Link between concussion and brain damage to ensure AFL debate rages

Class action from retirees will force the AFL to adjust its concussion management policy

The Guardian

Nicole Hayes

Mon 19 Mar 2018

Adelaide’s last chance to make consecutive AFLW grand finals took a serious hit onSunday when their co-captain Chelsea Randall received a knock to her head, and was taken from the ground. Minutes later, as Collingwood goaled to put themselves in a match-winning lead, Randall had to be held back by officials on the interchange bench, such was her determination to return to the field to rescue her team’s season. Try as she might, Randall could not return because the AFL’s concussion policy was in play – she was done for the day, and yet again, a player’s matchtime was cut short by concussion.

As the clock ticks toward round one of the men’s competition, the ongoing spectre of head injuries and concussion management looms over the AFL community, spurred on by last month’s revelations that St Kilda champion and Indigenous rights icon Nicky Winmar is reportedly suffering structural and functional brain damage. 

Manager Peter Jess. The plaintiffs currently include former Essendon and Geelong ruckman John Barnes, retired Melbourne and North Melbourne player Shaun Smith and former Brownlow medallist and four-time premiership player at Hawthorn, John Platten. Each of these players, Jess has stated, have identified a range of symptoms associated with brain damage, from dramatic mood swings and anger management through to significant memory loss.

Platten, who was concussed 36 times in his playing career, is concerned he may be experiencing early stages Alzheimer’s disease. As the suit gathers attention, more formerplayers are considering their options, a particularly problematic situation for the AFL given the growing evidence and research connecting concussion and head trauma with chronic traumatic encephalopathy (CTE).

Concussion is not just a concern for past players. The AFL injury survey last year revealed that the number of games lost to concussion has been rising. On Monday, the Western Bulldogs announced that Liam Picken will miss an indefinite period of football as he recovers from his latest concussion, the club choosing to ‘conservatively’ manage him.

In perhaps the worst individual case amongst current players, former No 1 draft pick and St Kilda forward Paddy McCartin’s 2017 season was cut short at round 12 after he suffered his sixth concussion incident since 2014.

His return during the JLT pre-season series earlier this year raises many complicated issues for the AFL, given the pending lawsuit, and questions around the AFL concussion management policy going forward.

Six players retired last year as a result of concussion-related concerns, prompting the AFLPA to broaden the criteria for player payouts for career-ending injuries to include concussion.

However, according to Jess, these players did not suffer specific “traumatic” incidents so much as an accumulation of “sub-clinical concussions” – that is, undiagnosed concussions.

Going forward, the AFL will thus need to ensure that sub-clinical concussions are also considered in its management policy.

In response to the concussion epidemic, the stated position of the AFL is to empower theMRP chief, Michael Christian, to impose penalties and charges aimed, more than ever, at protecting the head. This onus was evident in the first MRP decision of the pre-season competition, which saw Port Adelaide’s Robbie Gray suspended for one match for high contact against West Coast’s Jeremy McGovern, who was forced to leave the ground after showing signs of concussion. Christian noted McGovern’s inability to return to play as part of his judgement.

Despite the emphasis on protecting the head, however, there has been much confusion around the interpretation of these rules. The controversial MRP decision to allow Tiger Trent Cotchin to play in last year’s grand final despite the serious head injury incurred by GWS’s Dylan Shiel seemed inconsistent with this more conservative approach to head protection, particularly when you factor in the suspensions of Geelong’s Patrick Dangerfield and Collingwood’s Brodie Grundy a few weeks earlier for tackles – now deemed illegal – which left their opponents concussed.

If the AFL’s stated desire to protect the head and reduce occurrences of concussion is to be believed, the interpretation of the rules around a fair bump or tackle will need to be consistent on the field and at the MRP in season 2018. Most concede that it is almost impossible to erase head contact from footy altogether, or in any contact sport, so the emphasis going forward must also be on refining protocols for diagnosis and treatment to ensure players are given the best chance at recovery.

The AFL currently has a head injury assessment test for when players come off the field showing concussion symptoms, which puts the onus on club doctors to determine whether a player should be allowed to return to the match. Any sign of concussion currently rules out further play.

The AFL is also examining whether to extend this to include automatic exclusion from playing the following week given neuroscientists have argued that one to four weeks rest is required for head knocks, depending on their severity.

This might be best addressed with newly allocated funds that the AFLPA secured in last year’s contract negotiations. However, as Jess has argued, these are currently focused on finding a link between concussion and long-term or permanent brain injury, which, he says, has already been proven many times over. This funding could therefore instead be directed towards improving diagnostics and treatment in the context of the high-contact environment that is AFL.

With the new one-person MRP system of review under pressure to reduce head high contact and “protect the head” where possible, whatever else happens in 2018, concussion will continue to cause problems at AFL House.

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