This weekend saw The Spine Surgery London's Mr. Peter Hamlyn once again take on the role of Chief Medical Officer for this season's NFL games at London's Wembley Stadium. For the past five years, since the NFL started to play real league games of American football here in London, he has held the position, leading a team of HCA International medics.

The role has required the development of medical protocols for a sport previously unknown to UK medics. Mr. Hamlyn's work in multiple sports at elite level led to his selection, and it is a challenge he continues to enjoy.

Photo: Kirby Lee, USA TODAY Sports

The weekend saw the medical team positioned pitch side throughout the game and responsible for the immediate care of any player injuries. Mr. Hamlyn's team numbered two neurosurgical consultants (including himself), two orthopaedic surgeons, sports physicians, trauma specialists, as well as anaesthetic consultants, paramedics, and two fully fitted ITU standard ambulances. That said, and gratefully noted, none of the London games have generated any serious injuries so far. Like in most sports, the medicine and safety have improved a great deal since Mr. Hamlyn first entered this medical arena in 1990.

The principle concern today with most "collision sports", such as rugby and NFL, is no longer the deadly or paralysing acute injuries largely of yesteryear but the physical attrition of the constant and brutal training ad competition with players ​'gyming'​ from their early teens and playing continuously over careers spanning a decade and a half or more.

The consequences of repeated head injury and concussion in regards to later dementia have been well ventilated in the sporting and media worlds. Less well known are the concerns in regards to repeated minor neck trauma. Causing a gradual deterioration in the joints of the neck, they swell, encroaching on the spinal canal and the vital nerves it contains. Known as myelopathy and radiculopathy, the condition results in numb, stiff and clumsy hands and legs; a gradual paralysis that many only manifest after the player retires. The spinal equivalent of pre-senile dementia, no one knows if this will turn out to be a ticking time bomb for the current player community or merely a sparkler of transient medical concern.

Whatever the reality of these concerns over the medical legacy of careers in these sports today, the prime role of Mr. Hamlyn and his team was to care for acute neck injuries and manage even minor head injuries with extreme caution. At Sunday's game, Mr. Hamlyn was joined by another HCA International neurosurgeon; Mr. Ian Sabin. Vastly experienced in the lethal sport of Superbike Racing, Mr. Sabin knows only too well the importance of head protection. During the game, they were embedded in the team's dugout so that they could directly observe the neurology of any injured player immediately. Technology (pioneered by the NFL) allowed them to review any passage of play in which a player may have been injured, on a dedicated screen in the same dugout.

When a player is knocked-out, you don't need to be a brain surgeon or a replay screen to tell that they have a brain injury and need to come off. The difficulty arises when the player is not rendered unconscious but is sufficiently stunned as not to function normally. Often the player may not be aware that they have been injured, or the seriousness of the brain injury they have sustained. The first sign may be poor play, disorientation mild confusion, or headache. Then the replay is vital. The neurosurgeon can ask to see all the plays any individual was involved in. Immediately, banks of observers then feed these down to the pitch-side monitor, containing all the phases of contact in which the player was involved.

Brought into the HCA International team was a colleague and friend of Mr. Hamlyn's; Simon Kemp, who heads England's Rugby Medical Team. His critical eye was utilised in observing the usefulness of this video service as a tool in the combat against this element of risk in rugby.

Hoping to join the medical team for subsequent games is England's football medic, Dr. Ian Beasley. For him too, concussion management is of principle concern, and the NFL model of concussion management is one he will be observing with great interest.

Mr. Hamlyn's message to the reader: "Whilst exercise is undoubtedly good for you, sport, and especially collision sport, does have its down side!"

​Mr. Hamlyn runs the educational programme at the Institute of Sport Exercise and Health in London. A legacy project of the London 2012 Olympic Games, it is a combined venture between University College London Hospital, the British Olympic Association, and HCA International.