Yesterday’s harrowing Four Corners episode exposed the devastating impacts of degenerative brain disease chronic traumatic encephalopathy (CTE) and the link with contact sports, primarily Australian rules football.
The report, and similar recent media coverage, suggests the crisis of long-term brain damage in Australian rules footballers may be deepening.
These reports tell of an increasing number of diagnosed cases of CTE in brains donated to the Australian Sports Brain Bank. CTE can only be diagnosed after death.
They also reveal a concerning proportion of donated brains come from cases of suicide, some of whom are disturbingly young.
These young victims raise a number of questions about whether Australia’s contact sports, including the Australian Football League (AFL), are taking the most effective approach to reduce the risk of CTE.
The dangers of early exposure
A key moment in the Four Corners program is the story of Nick Lowden, a promising Victorian footballer who took his own life at 23.
He was posthumously diagnosed with Stage II CTE. There are four stages of CTE. Stage II is considered significant to brain health.
His mother said her family had never heard of CTE and were not aware of the potential long-term neurological effects of repetitive head impacts.
Unlike other brain diseases such as Alzheimer’s, which mostly occur in older people, CTE has been found in athletes as young as 20 in Australia (with Lowden being the second youngest at 23).
In the United States and United Kingdom, where sports such as American football, soccer, rugby and ice hockey are popular, it has been found in junior athletes as young as 17 and 15 respectively.
The ages at which these cases are presenting indicate early exposure to repetitive brain trauma is a risk factor for developing CTE.
Should we have seen this coming?
There is a popular perception CTE is a new disease. But its first published case was in American footballer Mike Webster in 2002. History also tells us concerns about repetitive head impacts and concussions have been discussed in the international medical literature since at least 1928. Australian physicians were discussing it as early as 1936.
The huge spike in public concerns about sporting brain trauma in the early 2000s tends to obscure the decades of scientific research that came before it.
It is reasonable to ask whether Australian football authorities were aware of this previous research and, if they were, did they respond to it appropriately?
These questions have been tested in international class actions and will soon be tested in the Victorian Supreme Court in a class action brought by former professional and amateur football players against the AFL.
AFL executive Laura Kane, who oversees player health and concussion, told the ABC:
The safety of our players playing our game all the way from grassroots to our elite competition is our number one priority.
But she added:
Our job is not to communicate every single aspect of risk that exists in our game. Our job is to govern our sport […] and it’s a responsibility shared by everyone who works in contact sport.
Are contact sports unsafe?
The AFL and other leagues have tried to minimise concussion risks by changing rules to reduce dangerous tackling and high contact, as well as mandating compulsory rest time after a player is concussed.
However, these are primarily aimed at mitigating the effects of concussion – they do not address CTE directly.
The latest research tells us CTE risk is attributed not to concussions per se, but rather the thousands of undetectable sub-concussive impacts experienced in normal play. These include bumping, tackling and incidental collisions during training and competition.
Finding a way to reduce those sub-concussive impacts is the next frontier for contact sport in Australia.
What is the way forward?
In 2023, the Concussion and CTE Foundation released its CTE prevention protocol, which primarily advocates to make all contact sports non-contact until the age of 14. This age was chosen based on evidence it would remove potentially six to eight years of contact exposure in children.
Some sports have already introduced strategies to limit overall contact:
- World Rugby has limited full-contact training to 15 minutes per week
- the National Rugby League has introduced contact training limits
- the AFL recently announced contact training limits will be introduced next year
- in soccer, the UK’s Football Association is phasing out headers for children under 12 in both training and games, as heading is linked to concussion and CTE risk.
These changes are for all levels of sport, although the details of the AFL’s policy are yet to be released.
Do we have the will to change?
We do not argue contact sports should be banned. They provide physical, psychological and social benefits to players and the community, and Australians have the right to engage in risky activities.
However, the evidence is growing these sports can damage young brains in ways that cannot be prevented by the current focus on concussion.
If a parent of a young athlete asked us whether we would recommend their kids play contact sport, our answer would be: “not in their current form – but we would be happy to have them play a modified non-contact version such as touch rugby or AFL Nines”.
Low grade, sub-concussive impacts are part-and-parcel of football gameplay, and an accumulation of these impacts over several years may cause just as much long-term damage as diagnosable concussions.
It is time for the conversation around brain trauma in sport to acknowledge these risks and let players and parents make more informed choices.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
