Chronic traumatic encephalopathy and sport : implications for furture generations

Chronic traumatic encephalopathy (CTE) achieved prominence following the 2015 film, 'Concussion', depicting the struggle of a forensic pathologist with American Football. Sporting organisations recognise potential implications of concussions. CTE poses risk for dementia and was found in brain autopsies of contact sports players experiencing mental health issues and suicide. Contact sport can cause elevated biochemical markers of brain damage, including neurofilament light, tau, S-100B, neurone specific enolase and circulating microRNAs. 'Heading' in football, provokes risk of dementia exemplified by the England 1966 World Cup winning team having 6 of 22 (27%) players, thus far, developing dementia, compared to 7.1% UK population prevalence. Sporting bodies are changing rules but are they reflecting scientific evidence? In Australian soccer, heading is banned for primary school children during training but not during games. Does this provide adequate protection? Professional 'no play rules', following concussion, vary across sporting codes. In Australian professional rugby league, 'return to play' rules, have become more conservative. Following concussion, a player must refrain from contact play for 11 days, unless cleared by an independent specialist. With two concussions, within 12-months, the player must consult an independent concussion specialist and neuropsychologist for more vigorous neuro-psychometrics. There is no mandated imaging nor biochemistry, following concussion. Cerebral MRI for players, joining a new club, having experienced concussion(s), is gaining acceptance. Whether science motivates change, regarding otherwise 'non-existing investigation policy', is unclear. Sporting bodies and clinicians, underwriting players to resume playing, must question whether the current practices will protect from litigation by future generations.