Adam Drought –
Sport represents one of the foundational pillars of the ‘Australian Identity’.
The Australian Government Department of Health and Aged Care stated, “Sport is an important part of life in Australia. It improves our physical and mental health, benefits the economy, and helps to strengthen our national pride and international relationships.”
On days such as the Australian Football League (AFL) and National Rugby League (NRL) grand finals, or world championship boxing fights, thousands, if not millions of Aussies, tune in to watch their favourite stars put their bodies and health on the line to the roar of applause only comparable to the sounds heard by gladiators in the colosseum.
As hall-of-famer and former American football running back Eric Dickerson once said:
“You are supposed to be tough. You are supposed to play through pain. You are not supposed to cry. We are taught that early on in the game as kids. Tough sport. Brutal sport. It’s like the gladiator. People want to see the big hits. They wind up on Sports Centre. And as a player, you don’t want to admit you are injured.”
It is this ‘bravado’ that seems to be putting more and more players and fighters at risk of developing various brain disorders. One such disorder is Chronic Traumatic Encephalopathy (CTE).
This disease represents a type of dementia where many repeated head injuries can affect someone’s brain function over time and can take the form of concussion or even smaller head knocks without symptoms, which are called sub concussions.
What’s more, the diseases affect one’s health beyond the parameters of memory, as it can also affect one’s thinking, mood, and behaviour, as well as induce anxiety, depression, suicidal thoughts, rage episodes, agitation, panic, and a loss of empathy, according to Australian Government consortium Dementia Australia.
“I have a good friend who no longer trains due to CTE”, says UFC Gym Ashmore Head Coach Shaun Roberts.
Speaking to this journalist on his own personal experiences when observing this disease, Roberts states this disease should never be taken lightly.
A few years ago, he started having issues at training with his balance then it grew to months and months of intense headaches. He had to stop, and it took around 2 years to get it to be manageable. But I fear as he ages, he will get dementia.”
WHAT IS CTE?
Whilst CTE is more well-known and understood in nations such as the United States (US) due to the rise of CTE amongst its football population, Australia is still working to uncover the truth behind the debilitating disease.
It is not known how many people within Australia have CTE as it can only be diagnosed after death, but some experts say thousands of Australians could be affected.
According to Dementia Australia’s submission to the Senate Inquiry into concussions and repeated head trauma in contact sports, repeated head injuries can take the form of smaller head knocks without symptoms or concussion.
The document also notes emerging and increasingly convincing international research findings suggest ‘strong’ circumstantial evidence for a causal link between repetitive traumatic brain injury (TBI) and CTE.
The dementia-focused organisation also highlights how the future is looking grim for people of Australia, more so within its sporting population.
“In 2023, it is estimated there are more than 400,000 Australians living with dementia. Without a medical breakthrough, the number of people with dementia is expected to increase to more than 800,000 by 2058,” says Dementia Australia Research Administrator Sarah.
However, for now, CTE still represents a foreign concept to physios and neuropsychologists alike within Australia and has left them scratching their heads as to what the longer-term effects of the disease are.
“It’s actually quite difficult to, at this stage, to make any cause and effect claims to say that playing contact sport will lead to getting CTE…it’s very difficult to make any statements about the longer-term effects of potential concussion causing CTE,” says Lecturer in Physiotherapy at Griffith University Dr Felix Leung.
Talking to this journalist, Leung, whose research focuses on sports-related concussions and has been used to inform clinical practice guidelines and injury management protocols, says that whilst nothing much is known about CTE in Australia, concussions represent a gateway to more devastating effects of CTE later in an athlete’s life.
“There’s a lot it can lead to. It may be nothing immediate, but it could be more long-term. But a serious brain injury is what it could lead to.”
“There’s a lot it can lead to. It may be nothing immediate, but it could be more long-term. But a serious brain injury is what it could lead to. Where concussion is considered a mild brain injury with no structural changes, you get another knock, [it] might potentially cause swelling in the brain and that would be a lot more serious.”
Current Sports Climate in Australia
As of 2022, 41% of Australians aged 15+ participate in a sports-related activity at least once a week, according to the Australian Government’s Australian Sports Commission.
Meanwhile, the document also highlights 47% of children aged 0-14 also participate in sporting activities in organised outside-of-school hours sport-related activities.
Males take the majority 47% stake in this population, while females make up the additional 46%.
Supporting these statistics, the SportAus Ausplay 2019 Martial Arts State of Play report shows more than 248,000 teenagers aged 15+ are actively participating in Martial Arts, with a median frequency of 65 sessions per annum.
It is not only males that dominate the population of sports participants but also the rate of sports-related hospitalisations as well.
Of 66,500 sports injury hospitalisations, males aged 15-19 took the cake with about 47,000 hospitalisations between 2020-2021, according to the Australian Government’s Australian Institute of Health and Welfare.
What’s more, most hospitalisations for intracranial injuries (concussions) in sports, which took a whopping 83% of all hospitalisations during this period, have led industry experts to question the potential health ramifications for our aspiring athletes.
Because one must remember, that while short-term symptoms are reversible, a single knock to the head can have serious consequences in later life.
Therefore, what do these knocks on the head open the door to as our athletes progress through their lives?
Addressing this daunting question Leung adds whilst the effects may not be immediate, enough knocks to the head could deliver more severe and significant effects.
“It may be nothing immediate, but it could be more long-term.”
“It may be nothing immediate, but it could be more long-term.”
Adding on, the Doctor explains continuous knocks to the head for children, at those borderline adult ages so vital for their development, can have disturbing, and potentially life-threatening effects. “What we do know is there’s a big energy imbalance. So, the brain is responding to this trauma, the brain is trying to recover. And if you continue to give it knocks, then you’re really going to lead to the brain being overloaded and that will lead to worsening symptoms.”
The effects on fighters and sports stars
Whilst CTE still requires a deeper understanding in Australia, the US has been hard at work on its own journey to understanding the origins of CTE.
According to a report published this year by the US CTE Centre at Boston University, up to 345 former National Football League (NFL) players were diagnosed with CTE out of a pool of 376.
This represents a staggering 91.7% of players.
When compared to a separate 2018 Boston University study of 164 brains of men and women, researchers found only 1 of 164 (0.6%) had CTE. This demonstrates a sharp rise of upwards of 90% in cases of CTE.
These figures out of the US have left many sports bodies in Australia worried, as Australia is now starting to witness the harsh reality of this disease within its most prolific sports, AFL and NRL, as well as within its combat sports such as Muay Thai and Boxing.
Concerns began arising following the death of AFL women’s player Heather Anderson, who represents the first and only female athlete in the country so far to be diagnosed with CTE, and the shocking potential CTE diagnosis of rugby league legend Wally Lewis.
As a result, Australian institutions have begun to undertake research into CTE.
Dementia Australia is one such organisation.
“We need to know a lot more about CTE”, says Dementia Australia Research Administrator Sarah.
“We need to know a lot more about CTE”
This work could not come soon enough, as there seems to be another demographic of athletes that seems to have been forgotten.
Fighting for survival
Sports such as Muay Thai and Boxing have defined themselves as 2 of the leading combat sports in the nation.
As stated in the Government of Western Australia Department of Local Government, Sport, and Cultural Industries Combat Sports Commission 2020-21 Annual Report, up to 20 contests were approved during 2020 and 2021.
At this time, COVID-19 represented a threat lurking in the shadows ready to strike at any point resulting in entire states being shut inside their homes and indulging in the ensuing frenzy of panic buying.
It was because of these reasons any events that went ahead had significantly larger bout numbers and saw a number of participants wanting to be a part of an event, therefore creating a backlog, states the report.
Also, during this time, 612 contestants participated in boxing and/or Muay Thai bouts, resulting in 38 reportable injuries. Of these, six concussions occurred.
That is 6 new potential CTE victims.
But in the age in which sports are supposed to be the safest, why do our athletes keep finding themselves on the back end of nasty head injuries?
Leung has the answer and notes that whilst there may not be enough awareness in Australia as of right now, we are already starting to see the effects of CTE amongst our sporting elite.
The Doctor also states athletes who take part in combat sports, such as Muay Thai, MMA, and/or boxing are at the forefront of sustaining irreversible damage.
“The fighting sports I would almost say they’re probably concussed more often than what is actually diagnosed and reported.
“The fighting sports I would almost say they’re probably concussed more often”
I guess boxing is probably one that’s been around for a long time and there would be many, I would once again suspect that a lot of them would be boxing while concussed if we go with the more conservative diagnosis and definition of concussion.”
Echoing these concerns, Head Coach at StrikeForce Muay Thai Gym Mark Pease says:
“I’ve had a fighter who had 5 fights with me and got clean knocked out 4 times, so I had to tell him that this sport wasn’t for him…but there are promoters out there who won’t tell fighters that.”
With these concerns in mind, states such as New South Wales have already implemented harsher restrictions for fighting promotions regarding the necessary precautions for fighters who take part in these sports.
Possibly inspired by the actions of New South Wales, other states are now looking to join the fray, and are working to improve the safety of its combat sports participants.
A cause for social change
Western Australia, known for its prominent AFL teams, is looking to define itself as a fight-friendly state coming off the quite lucrative and successful UFC 284 event which took place at the RAC Arena in the city centre in February this year.
Following this event, work has been accelerated by the state government to employ harsher restrictions for its fighters, according to the Government of Western Australia’s Department of Local Government, Sport, and Cultural Industries Combat Sports Commission Strategic Plan 2021-2025.
This document explicitly states the Government of Western Australia is focused on improving all aspects of safety for participants.
In order the achieve this feat, the Government of Western Australia says it will undertake the engagement with research partners to deliver an annual research plan, as well as complete a review of the Combat Sports Act 1987.
Other avenues it plans to investigate include research into all aspects of industry health and safety, as well as developing and implementing an engagement strategy with the medical and health professions.
Once put into action, these measures will solidify Queensland as the ‘last frontier’ for hardened combat sports.
As Roberts puts it, “It will take time, money & medical research to find ways best to deal with this. I think Queensland will always be the last frontier. But it will be interesting to see what happens in WA.”
While states such as Western Australia are seeing the light and are choosing to prioritise the safety of its fighters, Queensland and its many Muay Thai promoters see this as an opportunity to line their own pockets on the back of the state’s limited measures, and their own fighters brain cells.
Pease provides further context on this issue, stating this is not a foreign issue within Queensland.
“The infrastructure in QLD is quite extraordinary and has been for quite a while.
“The infrastructure in QLD is quite extraordinary and has been for quite a while”
Because there are so many promoters in QLD, and a lot of money is to be made off the back of these contests, trying to get everyone to adhere to these desired regulations is very hard.
There are some promoters out there who will do their own thing and run their own promotion with their own rules, which to me is wrong.”
What’s more, Robert adds Queensland is renowned within the fighting industry for its lack of policies and overall levels of protection.
“Queensland has steered away from it I think due to the fact it’s a short flight to Thailand for training or fighting, with most fighters preferring the purity of traditional Muay Thai. No headgear, shins with full elbows and knees.”
These perspectives are reinforced by the Government of Queensland itself, which admitted in 2016 that the government has dropped its guard when regulating its combat sports.
As Former Member of the Queensland Legislative Assembly and Australian Labor Party Member of Parliament (MP) for Toohey, Peter Russo said in a letter regarding the inquiry into health and safety outcomes for combat sports contestants in high-risk professional and amateur combat sports:
“Combat sports in Queensland currently self-regulate, including for contests. The forms of self-regulation can vary significantly between and within each discipline and between amateur and professional parts of the industry.”
The MP also mentioned how the state’s Department of National Parks, Sport, and Racing (NSPR) has only had a ‘limited’ interaction with the combat sports industry in Queensland.
“NPSR interacts with only a limited section of the combat sports industry in Queensland.”
Now that we have explored the severity of CTE, as well as some of the other accompanying issues that are contributing to a rise in CTE among fighters, it seems the story emerging is that the problem with CTE in combat sports, specifically Muay Thai, is being fuelled from a lack of governance and recognition, which is leaving fighters more at risk.
Moreover, it seems that Queensland specifically represents one of, if not the last state to employ the harsher rules and regulations that its neighbouring fight and sport-loving states have already had the foresight to implement.
Therefore, the question must be asked, what is being done within and outside of the fighting industry to help these fighters facing CTE in Queensland?
Making a (un)conscious decision
Sports is constantly evolving.
As more and more people aspire to be athletes within many of the sporting disciplines that Australia has to offer, rules, regulations, and policies surrounding safety and inclusion find themselves being adapted or changed.
However, these measures are facing a harsh reality check, as more and more Australian athletes are unknowingly putting themselves at risk of developing symptoms of Chronic Traumatic Encephalopathy (CTE).
In part one of this two-part series, this journalist explored the severities of this disease and how fighters in particular are at a more heightened risk of developing these debilitating symptoms.
What’s more, it was uncovered that Queensland specifically does not seem to be pulling its weight with keeping its fighters safe when compared to its neighbouring states.
As stated by Head Coach of Muay Thai at UFC Gym Ashmore in part one of this series:
“I think Queensland will always be the last frontier.”
Another component that was uncovered was the lack of governance within the greater competitive Muay Thai fighting industry in Queensland.
Head Coach and trainer of StrikeForce Muay Thai gym Mark Pease reminds us:
“The infrastructure in Queensland is quite extraordinary and has been for quite a while.”
This seeming lack of governance, coupled with a ‘quite extraordinary structure’ has birthed a level of concern among officials ahead of the Brisbane 2023 Summer Olympics.
Time for a change
Earlier this year, promoters and sporting agencies alike rejoiced in victory following the United States Olympic & Paralympic Committee’s (USOPC) decision to recognise Muay Thai as a new member of the USOPC board.
With Muay Thai now being recognised as a new member, officials are looking ahead to the encroaching Brisbane 2023 Summer Olympics and what the state’s lack of safety policies for fighters will mean for the sport during its infancy on the Olympic stage.
It seems the question on everyone’s mind at this current time is, what needs to be done?
A measure implemented by most sports in this circumstance is the use of headgear, but in the case of Muay Thai, is it enough?
Griffith University Lecturer in Physiotherapy Dr Felix Leung reiterates to this journalist in part one of this series, “Using protective equipment is probably one of the first things with reducing the risk officers getting a concussion…there is proven evidence to say that having headgear, which hopefully has the padding and reduces the force of the impact to the head, reduces the risk of concussion.
That’s an effective form of injury concussion prevention that can be implemented across the board.”
Roberts does not believe this, stating:
“Soft helmets stop cuts & bruising, but they don’t stop CTE-type symptoms as the brain is still getting knocked around regardless.”
In addition, Roberts adds the solution is not so clear cut, and that adoption of rules set out and implemented in other states does not seem like the most logical answer after experiencing the vast differences in training fighters from both Queensland and New South Wales.
“There are pros and cons to both rule sets. On one hand, it can be seen that New South Wales and International Muaythai Federation (IMTF) rules offer a “safer” gateway into competition for rookies while others say it hinders fighters when they choose to fight full Thai rules.”
What is in the pipeline?
With all these factors in mind, what must be done in Queensland to not only protect Muay Thai’s infancy in the Olympics but also its fighters?
Pease believes he has the answers.
“I have been an advocate for a multi-layered division system, meaning each level will embody certain levels of protection for fighters before moving onto the higher level. D level will essentially be what we call a ‘gym-spar’ with chest guards, headgear, elbow pads, and all manner of protection before fighters then move up and can remove certain protection and can move forward with fighting with elbows.
I do believe it should happen. I have been fighting sanctioning bodies for about 25 years and it still hasn’t happened. Unless a government-controlling body comes through to enforce this sort of stuff, I don’t believe it is going to happen.
The government has been slow on the upkeep of it [Muay Thai], and I think the sanctioning bodies and promoters have been slow on the upkeep as well.
“The government has been slow on the upkeep of it [Muay Thai]”
Everybody should be adhering to the same rules anyway, but there should be tiers and levels to the sport. [Muay Thai] should be governed, and promoters should be working to their governance.
The government must get stronger, but they need someone in government who knows exactly what the rules and regulations of Muay Thai are about. I believe it is here the problem might start being addressed.”
Adding on, Pease adds another reason why Queensland’s continuous issues keep returning to rear their ugly heads is a hunger for money and could be a main factor as to why the state has maintained its small level of safety.
“Because there are so many promoters in QLD and a lot of money is to be made off the back of these contests, that is where the government needs to step in and tell these promoters they do not have the infrastructure to even be a promoter.
Trying to get everyone to adhere to these desired regulations is very hard and there are some promoters out there who will do their own thing and run their own promotion with their own rules, which to me is wrong.”
Finishing off, the StrikeForce Head Coach states if these measures are met and implemented in Queensland, it could also see many more Queensland fighters not putting themselves in unnecessary risk and given better health coverage in regard to CTE and traumatic brain injury (TBI).
“Hopefully when these measures are implemented, and I am still hopeful even after 25 years, we will see fighters given the same respect as players in the NRL (National Rugby League) and AFL (Australian Football League), but it needs to happen soon.”
These views have gone unnoticed, with Secretary General of the International Federation of Muaythai Associations (which is the only Muay Thai body recognised by the International Olympic Council) Stephen Fox noting this could likely be the next move when he spoke to Channel NewsAsia in November last year.
“But they think that we are controlling them and that we are trying to put a sport under one umbrella and regulate it.”
With the governance of Muay Thai looking like the most sensible future for the sport, one must now look ahead to how fighters can expect to be kept safe from CTE and other traumatic brain injuries.
Muay Thai Medical Breakthroughs
Despite the lack of safety concerns within Queensland, that does not mean work is not being done in the background from other institutions who are leading the charge in establishing key research to better understand CTE and the cause/effects factors it can have on fighters.
Based in Manuka within the Australian Capital Territory (ACT), Dementia Australia represents more than 400,000 Australians living with dementia and the more than 1.5 million Australians involved in their care.
With CTE taking the form of severe dementia it should come as no surprise that the organisation has dedicated its resources to understanding CTE.
Dementia Australia Research Administrator Sarah adds that whilst Queensland is lacking in safety policies for fighters, Dementia Australia is determined to move forward with research and studies in order to establish a presence in Queensland.
“CTE is a form of dementia and so the risks that CTE pose are the same as those for dementia for which at the moment there is no effective treatment or cure – there are some newer medications now that can slow down its progression however – this is for dementia broadly not CTE specifically.
“We are only just now beginning to understand the long-term impacts of recurrent concussion and its relationship with CTE / dementia”
We are only just now beginning to understand the long-term impacts of recurrent concussion and its relationship with CTE / dementia.”
What’s more, Sarah confirms at this current rate Queensland specifically will see a spike in fighters, as well as the wider sporting community, potentially being diagnosed with CTE or other dementia-based brain disorders.
“With what we know about recurrent concussion through sport and its relationship with CTE, it is reasonable to think that there will be more cases identified.
Remember also that Dementia describes a collection of symptoms caused by disorders affecting the brain. It is not one specific disease and there are many other causes of dementia that are not related to concussion – we are seeing rises in cases of dementia across the board.”
With all of this information compiled and laid out, it seems the story that is emerging is that whilst Queensland is indeed behind in the times when it comes to sports safety, specifically for Muay Thai fighters, the state is not throwing in the towel just yet.
As time goes on, one can only hope our fighters find their footing sooner rather than later.