Concussion in sport - the knock-on effect

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Peter FitzSimons: For every 100 footballers like me who played serious football for a decade or so, out of every 100, how many do you think will have what you call brain damage? 

And this guy said, and I'll never forget it, he said "100 per cent." 

You bastards knew and you put us out there and this, this kind of legal approach is what does actually change the culture.

Dr Alan Pearce: Certainly, I agree with you that we're now seeing a tipping point in the discussion about this injury. You know the retired players that come into my lab do say that "I feel like just a, nothing more than a commodity", and you know sort of almost devaluing them as human beings and being more just products for a sport.

Michael Milton: Skiing over 6000 days of my life, you start adding up and thinking you know there's probably pretty high numbers of multiple impacts that potentially could have an issue in the future.

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Podcast Intro: “Welcome to On Side, the official podcast of Sport Integrity Australia. Our mission is to protect the integrity of sport and the health and welfare of those who participate in Australian sport”.  

Tim Gavel: Hello and welcome to On Side, I'm Tim Gavel. Well today we're looking at the issue of concussion in sport. Our guests a former Wallaby, author, prominent journalist and commentator Peter FitzSimons, Dr. Alan Pearce, Associate Professor at Latrobe University and Dr Pearce is also the Research Manager of Sports Brain Bank Victoria, and Australia's fastest downhill skier, Paralympic legend Michael Milton. Just a reminder, Sport Integrity Australia's Tokyo 2020 Course has gone out to sports.

Tim Gavel: As a Wallaby, Peter FitzSimons suffered concussion, in recent times Peter has written extensively about concussion, including headed to the United States and speaking to a number of people on the issue there and Peter is with us now. 

Peter how did you first become interested in the whole issue of concussion? We know that you've played for the Wallabies and very much a prominent journalist, how did you become involved and why did you take up this cause?

Peter Fitzsimons: I guess it really started with, in the age of the internet it was suddenly easy to read The New York Times and I guess, 15 years ago also in reading The New York Times, I became more and more aware of how concussion was a serious issue in sport and that there were lots of NFL players particularly that were to use the old terminology "Punch drunk" which was like a revelation to many people because a lot of us were naive enough to think that it was only boxers that could suffer damage through concussion. 

And so I started reading a lot about that, but the big thing for me was in 2013 working for that Channel 7 show the Sunday night, what was it called - Sunday Night and I went over to Virginia and then Boston, and I started in Virginia talking to brain experts and most particularly former line-backers and the widows of former line-backers and talking about their experiences with concussion. 

And it was shocking. And I, the first guy I interviewed his name was John Hilton and he was 71, 72 years old, he looked like Charlton Heston, a physically beautiful man that was the most feared line-backer in America in the early seventies with the Pittsburgh Steelers, and it was this wintry day and he was in this retirement home, and he was to use the old terminology completely "gaga". 

But he would have sort of lucid memories of what had happened and but then not realise who I was, what was happening and then every now and then I'd say so you played football and he'd get out, he'd get out from his wallet, you know this bubble gum card with John Hilton and then he started talking about it and then the doctor who was with me said, "John, is it 1993 2003 or 2013?", he had no idea. But then the lucidity would return and he would talk about the brutality of his experience and then what had happened to other line-backers he'd played with and other footballers over the years who'd suicided, gone mad, et cetera and then he started crying and he said "It was brutal. It was brutal."

And here he was 50 years later, 45 years later, talking about the consequences and manifesting the consequences of getting your brain hit so badly. And so I come away from that reeling and my next interview was with the foremost brain expert in America, and I sort of shook his hand and said "Look, pleased to meet you. I've got to say I've played a lot of football myself, and I'm 52 years old but I played a lot of football but I wrote a bestselling book every year so I guess I'm okay, am I?", hoping he would take my hand and said, "Well of course you're OK", but he didn't. 

He said, "How old are you?", I said “52”, and he said "No, no well we wouldn't know until you know 10 years from now. A few years from now, we'll see how you are in your late fifties early sixties and then see how you go.”, and then, I'm getting to the punchline, I interviewed him cameras on, camera one on, camera two on and I thought, I'll give this bastard another chance so I said "Look", I said "Look, you know, for every 100 footballers like me who played serious football for a decade or so, out of every 100, how many do you think will have what you call brain damage?", and this guy said, and I'll never forget it he said"100 per cent. 100 per cent."

And what he said was, and he was very evocative in his expression he said "Your brain is a bowl of jello floating around in a bucket of bones and it's meant to move around and sway around to Brahms, the music of Brahms and you know, just a symphony and just lightly and waving in the breeze like a chrysanthemum on a spring day.", what he said was "it's not meant to be going 'Bam! Bam! Bam! Bam! Bam! Bam!' against the sides of your skull and if it does go like that 'Bam bam against the sides of your skull", he said "There'll be damage”, and don't kid yourself, there will be damage. 

And part of the process with Channel 7, my producer not unreasonably said "Well, Peter, given, you know you've had so many concussions or concussive impacts it would be good for the show if you would take the brain test to see what damage is done.", and I said "No, I won't", because I was so shocked by the whole thing and I followed it ever since and what you see now, you know there's been huge progress with most of the football, well most of the codes gone to contact codes with protocols, which is great. 

What needs to be done however is an observation of said protocols so that when somebody goes down you don't go through the nonsense when you see somebody, particularly in rugby league which is where it's most flagrant, you see people clearly concussed, clearly gaga, still getting HIAs, (head injury assessments) which is you know, "Let's see if they're concussed or not", and then so often they come back on the field, more last year than this year 

"No, no. Okay, there's no problem with the head", to which I have written many times "Oh really no problem? What the hell was it? Was it flu? Was it a bad cold? Can you tell us what it was? Why was he wobbling at the knees and wandering all over the place? But you've done the head injury assessment, so it wasn't concussion. What the hell was it?", and I'll tell you Tim, we will see those cases show up in court 10 years from now.

Tim Gavel: Yes, you have written about the mixed messages on concussion a number of times, you know players passing a HIA cleared to return in some cases, sometimes not, you've got experts disagreeing with those at the front line, there's certain amount of scepticism, we really need to be on the same page, don't we?

Peter Fitzsimons: Absolutely and it's the law that's moving it forward. You know in America it was not taken seriously for many years, many decades until I think the first case was $800 million class action and then they went back and said, No. 1, I don't have the figures in front of me but there was serious money that changed hands and the essence of the reason why money changed hands was the footballers quite reasonably saying "You bastards knew. You knew what this was doing to our brains and yet you still sent us out there, you'd still, you put us out there week after week, we suffered brain damage because of what you did." 

So one of the things I say to the football codes is I was, for example, playing for the Wallabies against the French in 1990 at Sydney Football Stadium, I was knocked completely cold in the first two minutes, so no names, no pack drill, but it was Terry De-ve-ji that hit me, [LAUGHTER] to start the brawl and then Phillipe Cellar hit me from behind, I went down like a sack of spuds and I was knocked cold for a minute and I woke up singing Bob Dylan, and I then went on to play the game of my life I was so infuriated by what had happened. 

Now I was concussed, I played on, I for example, would have no legal case against the ARU or the team doctor or the coach, because I didn't know and in 1990 they didn't know, you know that the footballers could, there was a real danger of second impact syndrome on concussion. If you could wake up and they threw the water over you and you were a magic sponge you were ready to go and I played on and I was fine but now, when you have players that go down and they're still put back out there, one of the things I say to the CEOs of the of the codes is now you're playing for your lives and I put a thing in the paper the other day that for the footballers, you need to know the virtues of a contemporaneous note. 

If you are knocked out and a trainer or a coach or an assistant coach or anybody says to you anything along the lines of, "Don't tell anybody you're concussed, you’ll be fine just get back up quickly whatever it's fine” or “don't say to the press that you, you were gaga, you know just say you're fine and you hurt you're hip and you'll be back out there.", anybody says anything to you like that, take a contemporaneous note because it'll be valuable 15, 20 years from now if you develop brain malfunctions and stuff. 

And so we had another, we had another issue which was really profoundly shocking for me in November last year, I spoke at a, I was asked to appear at a symposium for Macquarie University, where they were doing a brain trauma episode and I didn't know anything about it and he just said "Just come and interview a couple of people as the cameras roll". So I go in, and there is this guy, there is this, people come into the room and they set the cameras up and there was a fellow, a boxer by the name of Dexter, nice bloke and a bloke I'd never met before with his wife and his name was Michael Lipson and I looked it up and he'd played 11, I think 11 times for England, an Australian born man played on the flank for England 11 times but had also played 2 or 300 games of professional rugby with his wife, nice woman by the name of Francis who I couldn't help but notice had haunted eyes. 

I thought "What's going on here? Why is she looking, you know, sort of upset? Haunted? Anyway, the cameras roll and the story comes out of Michael the 40 year old, 41 year old now but they'd gone, he'd had mood swings, he couldn't remember things, he couldn't, he was, erratic behaviour and particular explosions of temper out of the blue and she said "So we got him tested", and the cameras are rolling and we got him tested and the answer came back mild dementia, and she said, and he was 40 years old. 

And so I go, I was just shocked and the cameras stopped rolling, I go home and I write to them, to both of them and said, "Look, the cameras were rolling, the Herald protocol is when you speak with the cameras rolling, we are, you know, The Herald, The Sydney Morning Herald, if I'm interviewing you Tim, and this is an interview situation and you say it into my tape recorder, I own it. 

I said "But this was not like that, this was a symposium, this was not a journalistic Herald thing so I'm telling you what you said there is explosive, I would like to put it in the Herald, but understand that if I put it in the Herald, you know this will be '40 year old international football player has mild dementia through too many concussions' understand what you're doing", she said, "Let us both think about it.", came back 24 hours later, said "Well this is our experience, this is what happened, put it in the paper.", and they did put it in the paper and the world did go crazy and then Michael who's a nice fellow by the way and she's a wonderful support to him, but I think they're part of a class action. From memory I think it's 110 rugby union players in England taking the English Football Union to court, and the basic theme is, you bastards knew and you put us out there. And this this kind of legal approach is what does actually change the culture.

Tim Gavel: Yes Michael Lippman I think you wrote in your story – 

Peter Fitzsimons: That's it. Did I say Lipson? Lippman Yeah.

Tim Gavel: Yeah was knocked out 30 times, you also, you also said that it was very much the tip of the iceberg, didn't you?

Peter Fitzsimons: Well if you've got a 40 year old that's going down with that and then I went back, I think it was a while later because they continue to do this, Steve Roach has also talked about his problems and, and Steve Roach is now working as a football commentator but is honest enough to say he was knocked out many times in the 80's as a footballer and he's developing problems now and he's getting help. Jeff Vinik has also talked about that, and I in that same episode that I was up there doing that I went next door where the footballers, where there were a bunch of guys, former league players, union players, boxers talking about their experiences and it was again quite shocking that you had, frequently they came with their families and you had these guys that were good guys but in real trouble, in real trouble and then you had the families and it was just like it was when I was in America talking to the widows of the line-backers that we're talking about their experience and there was my friend. 

I was coached by a fellow called Barry Taylor, Tizza Taylor his name was and he was not a great footballer he was a pretty good coach, he was my Australian Under 21's coach but had played a lot of football for Manly on the flank and he was always getting into scraps, always on the bottom of the ruck, always getting knocked out and he'd done a bit of boxing I think early on, anyway to cut to the chase Tizza at the age of 57 or 58, late fifties had shocking mood swings, diagnosed with dementia, outbursts of anger, temper and his son Steven told me "I had to hold Dad down", they finally get him into an institution and he finally dies at the age of 70 or 71 and it was with the greatest respect, a blessing for all concerned because the man we knew as Tizza had left 10 years ago. 

And anyway after it happened I called his lovely widow Endet and said "Look Endet, I've been working with the Brain Bank in Boston and what they need in situations like this if there's a suspected CTE, which is the condition associated with too many concussions, which is a brain disease, they need to extract the brain within 48 hours of death and get it, get it, get it to Boston where they can analyse it", so I'm, "This is a strange phone call but I'm asking you, could we arrange to extract Tizza's brain,  get it in an ice bucket and send it to Boston?", and she said "Okay.", so they did and the analysis came back, and it gave the family closure. 

When the analysis came back it was one of the worst five brains they'd ever seen, and it was riddled with CTE and so for the family it gave, I'm not quite comfortable using words like closure because it can descend into psychobabble but it gave them an understanding of the experience they had been through as a family, why their devoted husband and father of the family had behaved in this manner, it wasn't him it was the suffering from too many concussions. And people say "Well do you say football should be shut down?", absolutely not but, concussion protocols have to be observed, all kids have to be raised on the mantra of, if in doubt, sit it out, and the professional football codes have to get serious about observing the protocols.

Tim Gavel: Just as a final question, given that you, as you've pointed out suffered head knock, quite a bad one given that you were knocked out, are you worried about your future?

Peter Fitzsimons: Of course, of course. But what I say to my doctor and I've shared my concerns with my doctor and what he says and gives me some encouragement, a lot of encouragement, I'm on a flight to London, back in the days before the plague descended I would fly to Europe fairly regularly and on a 23 hour flight I like to work for about 16 or 17 hours because I find in doing the books that I do the time in the air is just fantastic because I've got no interruptions and I can just work and what he says to me is, "If you can work 16, 17 hours in a time span of 24 hours”, and I don't do that often but only on flights, but he says “if you're capable of that level of sustained concentration, you will be fine.”, and I take that as encouragement. It still worries me, my wife, something else that I guess helps me, on occasion, I do occasionally lose my train of thought but it also happens to my wife and she didn't play a lot of football at all.

Tim Gavel: Okay yes lovely woman Lisa. Thanks very much for joining us Peter it's been a great insight. Thanks very much for your time.

Peter Fitzsimons: Thanks Tim.

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Podcast Transition: You're listening to On Side, the official podcast of Sport Integrity Australia.

Tim Gavel: Associate Professor at Latrobe University Dr. Alan Pierce is the Research Manager of Sports Brain Bank Victoria and Dr. Pearce has been involved in extensive research into the issue of concussion. Well Alan at last sports seemed to be taking it seriously but it's taken a while and there is still a fair bit of confusion about exactly what constitutes concussion and whether or not it does lead to some degenerative disease when it comes to mental health. Are we still in the dark to a certain degree about this, or do you think that we're heading in the right direction?

Alan Pearce: Well I certainly think that we're heading in the right direction. The emerging evidence worldwide is very clear that there are links between repeated head trauma and that's either with repeated concussions or what we call sub-concussions where the brain receives impacts but you don't see the obvious signs of concussion per say and what we do see from the international researcher is that there are links now to a range of diseases and cognitive impairments. So some of the diseases include Parkinson's disease, Motor Neurone disease and obviously the most world discussed is chronic traumatic encephalopathy.

Tim Gavel: Do think sports are taking it seriously?

Alan Pearce: Well I guess you can say that they are now. [LAUGHTER] They weren't up until probably about five years ago and certainly in the last 18 months when we announced Polly Farmer and then more recently, Danny Frawley and Shane Tuck's CTE diagnosis that the sports are really now starting to take the issue much, much more seriously and you can see that with their policy changes and their management changes of concussion. But there's still this, and I don't understand really myself, you know some hesitancy on whether you know the long-term outcomes as you asked previously, you know the research we see is so clear but there's still some hesitancy to accept the science.

Tim Gavel: The protocols that sports adopt, there is no uniform protocol and that possibly is part of the issue here in that sports really aren't doing enough in terms of protocols to, to ensure that the issue is sort of, to a certain degree, managed properly.

Alan Pearce: Yeah that's a really interesting point you make. I mean the Concussion in Sport Group have a fair amount of a consensus on what needs to be done but the sports seem to add their own flavour to it and so you do see some disparity between the different sports on what they do and what they don't do. But for me part of it is the fact that we need to have more objective markers that can actually tell or give the doctor's confidence on what they're seeing from their clinical judgement, and I think once we start to include more objective biomarkers and that could be blood, saliva, brain stimulation which is what I do in my research, I think we might hopefully find more uniform approaches to return to play guidelines in particular.

Tim Gavel: Part of issue too is that players often lie because they want to stay on the field they don't want to let their teammates down so they tend to say "No I'm fine. It wasn't a head knock.", is that part of the issue here?

Alan Pearce: Oh very much. It's that cultural, their eyesight, dare I say hyper masculine response to the invisible injury and so, unlike a knee injury or an achilles, ruptured achilles where it's so obvious that the athlete is injured, with concussion it's a brain injury that is hidden inside the skull so what we're limited to at the moment is symptom reporting or symptom observation and so athletes who have been I guess, trained for many decades, you know if you take it from, from junior's right through to professional levels to not show weakness to not show pain so for them to say "Actually I think I might be concussed 'cause I'm feeling a little bit dizzy", almost goes against what they've been trained psychologically to aim for at the elite level. So what we need to do is not only educate athletes but we actually have to change the culture around this injury, and have a almost a, some of my colleagues in the UK call it a 'psychological safe space' in order for athletes to be able to speak up with confidence, that they're not going to be deselected later on or they're not going to be seen as weak or letting their teammates down. And also having their teammates actually say "Look, my teammate looks concussed I think you need to go and check him or her out", and that is OK as well because the long-term ramifications you can be so devastating.

Tim Gavel: Is there an integrity issue at stake here in terms of sports and safeguarding and the protection of their athletes? Do you think that that is worth having a look at as well? The integrity aspect of this?

Alan Pearce: Without a doubt. Absolutely. I mean, you know we have to and the retired players that come into my lab do say that I feel like just nothing more than a commodity, and it's sort of almost devaluing them as human beings and being more just products for, for a sport and so I think there is certainly an integrity issue here because we have to look after the key component of these professional sports and they're not, they're just not entertaining playthings. And so I think it's very important that we need to take that aspect of the issue as well.

Tim Gavel: Because in America for instance we have seen NFL players have class actions legally and suing the NFL for damage done to their brains through repeated concussions and it would seem the bottom line is really driving a lot of this at the moment.

Alan Pearce: Yes, yes absolutely and that wouldn't have been done without the actual science showing that there was these players having CTE post-mortem and I think that was the game changer because up till then it was still very much "Well you know, we don't know if the players are just, you know, have got some other issues being alcohol or drug related", and "We can't tease out these other issues", but certainly the pathology doesn't lie and so I think that's changed a lot of the conversation around what is happening to our athletes that make, make our sports so exciting.

Tim Gavel: Alan you're the Victorian Manager of the Australian Sports Brain Bank, can you tell us about that? And I understand a number of former sportspeople have actually told you "Listen, we'd like to donate our brains to the Brain Bank. Can you tell us a bit about the Brain Bank?

Alan Pearce: Yeah so the Australian Sports Brain Bank started in mid-2018 by Associate Professor Michael Buckland at the Royal Prince Alfred Hospital in the Mind and Brain Centre and he's a, he's a neuropathologist and I guess from him setting up the Brain Bank, it was, I guess for me it was, it was the next step because I've been, I have been doing concussion research for nearly 12 years now but showing physiological changes isn't quite enough and having the pathology supporting the physiology has been a real help for me. And so what this has done now is alluded a lot of athletes who have thought and their families have thought "Maybe something's not quite right, we need to think about this more seriously", and so being the Victorian Manager I sort of liaise with a lot of the Australian football players, Michael being up in Sydney obviously he gets the rugby league and the rugby union players enquiries but having a Melbourne Sydney collaboration certainly allows us to cut across all the codes that are affected by this.

Tim Gavel: Alright so a couple of recommendations I noticed that you've made and other people in this space have made, a limit on full contact training, possibly 14 days sometimes 30 days before players are allowed back on the field. How successful do you think you're going to be in getting these guidelines implemented?

Alan Pearce: Well, we never thought that we'd get 12 day stand down with the AFL until this year so it's all about small steps and it's all about changing the attitude in the wider community to concussion and sub concussions, taking the injury more seriously and so we still keep calling for changes because we know that the long-term welfare will pay off in the end. The, one of the things that we do want to see is modifications to the sport particularly with junior players because we know that exposure to repeated trauma is a risk factor for CTE and so we don't want to stop, we don't want to stop the sports, I guess that's, that's one of the things that is misconstrued about what we're calling for. All we're asking for, just like tennis, they have modified equipment to protect the shoulders of kids, baseball have a what they call a pitch count so again they protect the kid's shoulders and I think even with cricket, you know Osgood Schlatter's with the knee injury, there are, there are limitations here so why not for brain health as well? Why can't we get kids to be able to learn how to play the sport, enjoy the sport but just not have to experience trauma to the head until at least 12 years of age, if not 14.

Tim Gavel: Just on that topic? One question that constantly gets asked is "Does headgear provide adequate protection?", what's your view on that?

Alan Pearce: [LAUGHTER] Yeah if I could get a buck for every one of those questions, I'd probably self-fund my research now. It is, it is the, one of the biggest myths in concussion that helmets will protect the brain from being concussed and the reason for that is because the brain sits in a sack of fluid called the cerebrospinal fluid but also the brain itself is very delicate tissue, it's not, it's not fixed like you see in biology classes when you dissect a lamb's brain, it's, It's very soft so even when you're wearing a helmet and you get an impact the force is still transmitted through to the brain tissue. So while a helmet can protect the skull bone from fracturing or lacerations, you know and I ride a bike I wear a helmet knowing that it's protecting my skull but I do know that it's not going to protect me from concussion because the brain tissue still moves and if that moves violently enough from an impact, that's where you start to see the disruption in the brain cells working and therefore you see the science and symptoms of concussion.

Tim Gavel: Yeah so very much it's on the outside protective headgear, on the inside things get shaken up that leads to concussion. So you watch players on the football field for instance wearing headgear really offers just the outside protection rather than the protection inside.

Alan Pearce: That's correct, absolutely.

Tim Gavel: Just as a final question, do you feel as though it is moving at a rapid pace at the moment and people are sort of still trying to catch up? You mentioned there a moment ago, Polly Farmer, Shane Tuck, Danny Frawley, we're seeing cases now that coming into the news, is it happening fast enough for your liking this, I guess evidence coming out and people responding to change?

Alan Pearce: Yes but I still think that science is lagging. You know science takes time to be able to actually analyse and interpret the evidence whereas I think the wider discussion driven by the media is outpacing that. So one of the concerns I do have is that there is a level of anxiety with parents and people generally in the community that we shouldn't be playing these sports at all and I think that's not what we're about, we're about trying to make the sports safer. But certainly I agree with you that we're now seeing a tipping point in the discussion about this injury and it's not something that can be just hidden away or devalued or humourized as getting your "bell rung" and so people are now taking it more seriously. We just need to get more independently funded research to really fully understand what is the rate of CTE in football. We don't know those questions yet. What are the differences between male and female concussions? What are the differences in or the effects of rugby and Australian football on kids brains? Because most of our data is coming from America right now so there's plenty of questions that we still have to answer.

Tim Gavel: Alright Alan, thanks very much for joining us today. Fascinating discussion and it is one that really is captivating and also, I guess to a certain degree providing a bit of a sobering context to sport at the moment as we progress forward. Thanks very much for your time.

Alan Pearce: No problems. Thanks for having me.

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Tim Gavel: It's not just contact sports that are impacted by concussion. Michael Milton is Australia's most successful Winter Paralympian, winning six gold medals, three silver and two bronze medals. He competed in events such as the Giant Slalom, the Downhill, the Super-G and Michael also holds the record for the Australian Downhill Speed Skiing record with a speed of 213 kilometres an hour and he joins us on the program now. Michael, obviously you have a look at some of the events that you're involved in, you'd think that concussion and head knocks would be a fact of life there.

Michael Milton: You know, you're always gonna have crashes as an athlete when you're pushing your limits, when you're trying new things you're going to make mistakes and you're gonna crash and that's a fact of life. And I guess you know the way you crash from kind of a whiplash-y type effect if you might spin backwards in the air and land on your bum and then kind of have your head hitting the ground, there's always going to be those sort of things in a sport like skiing.

Tim Gavel: What about you? Have you been impacted by yourself?

Michael Milton: I've certainly had plenty of I guess what I would call a head knock throughout my career, you know a couple of times been, loss of consciousness and stuff. I've never been diagnosed with concussion and never kind of seen some of those classic symptoms that you get from concussion, that kind of you know, the nausea, the vomiting, some of those sort of things and probably when I did get a head knock even when I was knocked out and stuff, it was probably, you know, go sit in a restaurant for an hour and see how you feel and if you think you're up for training then go back out and do it.

Tim Gavel: Is it fair to say that if you're doing it in the current day and you suffered what you call back then head knocks, it would be diagnosed as concussion because you did lose consciousness and that seems to be sort of part of the criteria these days?

Michael Milton: Yeah certainly there's that sort of evaluation. I guess you know the other, the other side of things, in sport during my time there was probably a bit less medical support so if you're overseas with a team, you might not have access to a team doctor and that means using local doctors and making appointments and those sorts of things so I would think that most times these days there would be a medical assessment pretty much straight away and a little bit of time off the hill, you know complete rest, etcetera, etcetera so I think the way that would be managed now would be quite different.

Tim Gavel: Have you been reading up on all these cases that are happening at the moment people are coming out and saying "Listen, later in life it has impacted quite severely on me.", "I'm getting depression.", "Having mental health issues", do you have a look at that and sort of take notice of what's happening in terms of some of the research that is coming out?

Michael Milton: Yeah I guess I've done a little bit of concussion type training while working as a coach with the Australian Winter Paralympic team and I guess certainly when these sort of things come up in the media, you hear about different stories my ears prick up and I listen and I go you know, I'm definitely not a high risk for these sort of things but it's certainly a concern going forwards that there was just, you know, just so many. I mean you know, when I start to think about skiing over 6000 days of my life, probably averaging a crash at least once a day, you know you start adding up and thinking there's probably pretty high numbers of multiple impacts that potentially could have an issue in the future.

Tim Gavel: Did you wear a helmet all the time? Even at training?

Michael Milton: Certainly, probably early in my career helmets were a bit more optional and throughout my career a helmet kind of became and everyday piece of equipment that was automatically there. But again even, even things, you know I remember having the same helmet for nearly five years and those sort of, the protocol for helmet replacement post impact etcetera would be quite different now.

Tim Gavel: When you were skiing and I mentioned just a moment ago the world skiing, the Australian skiing - sorry. I mentioned just a moment ago the Australian skiing record with the speed of 213 kilometres an hour as well as the Downhill, the Super-G, et cetera, did you have in the back of your mind "I hope I don't get a head knock here"? Was that a factor? Because I'd imagine there would be a certain amount of fear but was there a factor that "Gee I hope I don't knock myself out here"?

Michael Milton: You know I think when you when you're doing a sport like skiing, when you are, you know, speeds commonly well over 100 kilometres an hour in a downhill including turns, jumps, bumps, et cetera you know, you're probably a bit more specifically thinking about an injury, a crash than a specific head impact. And so yeah those things are always on your mind and it's a big part of sport being able to have, I guess that kind of mental ability to go "Hey what I'm doing is risky, I could hurt myself, I could even kill myself but it's something that I'm highly motivated to do and if I'm going to do it to this level I need to be able to push those kind of thoughts to the back of my mind and be able to push our art and take risks and kind of almost ignore those risks in some ways".

Tim Gavel: At a later stage in your life now do you still take those risks?

Michael Milton: [LAUGHTER] Later stage in life? You know, I'm not quite 50 yet but yeah certainly, you know I have a personality profile that is a bit of a risk taker and I think as you get older some of that gets mitigated but at the same time I'm the same person and you know, I enjoy going out and doing things. You know, certainly yeah I have that personality. Definitely.

Tim Gavel: Are you concerned about the impact that some of those head knocks you mentioned there just a huge number of crashes that you've had over the years, are you worried about the future at all?

Michael Milton: You know when you when you do a sport like skiing, you know, you kind of, particularly when you're young, very passionate about what you do and highly motivated you don't think so much about long term impacts. As you get older I think it's very natural for those thoughts to come in so you know, I've had cancer twice I probably worry a bit more about in terms of my long term health those sort of things more than any impacts that might be from multiple head knocks and impacts and potential concussion. So yeah, yeah I worry about my health and future, you know I see my parents going through health issues and go, you know "I don't want to get old", and the risk profile for me might be slightly higher but you know that's another thing is an athlete that you get taught you don't worry about the things you can't control, you worry about things you can control and I can't control what I've done in the past.

Tim Gavel: Just having a look at I guess a lot of the publicity these days seems to be around head knocks in contact sports such as football, not too much about what happens with other sports, such as Roller Derby or Downhill Skiing. Do you think there should be more focus on some of those other sports?

Michael Milton: I think in the public eye in the media that might be the case. Obviously, a sport, football codes in terms of public interest and stuff is massive, and some of the other sports are less so. It's my belief that within the sporting community itself that training of coaches, medical staff, athletes themselves is probably a little bit more relevant to that than the public interest. So you know I think certainly the way things are managed have changed over the years, and you know I think it's probably more important for those people involved in the sport to have education and an understanding.

Tim Gavel: Well spoken Michael. Thanks very much for joining us on On Side today and all the best, sounds like you're not slowing down. Thanks very much for joining us on On Side.

Michael Milton: Thank you Tim.
 

[MUSIC PLAYS]

Podcast Transition: Time now for our segment From Left Field, where we answer a question from the public.

Hayley Baker: Hey everyone, my name's Hayley I'm an Australian swimmer. My question From Left of Field today is "Do repeat offenders face tougher sanctions?"

This is determined on a case-by-case basis, however, sanctions can range from a reprimand all the way through to a lifetime ban and historically repeat offenders have received tougher sanctions.

SIGN OFF

Tim Gavel: Thanks for listening to On Side, I'm Tim Gavel. Thank you also to our guests Peter FitzSimons, Dr Alan Pearce and Michael Milton. We'll continue to cover issues that relate to integrity in sport.