AFL brain disease cases ‘tip of the iceberg’: US expert

The Age

By Greg Baum and Daniel Cherny

January 27, 2021

An American head trauma expert who helped to establish the Australian sportsbrain bank says the three cases of CTE uncovered in AFL players in the last year are enough to ring alarm bells in the sport.

Dr Chris Nowinski remembered initial scepticism in the US about the gravity of the CTE (chronic traumatic encephalopathy) when only a handful of cases hadcome to light.

"We had congressional hearings here in 2009 after 12 NFL cases," he said. "The reality is that 110 of our first 111 players had the disease. Concerning the AFL, it's important to recognise that it's a small sample, but if you look at the experience of similar sports around the world, this is just the tip of the iceberg."

Florida-based Dr Nowinski, a former pro wrestler, is co-founder and chief executive of Concussion Legacy Foundation. He is well aware of the CTE found in the brains of Polly Farmer, Danny Frawley and most recently Shane Tuck, but he did not presume to suggest explicit rule changes in the Australian code.

"There are universal changes that can be made," he said. "If we just talk about tweaking the rules at the pro level, we're not going to stop CTE. The risk accumulates over an athlete's entire career."

Dr Nowinski said it was not just about concussion. Bigger, stronger footballers, starting younger, training harder, playing more games and finishing later because of the money on offer had deepened the problem in all codes.

"I would say it's safer when it comes to concussion. We're acknowledging them and we're managing them appropriately," he said. "But we don't have any evidence to support the idea that changing how we treat concussions will significantly change CTE outcomes. We hope it's true, but there's no guarantees.

"If you have 30 per cent fewer concussions because of rule changes, but you still have as many hard blows to the head, you're not going to see a big difference.

"Tackling is dangerous. There's no safe way to do it. There are fair ways to do it, but there's no safe way to bring another man - or woman - to the ground and stop their momentum at the same time."

Dr Nowinski said there was no reason for children to play adult forms of any contact sport. "You just don't start hitting children in the head," he said. "When they're young, you don't play the adult, dangerous version of the game. What's the point? We're crazy to have children who are not getting paid and don't even understand what CTE means playing by the same rules as adults."

Melbourne AFLW champion Daisy Pearce said she was not deterred from encouraging her two-year-old twins, Roy and Sylvie, from playing when they are older.

"Footy has made me a healthier, happier person, and it's given me so much in a physical sense," she said. "My emotional wellbeing, social wellbeing, my mental health, I attribute footy to so much of that.

"I'm not in denial that I'm going to be exempt from it [CTE]. But I don't sit here worrying. It's something we have to consider. More time and more attention and more research on these things will give us more information. "But right here and now, whilst it's an unfortunate part of the game and it looks like it's going to become more prevalent as more cases come through, I think I trust that with every bit of new knowledge and research and information that does come through, the league and medical staff are taking it very seriously.

"We're in the best possible hands, and getting the best possible information. I have full faith that they're going to manage us to the best of their ability."

Adult recreational football - a staple in Australia - presented a different challenge, said Dr Nowinski. "That's educational, not ethical or about advocacy," he said. "If you're 30 years old and you feel like you need to tackle other people to getthrough the week - or are willing to be tackled - who are we to say you can't do that?"

Dr Nowinski said that as a rule, park footballers played fewer games at a lesser intensity than pros, were under less pressure to sacrifice themselves and did nothave a crowd to please.

"The audience should only matter when we're talking about professional sport," he said. "I'd say that if it's not professional, it really shouldn't be that dangerous."

For pros, the calculus is different. "I'm all for adults doing dangerous jobs if they choose, to support their families. But there's reasonable danger and there's stupid danger," he said.

This Pearce accepts. "Whilst you know you have to acknowledge that there is this risk, I'm prepared to take it on because of all the benefits that I get from playing footy as well," she said. "It's certainly made me a healthier and happier person to date, so I have to factor that into my decision to play as well."

For everyone, Dr Nowinski's remedies are in line with those of Dr Michael Buckland from the Australian sports brain bank: start them older, modify training, continue to search for ways to minimise heavy contact in games and play fewer games.

"Changes need to be made from the moment they step onto the field for the first time as a child all the way through to the end," he said. "I would say start later, hit less and we'll have fewer cases of CTE going forward."

Greg Baum


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