some of the possible interventions that could be considered on the road to recovery.
Sometimes the symptoms can be obvious, sometimes subtle but consideration of the autonomic system has a role to play in a multisystemic approach to assessment. As for the treatment here are three things to consider:
Medical – Potentially medication can be used to influence blood pressure and heart rate.
Physical – Graded exercise that respects the current heart rate threshold and any symptom provocation is generally accepted as an appropriate intervention.
Lifestyle – There is often a focus on structuring the loads (physical, mental and emotional) that a patient is placed under. Fatigue management is important and so is recovery optimization.
Autonomic deregulation can be seen in concussion, in particular those with persistent symptoms.
Recognition and a proactive approach to the management of autonomic irregularity is something to be considered by all members of the multi-disciplinary team.
The balancing act between the demands of life and the way we cope and recover from these demands is a skill. A bit like a soufflé – undercook it and no progress is made; overcook and collapse occurs – balance is everything!
Novak Djokovic steps onto Centre Court today, aiming for his 8th Wimbledon title and 25th Grand Slam victory, adding another milestone to his illustrious career. However, the past few months have posed significant challenges for the Serbian star.
It’s important to note that the following is anecdotal and depends on accurate reporting, but research suggests that management of head impacts can be just as important for both brain and body.
Could this be a case of a predictable coincidence?
10th May 2024 – Novak Djokovic is accidently struck on the head whilst signing autographs when a metal water bottle falls out of a spectator’s bag.
Djokovic reports “That has really impacted me a lot. After that I got medical care, been through half an hour, an hour of nausea, dizziness and blood,” Djokovic said. “I managed to sleep OK. I had headaches. The next day, or yesterday, was pretty fine, so I thought it’s OK. Maybe it is OK, maybe it’s not.”
12th May 2024 – Djokovic is unexpectantly knocked out of the Italian Open 6-2, 6-3 by 29th seed Alejandro Tabilo.
Djokovic reported after the game “Today under high stress, it was quite bad – not in terms of pain, but in terms of this balance. Just no coordination. Completely different player from what it was two nights ago.”
24th May 2024 – Djokovic is knocked out of the Geneva Open by world no. 44 Thomas Machac, beating the world no.1 6-4, 0-6, 6-1.
So what are some of the challenges athletes might face post-concussion?
Balance, coordination, concentration, vision.
Research suggests that more than half of sports-related concussions result in vestibular-ocular motor dysfunction. In an arena where even the smallest advantages can be the difference between winning and losing, the restoration of these components is critical.
With improved oculomotor function facilitating fast and accurate motor movements, this approach to training can even enhance sensorimotor abilities and hand-eye coordination. Could this be one of the secret weapons that elite athletes possess?
Post-concussion rehabilitating oculomotor function needs to be considered.
In a fast-paced sport like tennis, where top players rely on exceptional hand-eye coordination, it is likely to performance-critical.
Ever wondered why you never made it to Wimbledon? Maybe it wasn’t just technique.
4th June 2024 – Djokovic withdraws at the Quarter-Final stage of Roland Garos following victory over Francisco Cerundolo due to a meniscal injury in his knee.
Djokovic reported that he had felt the knee before the tournament, but a slip in the second set exacerbated the issue.
6th June 2024 – Djokovic announces on his social media that he has had surgery on his knee having sustained a meniscus tear during his last match.
With evidence showing that following a concussion there is a 2.5 times greater risk of sustaining a musculoskeletal injury, a doubling in the risk of lower limb injuries, and the likelihood of a further concussive event occurring, it becomes clearer that challenges can go far beyond the brain.
Regardless of gender, or even the level competition, the risks are relevant. And this increased risk can persist well beyond the typical period for symptom resolution.
While the exact reasons for the changes in risk aren’t definitively known, one theory suggests that deficits in neuromuscular control following a concussion contribute to this increased risk.
However, one thing that does seem apparent is that many lines of thinking are leading us back towards the importance of multimodal, targeted rehabilitation.
So, what to do?
Waiting for symptom resolution alone is no longer appropriate management.
Whether it be visual training, neuromuscular control, balance or coordination; we need to rehabilitate athletes in the quest to both optimise performance and reduce injury risk.
Unsure where to start?
Your Brain Health Level 2 – Comprehensive Concussion Management will delve into the vast array of multimodal assessment options for immediate an on-going evaluation. A 10 hour online course, it is split into easy to manage modules so you can go at your own pace.
Take a deep dive into concussion management today.
As we gather to celebrate the beautiful game at Euro 2024, it’s important to shine a light on an issue that affects players at all levels: concussion. Football brings us together, fostering inclusivity, progress, and care within our communities. We owe it to the players who inspire us to ensure their health and safety are prioritised both on and off the pitch.
While the most frequent injuries in football involve the lower limbs, concussions and other head injuries, though less common, remain a significant concern. Head and neck injuries are rank as the 5th most common type of injury, making up about 5% of all football injuries. Specifically, concussions occur at a rate of approximately 0.5 per 1000 match hours, with an even lower incidence during training sessions.
Head injuries often happen during aerial challenges. Collisions involving head-to-head contact, elbow-to-head, knee-to-head, foot-to-head, and head-to-ground impacts are the primary culprits.
Yes, defenders are most prone to concussions (33%), followed by midfielders (30%), forwards (24%), and goalkeepers (13%). These injuries are most common in the final and initial 30 minutes of a match, particularly in midfield areas where collisions and aerial duels are frequent.
Indeed, studies show that head and neck injuries occur more frequently in female players compared to their male counterparts (17% vs. 14%).
Growing concerns have emerged following studies indicating that former professional footballers are 3.5 times more likely to die from neurodegenerative diseases than the general population. Conditions like dementia, Parkinson’s, motor neuron disease, and Chronic Traumatic Encephalopathy (CTE) are linked to repeated head impacts.
One of the lesser-reported impacts of a concussion is that athletes are reported to have a 2.5 times greater risk of sustaining a subsequent musculoskeletal injury following an initial concussion.
The International Football Association Board (IFAB) approved the trial of permanent concussion substitutes in 2021. This measure was implemented in the Premier League and Women’s Super League, with FIFA initially trialling it in international competitions such as the FIFA Club World Cup™.
Authorities are continuously working to safeguard players. In 2021, new heading guidelines were introduced by The FA, Premier League, EFL, the PFA and the LMA, recommending that a maximum of 10 higher-force headers are carried out in any training week. In May 2024, the FA have begun phasing out deliberate heading in matches for all grassroots youth football from U7 to U11.
Your Brain Health is dedicated to promoting effective concussion management strategies within the football community. Through education, such as the online Level 1 course “Concussion – Are You Ready?”, players, coaches, and officials can learn to protect themselves and others, ensuring the long-term health and safety of everyone involved in the sport.
Together, by staying informed and proactive, we can ensure that football continues to be a source of joy, unity, and safety for all. Enjoy the matches, support your teams, and let’s keep our players safe on the road to glory at Euro 2024!
Concussions in cricket are less frequent than injuries to the hamstring, lumbar spine, and trunk. However, they still occur. Data indicates an annual concussion incidence of 0.9 per 100 players, or 2.3 males and 2.0 females per 1000 days in the elite game.
In England, during the 2023 domestic season, there were 17 reported concussions, each resulting in an average of 10 days lost per concussion.
The primary cause of head impacts in cricket is batters being struck by the ball from fast bowlers, accounting for 67% of such incidents. Other causes include close fielders being hit by the ball, collisions with other players or the boundary fence, the head striking the ground, and wicketkeepers being hit by the bat!
Yes, there is a difference. In elite cricket, concussion rates are 0.4 per 1000 player hours for men and 0.5 for women. Interestingly, 53% of head impacts in women’s matches result in concussions, compared to 32% in men’s matches.
Post-concussion, symptoms like balance issues, impaired concentration, and vision problems can affect performance relating to cricket. Repeated head impacts and concussions are linked to chronic traumatic encephalopathy (CTE), though there are no known cases in cricketers so far.
In 2021, Derbyshire wicketkeeper Harvey Hossein retired from cricket following a series of concussions.
In 2019, the International Cricket Council (ICC) mandated concussion protocols, requiring players to pass a series of assessments before continuing play.
Since August 2019, the ICC has allowed concussion substitutes in Test matches. If a player is diagnosed with a concussion, they can be replaced by another player who can fully participate.
Marnus Labuschagne became the first concussion substitute in the history of international cricket, replacing Steve Smith during the Lord’s test of the 2019 Ashes series. He went on to score 59 in the fourth innings to help Australia salvage a draw.
Modern cricket helmets are designed to offer enhanced protection but cannot eliminate concussion risk entirely. Helmets must comply with the British Standard BS7928:2013, a mandate from the ICC to improve player safety. The introduction of neck guards has also been developed which have now been mandated by both Cricket Australia and the ECB.
While elite teams have trained medical staff to manage head impacts, concussions also occur at the community level. In Australia, 28% of cricket-related hospital admissions were as a result head injuries.
Research indicates that players often lack awareness about guidelines, testing, and helmet regulations, highlighting the need for ongoing education. Australian Guidelines now recommend clubs and schools appoint a concussion officer to manage concussions.
Your Brain Health offers education on concussion, including the online Level 1 course “Concussion – Are You Ready?” This 45-minute course is designed for those at elevated risk of concussion or who wish to become designated concussion officers.
