Tackling concussion

An image of Former Brisbane Lions player and UQ student Justin Clarke, who was forced to retire from the AFL in 2016 due to concussion.

Former Brisbane Lions player and UQ student Justin Clarke, who was forced to retire from the AFL in 2016 due to concussion.

Former Brisbane Lions player and UQ student Justin Clarke, who was forced to retire from the AFL in 2016 due to concussion.

Footballers have long been celebrated for their ability to take a hit. But what happens when they take one too many? Former Brisbane Lions star and current UQ student Justin Clarke knows all too well after a head knock at training brought his AFL career to a premature end. Clarke is now an ambassador for UQ’s Queensland Brain Institute, where scientists are tackling some of concussion’s unanswered questions, while working to improve diagnosis and management of brain injuries.

Justin Clarke can’t remember the blow to the head that ended his AFL career at just 22 years of age.

Some might say that’s a good thing.

The problem is that the UQ engineering student struggles to remember the great times before the accident, when he was living his sporting dream. The times that were supposedly the happiest and most exciting of his life.

It was January 2016 and Clarke was working hard to make his mark on the upcoming AFL season – his fifth with the Brisbane Lions. 

Pre-season training was in full swing at Giffin Park in Coorparoo and the sun was beaming. But as Clarke flew into a marking contest, everything went black.

“Reports say I was pushed in the back as I jumped and when I fell forward I cracked my forehead into the knee of a teammate,” Clarke said.

The collision left the key defender unconscious on the playing field for almost 20 seconds and he was taken to hospital with severe concussion. 

X-rays cleared him of spinal injuries but, after a week, the concussion symptoms were still strong. Almost two months later, he was still experiencing dizziness, headaches and memory loss.

“I was struggling to concentrate, losing my place in conversations and slurring my words."

“That was pretty scary, but my thoughts were so foggy at the time that I don’t think I could comprehend the full impact of the injury.

“I was just hopeful that everything would go back to normal and there wouldn’t be any lasting damage. Hopefully, I could get back to training and resume my footy career.”

Reality sunk in on a day when Clarke left his Cannon Hill home to drive to university. 

Along the way he realised he had to stop. He had driven the same route many times but now, with the car idling and traffic banking up behind him, he couldn’t remember which way to go. 

“It was a moment when I just stopped and thought ‘I’m not sure what I’m up to here’,” Clarke said.

Listen to Justin Clarke's story on the UQ ChangeMakers podcast or subscribe to the series on iTunes.

Listen to Justin Clarke's story on the UQ ChangeMakers podcast or subscribe to the series on iTunes.

Reflecting on the months and years since the accident, Clarke admits that retiring from football hurt more than the blow to his head.

“I’d been having neuropsychological testing – testing my memory function in comparison to my cognitive function. My memory was still affected and things that I should have been able to do easily were a massive battle,” Clarke said.

“It was so frustrating and devastating because at the time of the accident it didn’t seem like a concussion that should have ended a career.

“I knew that to return to footy would be a very silly risk to take. But I was worried I would be letting people down if I didn’t – my teammates, the club that had put so much time and effort into developing my game, and my parents who supported me the most to help me succeed.

“Eventually the doctors took the decision to retire out my hands, which was a relief.”

It’s a common scenario and Clarke is just one of a worryingly long list of athletes around the world with reported brain injuries due to high-impact contact sport. 

Rugby and AFL footballers lead the list of Australian athletes, while a significant number of National Football League (NFL) players in the US are experiencing similar injuries.

The 2015 film Concussion tells the story of a forensic pathologist’s attempts to shine a light on the NFL’s hidden secret of chronic traumatic encephalopathy (CTE) – a long-term complication of repeat concussions.

Watch the trailer to the film Concussion.

The film’s release represented a peak in public attention on a condition that had previously not been discussed much outside medical circles.

Through research, scientists at UQ’s Queensland Brain Institute (QBI) are working to improve the diagnosis and management of concussive episodes. 

QBI Motor Accidents and Insurance Commission Senior Research FellowDr Fatima Nasrallah uses functional magnetic resonance imaging (fMRI) and other imaging techniques to study what happens to the brain in the immediate aftermath of a concussion, as well as in the following weeks and months. 

Her work aims to study brain changes and the effects of different treatments and interventions to reduce long-term damage from concussion.

QBI Motor Accidents and Insurance Commission Senior Research Fellow Dr Fatima Nasrallah.

QBI Motor Accidents and Insurance Commission Senior Research Fellow Dr Fatima Nasrallah.

“Studies from the NFL have shown that players with reported brain injuries are experiencing symptoms of younger-onset dementia, or actual dementia,” Dr Nasrallah said. 

“There have also been cases of players committing suicide or experiencing psychosis, but the consequences can vary from concussion to concussion.”

A recent University of California San Francisco study, published in the JAMA Neurology journal, found that even mild traumatic brain injuries that do not result in loss of consciousness might have long-term consequences.

In fact, results showed that, of the 350,000 US military veterans who participated in the study, those who suffered a concussion without losing consciousness were two times more at risk of developing dementia. 

“Different people can suffer varying effects based on their genetic make-up, lifestyle and injury history,” Dr Nasrallah said.

“The brain has to heal after impact and if a player has suffered multiple concussions, they’re more likely to suffer long-term consequences. 

“We really can’t tell what the severity of an injury is likely to be without taking into account the history of that player to determine how long they should stay out of play.”

Dr Nasrallah said longitudinal studies to track brain changes have never been undertaken before, and are the missing piece of the concussion research puzzle.

“Finding a suitable biomarker to test for the progressive changes in the brain induced by a concussion will enable rapid diagnosis and inform the most suitable interventions," she said.

“At QBI, we are testing footballers and other athletes who haven’t experienced concussion for at least six months.

Watch the video and learn about the concussion study at UQ's Queensland Brain Institute.

“We perform a baseline MRI scan to generate a profile of the athlete’s basic brain function. 

“If our volunteers happen to experience concussion in the future, they come back for tests within 36 hours, and again over the next seven, 14 and 30 days, so we can track how their brain is changing over that time.

“At one point, we will be able to determine how long it will take the brain to recover from a concussion, how severe the damage is, and how long-lasting the effects will be.”

Clarke is a concussion ambassador for QBI and said research was crucial in determining how concussion was diagnosed and treated.

But he admits that calmly taking medical advice can be a different story when a player sustains a head knock during a game. 

“A player in that moment – whether it’s for the best or not – will want to be back out there. I wanted to be back out there."

“It’s about being able to control how much say that player has in that moment – and in the days and weeks to come – and being able to ensure their safety.”

Clarke agrees that the AFL has been ahead of the game in terms of managing concussion. The AFL has worked with experts for many years and convened a concussion working group in 2010, long before head knocks began grabbing headlines. 

That working group has developed guidelines to help doctors, coaches and players diagnose and manage cases across all levels of competition. These guidelines include a period of rest, monitoring for ongoing or changing signs and symptoms, neuropsychological tests to monitor recovery, a graduated return to activity in conjunction with monitoring, and a doctor’s sign-off before returning to play.

“People love the game for what it is – a high-impact, contact sport,” Clarke said.

“From a purist’s point of view, it’s sad to see the game cracking down on the ‘bump’ and other collisions. 

“But in terms of player safety and welfare, it’s a fantastic thing that the players know the rules are there to protect them.

“There’s no need to be a hero and go back out onto the field if you’ve been concussed or have concussion symptoms.”

Clarke made a return to football this year as an assistant coach with the Western Magpies, in the Queensland AFL competition. It’s a big step forward for the former Lion, who admits he has struggled to be around the game since his accident.

“I get frustrated. Structurally, my brain seems fine, so why can’t I go out and play the sport I love?” Clarke said.

“I’ve tried getting involved with other clubs in different capacities since I retired. I would enjoy it while I was there, but then I would head home and think about how they were all doing something that I would really love to be doing. 

“So I removed myself from those situations as much as possible.

“It feels different this time. I have a role and I enjoy being around the game again. There’s a sense of camaraderie that is nearly impossible to find outside a team-sport environment.”

On top of coaching, Clarke is also focused on completing a Bachelor of Engineering (Honours)/Bachelor of Science dual degree at UQ.

“I’m three years into the degree and feel very fortunate to be able to study something like this after playing professional football,” Clarke said.

“I was very focused on my studies at school and always had a goal to study engineering at university.

“Many players are lost after they retire because football has been their life from such a young age.

“As a footballer, it’s easy to lose sight of the fact that you also need to think about what you’re going to do beyond the age of 30. 

“It doesn’t necessarily need to be academic, but it’s important to remember that there’s life after the fun and games.”

Learn more about concussion and the research at the Queensland Brain Institute. You can also sign up to participate in the concussion study, or give now to support this important work.