Head injuries have long been a common part of football, but administrators, former players and medical experts are working hard to change the rules.

By AGRON DAUTI

In all codes of football, at all levels, players face the reality of injury every time they play. Most expect to finish a game with no more than sore muscles and a bruise or two, it’s all part of playing a physical sport.

But when it comes any contact involving a player’s head, the rules are beginning to change.

Head and neck injuries have been in the headlines recently for tragic reasons. Australian Rules footballer Casey Tutungi and Newcastle Knights rugby league player Alex McKinnon both fractured two vertebrae in their neck while playing, and both are likely to be permanently paralysed.

Although initially less severe, concussion is a common injury that is causing increasing concern. While it seems less dramatic, it is having long-term effects that are becoming a major concern for athletes, particularly in the AFL. One expert described it as a looming epidemic.

Rules changes now require AFL players with concussion to leave the field and take no further part in the match. This week  Greater Western Sydney captain Callan Ward suffered a high bump in an off-the-ball incident. A diagnosis of concussion forced the young club’s most experienced player to be subbed out of the game at half-time.

While many footballers want to play on, the concern about brain injury is causing clubs to take a more cautious view.

Dual Brownlow Medallist Greg Williams says he cannot remember chunks of his career and thinks it may be the result of head injuries sustained over years of play.

Williams, nicknamed “Diesel”, was known as one of the hardest men to play football throughout the 1980s and 1990s and enjoyed a decorated career with Carlton that included two Brownlow Medals, a Norm Smith Medal and an AFL Premiership.

Williams struggles with memory problems and has admitted his memory lapses could be attributed to symptoms of dementia, triggered by his numerous head injuries.

Former Melbourne Demons player Daniel Bell was delisted in 2010 and retired from football aged 26, on medical grounds. Bell was diagnosed with brain damage after suffering more than eight concussions during his time with Melbourne.

Shaun Valentine played 36 matches in the NRL with the North Queensland Cowboys from 1999-2002 but had his career cut short due to head injuries. Valentine was delisted in 2002, aged 26, after sustaining repeated concussions, including seven severe concussions in the space of 18 months.

In 2011, Valentine became the first Australian to commit to donating his brain to the Sports Legacy Institute at Boston University to study the effects of head injuries caused by professional sport.

Sports Concussion Australasia describes concussion as a disturbance of the brain’s ability to acquire and process information. The impaired function of the brain represents damage to nerve cells (neurons).

Concussions can have long-term effects on professional athletes, including a disease known as dementia pugilistica or punch-drunk syndrome. This has long been associated with boxing, but recent research has linked the disease with footballers.

Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in athletes with a history of repeated brain trauma, which includes concussion.

Symptoms of CTE include memory loss, confusion, impaired judgment, aggression, depression, and, eventually, progressive dementia. CTE does not appear during brain scans and is diagnosed after the death of the patient.

Chris Nowinski, the co-founder and executive director the Sports Legacy Institute and co-director of Boston University's Centre for the Study of Traumatic Encephalopathy, said he was confident Australian footballers would suffer from CTE, in an interview withThe Age.

Nowinski – a former Harvard gridiron football player and professional wrestler who retired after enduring years of headaches – has also said that there is a “looming epidemic of punch-drunk footballers”.

In light of the dangers of concussion, researchers now recommend that “all contact sports should adopt and evaluate the effects of precautionary policies that require concussed players to leave the field”.

In recent years, football codes have increasingly taken note of concussions and have made strides to improve the welfare of players. The AFL is one code that has begun action to reduce the number of concussions and protect players.

Nick Rushworth, executive officer of Brain Injury Australia, says sporting organisations need to redirect their focus and should be motivated by player welfare rather than fear of litigation.

“Administrators of elite sports have had to come to the party because they’re afraid of what kind of litigation might result if a player can prove that their early onset Alzheimer’s, Parkinson’s or CTE, is down to one or more poorly managed concussions in their playing days … as a disability advocate you’d like to think it doesn’t necessarily need to come to that,”  Rushworth says.

“The fear of litigation shouldn’t be the one and only driver of sport administrators engaging in concussion education and awareness.

“It should be player health and safety welfare that should be the primary driver of all of this,” he said.

In the 2012 injury report, the AFL said it “remains strongly committed to player welfare and has introduced several law and tribunal changes in recent years to reduce the risk of head and neck injury such as a reduced tolerance of head-high contact, stricter policing of dangerous tackles, and the introduction of rules to penalise a player who makes forceful contact to another player with his head over the ball.”

Progressive rule changes provide evidence of the AFL’s commitment to tackling the issue of concussion in sport. There have been a number of changes made to rules to protect against head and neck injuries including the following:

• New definition of charging (2000)
• Emphasis on protecting player on ground from being contacted from front on (2003)
• Bumping/making forceful contact from front on/bumping player with head over the ball (2007)
• Stricter policing of dangerous tackles (2007)
• High contact classification given to incidents where head hits the ground (2009)
• Rough conduct [head-high bump] (2009, 2010 & 2011)
• New guideline under rough conduct for dangerous tackles (2010)
• Clarity on negligent and reckless dangerous tackles including sling tackles (2012)
• Concussion substitute rule (2013)

In addition, the AFL was one of the first professional sports to introduce a rule prohibiting clubs from playing a medically unfit player and sanctions of up to $50,000 apply for each individual breach within this rule.

Australian rugby has also taken note of similar initiatives to protect player welfare with the first sanctions handed down this month.

The Canterbury Bulldogs are the first club to be hit with a $20,000 fine for breaching the NRL’s new concussion laws after forward Josh Jackson was allowed to continue playing after sustaining a heavy head knock. The Bulldogs are only one of five NRL clubs this season that have been asked to explain their handling of players who exhibit symptoms of concussion.

“While fines and punishment is a good idea, what really needs to happen is that everyone involved in the game needs to be educated about head injury how fragile the brain is along with the kinds of forces that are involved in tackling, scrums and mauling,” Rushworth says.

“Education [is the key] absolutely because if you look at it, if you were a young fan or a parent of who’s a fan of the [Canterbury] Bulldogs, watching their players play on TV, and you see a player who is concussed being returned to the field in the same game, it hardly sets the best example for you, or your children playing on the weekend in their local competition,” he added.

“While I think that the elite ranks of league, union, AFL and soccer are doing a great job with their professional players, I’ve got serious doubts that [concussion management] is reaching the grassroots, the amateur and the junior ranks,” said Rushworth.

Individuals involved in all levels of sport recognise that injuries are part and parcel of participation in sport but we need to also equally recognise that further steps need to be taken to ensure the safety of athletes and prevent – rather than deal with – serious spinal and head injury.