Concussion call

David Walder stands with his caricature. Photo by Tahlia Sinclair.
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As concussion numbers in junior AFL increase, doctors try to find the best treatment option. Tahlia Sinclair reports.

David Walder knows all too well the risks of not taking impact to the head seriously. Playing as a senior for the Drysdale Hawks, he received a significant blow to the head and insisted he was fine. Continuing through the game, he was rushed to hospital and required emergency brain surgery – a caricature sits on the wall of his office as a reminder of the metal pins now in his skull.

As a full contact, no holding back sport, injury is not uncommon for AFL players, with many learning early that football can hurt. In 2016 over 195,000 children participated in the Australian Rules Football (AFL) Auskick program and nearly twice as many children played in junior competitions. In recent years one injury has come to the attention of players, parents and spectators.

The AFL reports that on average there is one concussion per team every three games at junior level.

Caused by the movement, or twisting of the brain within the skull, the risk of concussion has been widely publicised in recent years. Yet it is still largely under-researched, and many players have misconceptions about the protective abilities of helmets.

SEDA College graduate and ex-Greater Western Sydney Giants Academy player Robert Stewart, says helmets affect the ability of players. “The helmets change how you play, they’re really uncomfortable and do impact your game. I know some guys who have to wear helmets to play because they’ve had too many head bumps.”

In 2013, Sports Medicine Australia released a statement against the use of helmets in AFL as a preventative measure for concussion. Professor Gavin Davis said that while helmets can protect the head from laceration, they do not provide protection against concussion.

Medical student and Western Bulldogs AFLW women’s football physician, Jacob Jewson, agrees. He says he was not educated on concussion during his university degree but now understands helmets do not have a protective ability against it. “We were taught about head trauma and brain bleeds but not concussion. I didn’t even really know about it until I started working in a hospital.”

The 2017 community concussion guidelines released by the AFL for use in local and junior clubs says there is insufficient evidence to recommend the use of helmets in preventing concussion. This supports both Walder and Jewson’s claims, and goes against many players’ knowledge.

“I got knocked out and concussed all the time, I didn’t know helmets didn’t help. Coming from Albury-Wodonga, you trust whatever the club tells you. There’s not a lot of medical knowledge there so if the club says a helmet will help, you believe them,” says Stewart.

This lack of understanding concerns GPs such as Walder. He emphasises that a long recovery process should be followed for immature brains following a concussion. “Boys could be out for up to six months following a concussion,” he says.

The male brain does not reach full maturity until the age of 25, causing an argument for all individuals with concussion to be treated as juniors until this age, Walder says. “For juniors a concussion should be season ending.”

Players and coaches at a local junior AFL game. Photo by Tahlia Sinclair.

Jewson, who works with the men’s seniors at Melbourne University Football Club, says the club has a concussion test that players must pass before playing if suspected of a concussion. “It’s an immediate week off and then if they pass the test they can go from there.”

As an ex-player however, Stewart believes concussion tests are too easy to pass. “It’s name, day, date, DOB. I failed a concussion test once because I didn’t know the date, I knew it was October but I never know the date, not even today. It’s a pretty simple test, especially when it’s the day after that you feel really groggy and out of it.”

Walder’s post concussion treatment includes two weeks of bedrest to allow the brain to recover, and two half weeks of work or school before returning full time. Physical activity is off the calendar for three weeks, before light movement such as stationary cycling is allowed. A game of AFL might be months away. “They might feel physically fine, but we don’t know what’s happening in the brain,” he says.

When playing, Stewart was unaware of the seriousness of concussion, and that playing the week following a blow to the head may not be suggested. “I’m glad that my mum never found that out. We just want to play, and when you’re at the academy if you didn’t play, you weren’t going to get drafted.”

Stewart says the medical knowledge at local level football is not great and the medical staff at clubs often have no real medical knowledge. One of the medical staff at his junior club was a butcher by day.

Playing with the GWS Academy, Stewart was knocked unconscious during a game, and had just one week off. “At the academy we put our lives in those doctors’ hands. If they tell us to take two of these Panadol and one of these because it’ll make us feel better we’re going to take it. They’re supposed to be professionals, and we want to make it to the draft. It’s worrying now that maybe it was the wrong treatment, but I wouldn’t have wanted to sit out for that long.”

With concussion still being widely under-researched, and medical scanning unable to provide answers, it is hard to give a definitive answer on the absolute correct treatment. Walder, with his long-term, staggered approach to returning to full-contact sport may be seen as over cautious, and too protective of a young brain, especially by young players wanting to jump back into the game.

However, due to the lack of research into concussion and possible long-term effects, cautious treatment may be the safest form of treatment for players. Research is being undertaken in the US regarding the long term impact of concussion, and though there are still no definitive answers, early results are suggesting concussion has a long-term, negative impact on the brain.

Stewart, who had over 20 concussions during his time playing football, believes the knocks to his head may still be impacting him today. “I was never great at school, but I can’t read or write very well and I think some of the ones I had when I was younger definitely impacted on me in the long run.”

Concussion treatment is currently not monitored by the AFL, or AFL regional governing bodies. Treatment, and policies, are implemented at the discretion of individual clubs. The AFL has created guidelines and concussion testing forms for local clubs to use if they wish. Both the AFL, and Royal Children’s Hospital, suggest seeking proper medical assistance if a player is believed to have a concussion.

Concussion is still a taboo subject within the AFL community. Players do not want to miss games, and clubs do not want their best players out for weeks on end. Stewart says that missing several games for a concussion could have serious impact on the potential of players to build their professional careers. “I wouldn’t be sitting out for that long. The no school is great, but the doctors need to stop being pussies,” he says.