Community footy needs to protect non-elite footballers from concussion

According to The Australian, the AFL recorded more than 100 concussions this past season.

Nearly one million Australians play Aussies rules football (913,668 participants aged 15 or over recorded in 2019). Consequently, concerns must be raised about how many concussions could be occurring across the nation this football season. And how many of those will go undiagnosed?

Change must occur at the community level of sports to protect non-elite athletes from the potential long-term consequences of sport-related concussions.

As a result of recent media attention and growing health concern in Australia surrounding repeated concussions and concussions occurring in close time proximity, sports governing bodies appear to have grasped the importance of acting to protect professional athletes.

But with so much collision and contact sport occurring at the grassroots level, more needs to be done to increase appreciation and recognition of reporting symptoms and complying with health advice in the event of a suspected sport-related concussion in recreational athletes.

In January, the AFL set a new standard following the release of their updated 2021 AFL/AFLW Concussion Guidelines. Changes to the guidelines included the mandatory lay-off period for concussed athletes being doubled from six to 12 days.

This is helpful as according to the Concussion in Sport Group’s Consensus Statement (Berlin, 2016), most individuals recover from a concussion in ten to 14 days. Thus, the lay-off period allows for rest and the return to sport process to occur gradually, promoting better health outcomes for elite athletes.

(Photo by Michael Dodge/AFL Media/Getty Images)

Subsequently, the AFL brought their community football concussion guidelines in line with the professional AFL and AFLW rules.

While this is beneficial for all players, several factors make junior and local participants more vulnerable to the effects of concussion.

There is a lack of baseline testing at the community level when contrasted with that of professional sporting leagues and associations.

Computerised neurocognitive testing conducted in pre-season can be used as a part of concussion assessment and can help to track recovery when compared with post-injury scores.

As outlined in the Concussion in Sport Australia Position Statement:

“There is currently no serum biomarkers or genetic testing that assists in the diagnosis of concussion. Blood tests are not indicated for uncomplicated concussion. [And] medical imaging is not indicated in the diagnosis or management of uncomplicated concussion”.

Neurocognitive testing is also more detailed than the abbreviated cognitive component of the SCAT5 and more objective than scoring patient-reported symptoms, both of which are strict requirements of sideline evaluation in recreational sport.

Another inequality that exists concerning the use of modern technology in community and professional sport includes the lack of access to instant sideline video replays. This footage is a valuable tool as it can help to detect concussions by immediately showing the details of a direct blow to the head or body.

AFL Executive General Manager Steve Hocking said that since 2019 the AFL “have used the technology that is embedded in the ARC to provide another opportunity to identify potential concussive incidents that would not have otherwise been detected”.

Due to the dearth of understanding around concussion biology, diagnosis, management and return-to-play decisions are largely subjective and left up to clinical judgement on an individual basis.

A diagnosis of concussion should always be made by a medical practitioner. However, when there is no medical supervision present at a sporting venue (which can often be the case at the community level), the vital decision of whether to permanently remove an athlete from play or training because of a suspected concussion is left to uninformed trainers, parents and coaches.

This outcome has the potential to cause significant health ramifications for concussed athletes if they return to sport on the same day of injury or if their concussion is not managed properly. An example of this includes the development of acute cerebral oedema.

According to the Concussion in Sport Australia Position Statement, “acute cerebral oedema refers to rapid cerebral swelling that can occur when a second concussive injury is sustained during a ‘vulnerable’ period when the brain has not recovered from an initial insult”.

Children and adolescents make up a large portion of recreational sports participants. Growing evidence shows a slower rate of recovery from concussion in individuals aged 18 years or less.

The Concussion in Sport Group’s Consensus Statement (Berlin, 2016) states that the expected duration of symptoms in children with a sport-related concussion is up to four weeks.

As a result, it is recommended that the return to sport protocol for children be extended so that no child returns to any sort of contact activity earlier than 14 days from the complete resolution of all their symptoms. Therefore, more conservative, child-specific paradigms are needed for starter and introductory programs such as AFL Auskick, NetSetGO and Cricket Blast, as well as at junior sports associations.

(Photo by Mark Dadswell/Getty Images)

Schools are also encouraged to have a sport-related concussion policy that incorporates modifications to attendance (if required), academic accommodation and support for students recovering from a concussion.

The Concussion in Sport Group’s Consensus Statement (Berlin, 2016) states that “children and adolescents should not return to sport until they have successfully returned to school”. Thus, prioritising that children return to learning first.

As identified in the Concussion in Sport Australia Position Statement, “there is a need for clear, unequivocal and reliable information to be readily accessible to all members of the community”.

Building on general knowledge, more information is sort by sports administrators, medical practitioners, support staff, coaches, parents and athletes regarding the appropriate detection and management of a sport-related concussion, and the principles of safe return to sport.

Most importantly, sports organisations must continue to educate their athletes on the potential long-term consequences of multiple concussions, to build a greater understanding of the seriousness of concussion as a traumatic brain injury. This is especially important as there is still so much about concussion that is not yet clearly understood.

Public awareness is the only way to create cultural change, especially in hyper-masculine culture, to increase recognition and appreciation of reporting symptoms, repeat assessment and complying with medical advice. Each of these elements is necessary for improving safety and health outcomes for all participants who suffer a concussion while playing sport at the community level.