Concussion and Australian Rules Football

News of football great Graham “Polly” Farmer being posthumously diagnosed with chronic traumatic encephalopathy means we can no longer deny the long-term consequences of repetitive head knocks in sport.

CTE is a degenerative brain condition that has a long history. The first report dates back to 1928. The title of the report, PunchDrunk, became entrenched in our conversations whenever we saw a boxer staggering around after a knockout blow.

More recently, when Bennet Omalu reported his case study from an American football player in 2005, the term CTE was used. While CTE was not new, this report was groundbreaking, because it was the first time an athlete outside of boxing was seen to have this disease.

Since then, studies of deceased athletes who presented with a range of signs and symptoms — such as memory loss, impulsiveness, aggression, depression and anxiety — across not just American football but ice hockey, professional wrestling,soccer, rugby union and rugby league have been diagnosed with CTE post-mortem.

So does the finding of CTE in Australian rules football mean we stop playing contact sports? Of course not.

What this case study means is that we can no longer dismiss CTE as a disease from overseas sports. And we need to not only continue independent research, but also educate our coaches, sports trainers, parents and athletes themselves on understanding the risk of sports.

A key element of CTE is the exposure of the brain to repeated impacts. These are not just the bone-crunching concussions that cause us to hold our collective breaths when we see a player being steamrolled by an opponent. They also include the smaller incidental bumps and knocks players receive both at training and in the heat of competition.

A recent US study showed the longer the exposure to repeated hits, the greater the risk of CTE.

One analogy compares CTE to smoking. While one cigar (or cigarette) is not recommended, the risk of lung cancer increases the more an individual smokes.

However, just as not everyone who smokes cigarettes will get lung cancer, not every individual who plays contact sports will be afflicted with CTE. In fact, in our research report published yesterday, we compared Polly Farmer’s brain with another Australian rules football player who did not have CTE but whose post-mortem diagnosis indicated Alzheimer’s disease.

But at the heart of the research report is the need to understand and reduce exposure risk where possible. One avenue for contact sports to consider is reducing full contact until players have reached the age of 12.

Two days ago, the Football Association in Britain mandated that children under 12 years will not head the ball in training or competition. That, in my opinion and based on evidence, is a good decision. Contact sports in Australia should also consider modifying their play. In the same way many non-contact sports modify equipment and rules for kids to protect growing bodies, why can we not do the same for developing brains?

The research we published yesterday produces mixed feelings. As a neuroscientist, I am pleased we have been able to answer a question that has been asked of me for many years now. Providing evidence reduces the doubt and conjecture about Australian football compared with many other sports that have reported CTE.

But as someone born and raised in Perth, I was fully aware of Polly Farmer’s football prowess and his stature as one of the greats of the code. Being involved in the study that showed Polly had a degenerative disease, possibly as a result of the sport he — and we all — love, saddens me.

While this was the first case of an Australian football player suffering from CTE, it may not be the last. We must continue more independent research to understand the prevalence of CTE in Australian football, not just at elite levels but at club levels too, as well as working towards diagnosis and potential rehabilitation in living players.

The fact CTE exists across a range of sports is now a call to action to recognise and continue research. Because we understand repetitive head injury is a risk factor means we need to educate all stakeholders in these sports and be brave enough to consider modifications where appropriate.

Those who claim there is a lack of demonstrated causality, creating confusion and doubt in the community, does not help us to understand CTE. We must invest in research. We do not want our next generation of players and scientists to be asking the same questions we should be answering now.

Polly’s legacy is not just to the sport, but also to science.


This article was originally published in the Herald Sun.