Underreporting puts Aussie rules football on verge of concussion crisis

Australian Rules Football, Douglas Howard, Power, Luke Ryan, Dockers
Douglas Howard of the Power tackles Luke Ryan of the Dockers during the round 13 AFL match between the Fremantle Dockers and the Port Adelaide Power at Optus Stadium on June 15, 2019 in Perth, Australia. (Photo by Paul Kane/Getty Images)

Australian rules football is the most popular sport in its country of origin, with more than 1.2 million participants throughout the country. The sport has been played for more than 150 years, and its highest level of competition is the Australian Football League, comprised of 18 teams — 10 of which are in the state of Victoria.

Black text that reads why this matters
It is possible Australian rules football could face its own concussion crisis as the league does not always report players’ head injuries.

However, a controversial aspect at all levels of the game is the lack of protective gear seen in other forms of football, such as the National Football League. The only protective measure recommended by the AFL is a mouthguard. The vast majority of players do not wear helmets. The AFL holds the position there is “no definitive scientific evidence that helmets prevent concussion or other brain injuries in Australian football,” and the league does not recommend their usage in part because they can change playing style.

A 2016 report in the Geelong Advertiser indicated 90 percent of AFL players sustained a concussion while playing, and 1 in 10 suffered the effects of repeated concussions after their career. Of 429 AFL players polled, 40 percent reported having had at least four concussions in their career, and eight percent had suffered double-digit concussions. Smaller players tend to be at a higher risk for concussion if they come into contact with a larger player — such as a ruckman, a player in the middle of the field who is often the tallest on their team. An inadvertent — or even purposeful — punch to the back of the head or a headfirst fall to the ground while backtracking can result in trauma that must be examined by medical staff.

A 2016 report in the Geelong Advertiser indicated 90 percent of AFL players sustained a concussion while playing, and 1 in 10 suffered the effects of repeated concussions after their career.

The league’s definition of a concussion is “the immediate and transient posttraumatic impairment of neural function and was typically caused by any force to the head (direct or indirect).” It is possible the league’s definition of “injury” — any ailment that causes a player to miss at least one match — can lead to the understatement of head injuries.

A study published in 2017 attempted to monitor over a 14-year span the number of concussions treated by a successful team’s medical staff and the effects seen from this injury. The researchers concluded concussion risk depended heavily on matches played and less on recurrence. Over a span of 333 matches, the research showed that of 140 concussions, players stayed conscious 88 percent of the time. Players who did not lose consciousness after a head injury returned to play in more than 80 percent of incidences. Figures also showed the chance of sustaining a traumatic head injury skyrocketed once a player crossed the 150-game threshold.

Part of the contention some head injuries go unreported is “match-play concussion injuries are diagnosed as players unable to pass the sport concussion assessment tool test within 20 minutes.” This could lead to omissions and misdiagnoses if players do not exhibit ill effects immediately. Thus, even as the league compiles and publishes injury reports from each of its teams upon each season’s conclusion, which offers a valuable springboard for research, it is not difficult to understand how the impact of concussions can be understated.

An investigation published in 2013 by researchers at the University of Sydney tracked 20 years of injury surveillance and data made publicly available by the AFL. Nearly 4,500 players were tracked between 1992 and 2012, and combined for more than 162,000 matches under their belts — with a further 91,000 in lower, state-level competitions. Aside from a spike in the mid-1990s, injury rates have stayed fairly constant around 34 and 38 injuries per AFL club each season. Injury recurrence fell substantially over two decades as advancements were made, bottoming out at a little more than three per season in 2012.

The most commonly reported malady in Australian rules football is the hamstring strain. Between 2003 and 2012, an average of six injuries per season were hamstring strains, a rate far ahead of groin strains (3.2) and ankle sprains (2.6). Concussions that caused a player to miss at least one match made up, on average, 0.5 injuries per team per season.

A study published in June 2018 showed the results of tracking different injury rates and patterns across AFL play and pointed out why muscle strains are so common in the sport: the sheer amount of running at high speeds in addition to hip and knee tension result in a relatively high number of injuries annually. Concussions, however, spiked between 2014 and 2015, from 1.6 average incidences to 4.2 per team. The game inherently creates situations where players can be tackled at any angle, and collision possibilities rise due to the number of players on the pitch at any given time.

It is possible the league’s definition of “injury” — any ailment that causes a player to miss at least one match — can lead to the understatement of head injuries.

The results are even more troublesome in the women’s game. According to the study, 33 percent of injured female players responded that concussions were their most severe injury. In male community leagues across two states, male adults were found to have sustained 63 percent of their concussions from plays deemed legal by the laws of the game.

One study published in 2014 called “The Long-Term Effects of Sports Concussion on Retired Australian Football Players: A Study Using Transcranial Magnetic Stimulation” expanded upon what can happen to players who sustain repeated concussions in AFL play.

TMS is a non-invasive procedure that utilizes magnetic waves to understand and treat patients with depression. The researchers examined 40 former elite and amateur Australian rules football players who had sustained on average three concussions over the previous two-plus decades. By observing cerebral cortex excitability and functions in addition to cognitive testing and dexterity, the researchers found “differences in motor control and intracortical inhibition in (Australian rules football) players who had sustained concussions” over their playing careers.

Long-term neurological effects on Aussie rules players remain unclear, in part due to the fact most concussions are not recognized and/or reported.” Nevertheless, researchers found “changes in functional motor outcomes and intracortical inhibition” mirrored, in part, previous research into concussed American football players. That particular form of football has had demonstrable problems with chronic traumatic encephalopathy, the degenerative brain condition found in many former players.

Such findings might warrant further research and someday could provoke change in Australian rules football, including its top league. The AFL is positioned to learn from the mistakes in other forms of football and be more vigilant and flexible in how it defines head injuries, thus improving chances to properly treat players, extend their careers and ensure post-career stability.

Jeremy Beren is a senior sports journalism major at Arizona State University

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