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Opinion: 'The culture of playing through pain and concussion needs to change'

‘I’d become wise how to beat the tests’ – responses to concussion researcher show more than protocols and workshops needed to change culture.

Dr Katie Liston

SOCIOLOGISTS HAVE LONG agreed that most competitive team sports involve a cultural commitment to a sports ethic: the willingness to make sacrifices; the acceptance of risk and the possibility of participating while enduring pain; and, an acceptance that there is no limit to the pursuit of the ultimate performance. This ethic often becomes more visible to the eye only when we stop to reflect. 

Concussion or sports-related brain injury has been lying in plain view behind a set of highly established beliefs around risk which impact on how players, coaches and the general public view the injury.

  • (Read more here on how you can support a major Noteworthy project to find out if the GAA is doing enough to tackle concussion and whether the culture of staying on the field while injured is still prevalent in gaelic games.)

Concussion is similar to other injuries in terms of the acceptance and normalization of injury and the expectation to play on, as well as the associated burden on sports medics to declare players fit to train or return to a game.

Crucially, however it is different because it is potentially life threatening. It is also unique in having discrete and often lengthy codes of practice and protocols written into the regulations of sports.

Loss of consciousness does not occur in the majority of cases and there can be limited perceived impact on sports performance because of its complex presentation as well as delayed and even hidden symptoms. There is also emerging research about longer-term harm, including dementia and other debilitating cognitive impairments, associated with repeated sub-concussive impacts that shake the brain.

‘You’ll play at all costs’

Despite the growing awareness surrounding the injury, there are many who are aware of concussion but, for various reasons, are ill-inclined to act. Some even actively oppose preventative action.

In our research at Ulster, we found that players had developed a high tolerance towards pain and injury, and an irreverence of sorts to concussion, which led to a set of self-exempting beliefs about its management.

In Gaelic games, we have well-established research on pain and injury attitudes and on the risk of burnout.

As part of my research, we gathered testimonies about the views of players regarding concussion:

  • “It’s like a setback for three weeks and then you’re back again.”
  • “You like to be manly about playing and you’ll play at all costs.”
  • “I’d become wise how to beat the tests.”
  • “I knew I was concussed but I wanted to play on.”
  • “At club level it wasn’t an issue (to play on) because there wasn’t a lot of medical staff.”

Having completed an awareness programmes, these players continued to deny the existence of concussion. The explanation for this is cultural.

Addressing culture is crucial

The most important of the cultural enablers when it comes to managing concussion is identity – personal and group identity. Culture is the glue that holds sportspeople together.

From an increasingly young age, we are socialised into the culture of sport in Ireland, specifically, a culture that values risks and rewards those who exhibit the right attitude: the players that take one for the team, the player that takes a risk for that ‘big game’ because the coach and team needs him or her.

As one Gaelic player put it:

Well as I know, scientifically and logically, it’s very negative [to play with pain and through injury]. You should be looking after your body and health and you should be taking all the time out. You shouldn’t be risking anything that’s going to be a threat for you in the future. But as a player, it’s good [playing through pain and injury]. It makes you a stronger player and better in the future … It sounds so petty but what doesn’t kill you does make you stronger.

Such judgements about about risk and its perceived value to sport are given to perhaps only one other occupation – the military. This tells you something of the elevated position of sport in the lives of people, around the world and here in Ireland.

Being socialised into this leads to a set of self-exempting beliefs about health that are specific to competitive sport. 

Put simply, revised concussion protocols, posters and awareness workshops are most likely to have limited impact, especially in amateur and community sport.

Sports bodies such as the GAA need to first examine the effects of pre-existing cultural imperatives, in particular, the imperative to play through pain and injury, no matter the cost.

Dr Katie Liston is a former elite sportsperson, senior lecturer and researcher in the social sciences of sport at Ulster University (Jordanstown).

HEAD IN THE GAME Investigation 

Do you want to know if the GAA is doing enough to tackle concussion?

The Noteworthy team want to do an in-depth investigation into this issue and find out if the culture of staying on the field while injured is still prevalent in gaelic games, especially when it comes to head injuries.

Here’s how to help support this proposal>

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About the author:

Dr Katie Liston

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