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Another new footy season is here, but in 2024 something in sport has changed. An increasing acknowledgment of the risk of concussion is helping to drive rule modifications and investment in state-of-the-art research and technology designed to limit the impact of head trauma.
Once treated with suspicion or outright contempt by some in sport, the link between head impacts and long-term brain injury has been not only established but widely recognised, as current and former players begin to understand the risks of playing the games they love.
More research is required to understand exactly how brain diseases like chronic traumatic encephalopathy (CTE) develop, but a new reality in sport has dawned.
The AFL – which employs six staff dedicated to concussion issues – is entering its fourth year of an agreement with “smart” or instrumented mouthguard manufacturer HitIQ. Every player in the AFL or AFLW has the option of wearing one of the devices, which transmit information about how much a player’s head shifts during training and games. These intermittent spikes allow medical staff and coaches to monitor the kind of movement associated with head trauma and concussion.
This year players and clubs can access the data for the first time to assess contact training load. The NRL is following suit, and has engaged HitIQ for its own trial starting this year. HitIQ’s chief commercial officer, Damien Hawes, said ideally every player would wear the equipment to provide competition-wide data, but take up – while growing – still needed champions.
“When we have player ambassadorship, captains, high performance managers, coaches and the medical staff standing up in front of the group saying, ‘this is the mouthguard, these are the benefits of it’, and it’s a one-in, all-in ethos, then we get really good compliance,” Hawes said.
World Rugby has bypassed that issue, and mandated the devices for all players at the elite level this year. Some teething issues have occurred – players in Super Rugby have already complained when the devices triggered needless head impact assessments – but the rule underscores how serious the sport is in addressing concussion risk.
In Australia, a two-year trial to reduce the tackle height in community rugby – which includes top grade and school competitions – has started this season. Contact must now be made below a ball carrier’s sternum, though high contact is still allowed in the ruck.
Rugby Australia is currently rolling out 55 face-to-face coaching sessions, presenting the changes to more than 1,600 coaches and around 600 referees. General manager of community rugby at Rugby Australia, Michael Procajlo, said there hadn’t been much backlash so far, and the game had been careful to advise there were likely to be more penalties initially as players adjust to the new rules.
“We’ve asked for patience, we’ve asked for calm, we’ve asked people to respect the positions of the match officials and their decisions in all of this as well, as we look to transition ensure we give the trial a good a good crack, because safety is the number one factor that we will always put as first in our considerations,” he said.
Concussion researcher Alan Pearce, who has spent much of the past decade working in the CTE space, said although there is some funding available for research, including a $5m a year as part of the federal government’s Medical Research Future Fund, more is required.
He is currently running a pilot human trial along with his former colleague at La Trobe University (and former NRL player) Craig Patch, following promising results in earlier literature among rats and mice who consumed omega-3 fish oil after a concussion. “We’re trying to get people to take about four times the daily dose, particularly those with what we call post-concussion syndrome,” Pearce said. The pair hope to publish a paper that could lead to funding for a full, randomised clinical trial.
In December, the Victorian coroner investigating the suicide of former Richmond player Shane Tuck – who was found to have severe CTE – made sweeping recommendations to improve player safety in the AFL, including limiting contact training.
The AFL and AFL players associations are preparing responses to the report, and the league’s concussion protocols are under review. AFLPA chief executive Paul Marsh said “the industry’s understanding of this issue is evolving and improving”, and collaboration was needed for “successfully mitigating the risks for our members”.
The league’s head of football, Laura Kane, said this month more than 30 changes have been made to the game’s rules recently to make the game safer, and AFLW premiers Brisbane were fined for a concussion protocol breach in last year’s grand final, even though the player in question did not suffer a concussion.
Melbourne player Angus Brayshaw retired last week due to concerns for his brain, saying concussion was a “massive issue”. Wally Lewis, known as “the King” in rugby league, has declared he has “probable” CTE, and was lobbying Parliament this week for more funding for CTE education and support.
The Australian Sports Commission released concussion guidelines this month covering elite sport for the first time, partly in response to a high-profile Parliamentary inquiry last year.
Pearce believes sport has entered a new era. “There are a lot more people doing research in this area, there are a lot more advocates, and a lot more players are starting to make stronger comments about player safety than ever before,” he said.
University of Otago’s associate professor in biomechanics, Melanie Bussey – whose work has used smart mouthguards to identify the moments in rugby union which tend to lead to the most violent head movements, informing recent World Rugby rule changes – said there were times in the past decade where sporting organisations sought information but were scared about where it might lead. But she now believes those attitudes are becoming outdated.
“Nobody’s saying there’s not some risk associated with head impacts, everyone understands that there’s a risk, which is why we’re all doing this work,” she said. “But I think we all want the same thing: In the end, I think we all want players to be safer when playing sport.”
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