Australia’s sports medicine body defends denial over link between concussion and CTE

The peak body for sports medicine in Australia has defended its official position of denying a clear causative link between head injury and debilitating neurodegenerative disease, despite one of its own advisers telling a Senate inquiry that the evidence is “undeniable”.

Sports Medicine Australia (SMA) gave evidence on Monday at the first public hearing for the Senate inquiry into concussions and repeated head trauma in contact sports.

The inquiry was established in the wake of increasing public concern, including ongoing reporting by Guardian Australia, about sporting organisations’ management of player head injuries and the large and growing body of scientific evidence showing links between repeated exposure to head injury in contact sports and the neurodegenerative disease chronic traumatic encephalopathy (CTE).

CTE often manifests in life as behavioural changes, memory loss and other cognitive impairment, mood swings, depression and anxiety. It is unable to be definitively diagnosed except postmortem by autopsy, but has been found in the brains of multiple Australian sportspeople, from amateurs to professionals.

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Representatives from SMA were asked by Greens senator Lidia Thorpe if the organisation still stood by its 2019 position paper, which says “there is currently no reliable evidence clearly linking sport-related concussion with chronic traumatic encephalopathy, a condition with unclear clinical diagnostic criteria”.

The SMA chief executive, Jamie Crain, said the statement was currently undergoing review, but until the review had concluded, that remained the organisation’s position.

“That’s not to say that necessarily we’re swaying one way or the other. But that 2019 position statement is currently going through a new refresh,” Crain said.

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His comments came as Dr Reidar Lystad, a member of the SMA’s scientific advisory committee who also appeared at the hearing, expressed both concern about the official position of the organisation and its origins, which appear to be the widely criticised global Concussion in Sport Group’s 2017 consensus statement on concussion in sport, which also denies a link between CTE and concussion.

Lystad said he had “reservations” with the methodology as well as the conclusion of the consensus statement.

“In my view, the evidence for a causal relationship between repetitive head trauma and neurodegenerative diseases such as CTE is imperfect but it is undeniable at this stage,” Lystad said.

The Senate committee also heard from the families of four athletes who were diagnosed with CTE after their deaths.

They described the universally harrowing experience of living with someone experiencing profound personality changes alongside physiological and psychological decline, and the difficulty of getting appropriate assistance from medical professionals, even as CTE became more widely understood.

Michael Strong described the decline of his father, Terry, who died in 2021 at the age of 68. Terry Strong had played rugby league as an amateur and semi-professional in the 1970s and 1980s, and was diagnosed after his death with late-stage CTE, along with Lewy body dementia and other forms of neurological decline.

“He was a very outgoing man, loved his sport, loved engaging with others [and] was very helpful. He would always put his hand up to help other people. And I’ve always tried to live up to the standard that he set. So watching that decay – it was very, very difficult,” Strong said.

The family began noticing Terry’s significant decline in his 60s, when he would forget things like how to use the remote control for the TV or how to turn on the air conditioning.

Michael Strong said it was difficult to describe “how mad Dad was”. “One night when he came home from hospital and we were trying to look after him, he was tearing sheets into thin strips and then trying to create into some type of craft … He was turning a hatstand into a weapon because he thought people were coming to get him,” Strong said.

“This is a man that until two years earlier had complete control of his faculties and [then] he fell to pieces.”

Strong called for sporting bodies and the government to take a “duty of care” towards athletes seriously. “When injuries occur, care needs to be given to people,” he said.

Neurologist Dr Rowena Mobbs, who also gave evidence at the inquiry, said she urged athletes and sporting bodies to take a conservative approach to concussion management and advocated for four weeks off play after a concussion diagnosis, “inclusive of that weekend’s games, none of this sort of 11 or 12-day approach where you can scoot into that fortnight’s games”.

The inquiry continues.