Former players are threatening to sue the AFL for memory loss and other cognitive issues they say stem from on-field concussion. But the science in this most emotive of areas is anything but clear.

Normal text size Larger text size Very large text size Under lights in a drifting rain, a flaccid windsock flops about as 44 footballers slip, slide, trip and collide on an oval east of Adelaide. It's a Friday night game in the South Australian National Football League (SANFL), and commercial lawyer Greg Griffin is among a crowd of a few thousand swilling Coopers Ale and scarfing Vili's Pies. He proudly wears his red and white North Adelaide scarf, and cheers with provocative volume as his team takes a lead against Norwood. Unfazed to be the lone Rooster barracker in the Redlegs grandstand, he roars good-naturedly about incompetent umpires and unskilful players and generally makes his presence known. That's his shtick. He has been a wily player agent for decades, helped establish the SANFL Players Association, and until recently was the dial-a-quote chairman of A-League soccer team Adelaide United. Now, though, Griffin is angling to become a thorn in the side of the Australian Football League, this time representing ex-players – including a premiership ruckman, a Brownlow Medal-winning rover, and the man who once plucked what is commonly called "The Mark of the Century" – who are dealing with crippling memory loss, frightening mood swings and despairing cognitive issues they attribute to repeated concussions suffered throughout their careers. A lawsuit could be filed as soon as this winter, he says, which will allege that the AFL breached its duty of care by allowing players to routinely return to the field on the same day after suffering a serious hit, and almost always play again the week after such hits, leading to the devastating maladies they now endure. The case is well timed. Concussion is big news. The finer details of a class action brought against the National Football League (NFL) in the United States were settled in 2017 with a fund to compensate thousands of damaged gridiron players; it has already handed out more than $US629 million ($895 million). As more claims are lodged, the estimated payout could balloon to as much as $US1.4 billion. A similar but smaller suit, resisted at first by America's National Hockey League, was settled in November on behalf of potentially 318 players. Meanwhile, in the modern AFL news cycle, talk of concussion is ubiquitous. Roughly five dozen concussions are recorded every season, and every "ding" creates its own reverberation of commentary and dissection over the dazed victims and scrutinised perpetrators. Not only that, but the list of young players cutting their careers short after being hit in the head too hard or too often (or both) continues to mount. Griffin, in the top-floor office of his Adelaide law firm – a four-storey building with 35 staff, walls plastered with signed sports memorabilia – summarises the charged landscape, at least as he sees things. "We say that AFL is an inherently physical and dangerous sport, and that there is an acceptance by the players – to a degree – of risk," he says. "That's the starting point." But, he adds, pointing a finger, there are ways in which those who administer the game can and should ensure the game is not dangerously violent. "And up until the past handful of years, that has not been the case."


In November 2017, he began building a Federal Court action, and the stories of the plaintiffs – from their playing days in the 1990s to their lives now – were trickle-fed to media. First there was roguish Geelong and Essendon flag ruckman John Barnes, 49, now dealing with random, horrifying seizures. Then there was Hawthorn's champion rover John Platten, 55, struggling to cope with acute memory loss. Also on board came former Melbourne and North Melbourne high-flyer Shaun Smith, 49, beset by painful mood swings, anxiety and depression. Griffin claims close to 100 former footballers with similar issues have shown interest in the suit, although at this point only five have signed up. As the stories rolled out, a turbulent and litigious era seemed foretold for footy, at least according to headlines such as "Brain injury in sport: the new asbestos?" and "AFL facing a concussion Armageddon". Yet the concussion conundrum is not so simple. Experts in neuroscience, sports law, AFL administrators, club doctors, former players and union officials mostly agree that the science behind this issue is far from settled, while the medico-legal complexities remain unexplored. "There's so much we don't know – so many questions we have to answer," says neuroscientist Dr Alan Pearce, who discovered cognitive impairments in the likes of Barnes, Platten and Smith, and dozens more, almost a decade ago, and has since seen the concussion discussion see-saw wildly between secrecy and hyperbole, sensationalism and denial. "Uncertainty – it's driving this vast difference of opinion," he sighs. "I just wish we had more people talking." Geelong’s John Barnes is stretchered off in 1996. Credit:Ken Irwin It can be difficult to even define the elusive condition, but let's try. Concussion is a transient injury caused by any jolt to the head (or body) that delivers an impulsive shock to the brain, causing it to rock back and forth in the skull, or twist on its axis. It is a "neurological disturbance" rather than a structural injury, and hides itself well. It will not show up under X-ray or CT scan or MRI, or in tests of blood and saliva. In fact, concussion is only diagnosed through an examination of overt symptoms such as dizziness and confusion. These symptoms can manifest instantaneously – or hours later. They can linger for months – or disappear within minutes. That's the jumbled, evolving clinical definition. For what it looks like in practice, it's worth revisiting the Channel 7 highlights special known as Biffs, Bumps and Brawlers, hosted in 2001 by effervescent former footy caller, Rex Hunt, who gleefully introduces a hits package he says "would make a 16-stone wharfie cry". What follows is an hour of collisions from the 1960s through to the 1990s that send men to the turf, where they lie unresponsive, twitching, or groggily struggling to stand. What stands out most is the celebratory commentary. An elbow to the temple: "Bang! Got him a beauty!" A coat-hanger forearm: "Ho-ho! Fixed him up!" "You might think we've been glorifying the biff here, folks. Not at all," Hunt assures the viewer. "We're just showing you how much the game has changed." And the game has changed, in particular in the past decade, as the AFL began instituting a series of rolling improvements in both playing rules and the strictures for treating heavy hits. In 2008, the league codified the way players need to be assessed after head knocks. In 2009 and 2010, and a handful more times since, they tweaked the laws of the game, curtailing reckless high bumps and potentially dangerous tackles. Fans wrung their hands over the sanitisation of a contact sport, but then-league CEO Andrew Demetriou remained unbowed. "The head," he famously said, "is sacrosanct."


As a result, the game evolved. Now, a clumsy but unintentional hit to the head can lead to a longer suspension than a spiteful punch to the body. A tackle that pins the arms of an opponent (once technically perfect) is now illegal if the tackled player's head hits the ground. On the bench, clubs have access to the HawkEye sideline vision system, so doctors can replay any blow, from seven different camera angles, on a touch-screen tablet. This coming season, "spotters" will be employed by the AFL to scan vision as games unfold, looking for potential "concussional events". In our day, you got hit, they ran a finger in front of your eyes, and then it's 'Yep, you're right to go'. John Barnes The case that the AFL must answer, then, relates to what happened before all that, in the time of biffs, bumps and brawlers – the time of lead plaintiff John Barnes. The blond ruckman retired in 2001 after 202 games in a career that began in 1987. Sitting in his gleaming kitchen in Essendon, a few blocks from the Bombers' old training ground, Barnes recalls cutting his teeth against "absolute monsters" as a teenage stripling from country Victoria. "You continually got the shit kicked out of you. You look at the ball and bang, your nose is broken. You go into a pack and bang, it's broken back the other way. You can't see because there's blood in your eyes. Your mum asks how you're doing and you say you're fine, but you're not." Barnes copped about a dozen big hits in his career. Credit:Joe Armao Today, when a player is hit in the head during a game, the gears of league protocol whir into action. The club doctor approaches the dazed player, asks various questions – What team are you playing on? What's the score? What day is it? – and looks for red flags such as nausea or disorientation. Then the player rests before undergoing a heavily proscribed battery of tests known as the SCAT5 (Sport Concussion Assessment Tool, fifth edition), checking everything from gross motor skills to balance, memory and recall. If they're diagnosed with concussion, they're out of the match. "In our day," says Barnes, "you got hit, they ran a finger in front of your eyes, and then it's 'Yep, you're right to go'. If you asked to come off the ground, the attitude was, 'You might as well go home, weak prick.' " Rowena Barnes has been married to John for 31 years. Her mind turns to what the couple estimate were a dozen serious concussions in his career. The fallout, she believes, has been catastrophic. Beyond leaving stoves on or putting Weet-Bix in the freezer, six years ago he was diagnosed with epilepsy. Rowena recently awoke in bed as a seizure took hold, hearing him choke through convulsions. When he recovered, he remembered nothing. "He just looked around the bedroom and asked, 'Who are these people?' " Her voice breaks now. "They were his sons!" There is no hereditary explanation for Barnes's epilepsy, according to Dr Mark Cook, the neurologist who treats him. But large studies of people with traumatic brain injuries, he says, show an increased risk of epilepsy. "Even through mild brain injuries, the risk is at least doubled." Cook, a professor, is also chair of medicine at the University of Melbourne, and head of neurology at St Vincent's Hospital in East Melbourne. He says the connection between hits and seizures is self-evident. "I don't understand why that's a difficult thing to accept," Cook says, bemused. "To excuse the pun, it's a no-brainer."


There is a wealth of scientific inquiry establishing a connection between repeated head injuries and an increased risk of long-term neurodegenerative conditions – everything from motor neurone disease to Parkinson's. An American study of retired professional football players from as far back as 2005 found that three or more documented concussions correlated with a five-fold prevalence of cognitive impairment later in life. The main issue Griffin's court action hopes to address, however, is the idea that the plaintiffs were allowed (or expected) to play (and train) when they had not fully recovered – and the earliest local study into concussion offers some support for this contention. It was done by Melbourne University and was based on data gathered from 130 players at three clubs – Melbourne, Geelong and Fitzroy – between 1989 and 1992. It found that symptoms such as headache or nausea disappeared within hours or days of a hit, but decision-making and speed of processing were often impaired for weeks. "It caused quite a ruction," says professor Michael Saling, a co-author of the study, "because players usually would go back to play within minutes after an event, and some of them were noticeably disoriented on the field." And yet, it is worth considering a competing body of evidence from Dr Nathan Gibbs, head doctor for the Australian Wallabies. Gibbs compiled his own research over 12 years while club doctor for the Sydney Swans, and in 2017, published his surprising results. In the aftermath of the 140 concussions he recorded, every Swan played the following week. And their immediate performance – based on a mark out of 20 given by the coach – was unaffected. "They played well," Gibbs says. "The outcomes were good." At every turn, the debate around concussion is maddeningly muddied by findings and counter-findings, and perhaps also by the tendency of media to latch on to the chronic traumatic encephalopathy (CTE) story from America. CTE – a condition that can only be diagnosed post-mortem, and which was first found in boxers under the descriptor dementia pugilistica (also known as "punch-drunk syndrome") – is believed to develop in gridiron players as a result of the "sub-concussive impacts" that arise when gigantic men use their helmets to butt heads thousands of times throughout a career. But that incremental, insidious damage is quite different to the big, rare blows that befall AFL players. The codes are not "concussion cousins". Two of the ex-players set to feature in a suit against the AFL for being allowed to play while injured. Credit:Archives CTE might never be found in retired AFL players, but if it is, Michael Buckland will be the first to know. Buckland runs the neuropathology department of RPA Hospital, in Sydney's inner west. He examines a few brains every week for a living, mostly for the NSW State Coroner. He is also head of the Australian Sports Brain Bank, launched a year ago. A handful of high-profile sportsmen pledged their brains to the bank that day, including retired AFL player Daniel Chick, former National Rugby League (NRL) star Ian Roberts, and former Wallaby (now journalist) Peter FitzSimons. More than 50 athletes have since pledged their brains.


Only one Australian brain had, until that point, been diagnosed with CTE; that of former rugby union player Barry "Tizza" Taylor, who died in 2014 aged 77. His brain, studied in America, displayed all the hallmarks of severe CTE. The case became a cause célèbre. More such addled minds were expected to turn up, but science moves methodically, and not always in the direction you might expect. Buckland's local brain bank recently finalised its first analysis of an Australian rules footballer, a deceased West Australian Football League player. The grey matter of South Fremantle rover Ross Grlusich – who sustained multiple concussions and died of dementia in a nursing home last year, aged 76 – showed no signs of CTE. "Initially we were disappointed," admits Buckland. "But the more I thought about it the more I thought, 'This is good.' It's good that we're not just seeing CTE everywhere we look. Many people feel like if they've had a couple of concussions, they're going to get CTE. But that's not necessarily the case, and it's just as important to get that message out." Another of the ex-players set to feature in a suit against the AFL for being allowed to play while injured. Credit:Archives It's not the only piece of evidence suggesting CTE might not pose an existential threat to Aussie Rules. Hannah Blaine is a neuropsychologist working with children in Queensland, but in 2013 she was a master's student under Melbourne University's Michael Saling, when she began a 25-year follow-up with a portion of his initial sample of players. They're lawyers and politicians now, schoolteachers and farmers and pub owners, and Blaine had them pushing buttons on reaction-time machines. "They were all very keen to help out," she says. "Most were pretty on edge about what the results might show." Yet the ex-players tracked well – within normal limits. The one who performed best had reported 20 concussions throughout his career. Within certain circles, the preliminary findings were unwelcome. Saling and Blaine remember presenting them to the International Neuropsychological Society in 2015, at a Sydney hotel. The conference room was consumed by immediate anger. Outrage. A group of North American researchers mocked the work because two members of the original sample weren't re-tested. "I've never seen anything like it at a scientific meeting," says Saling. "One young scientist got up and began to scream that this was all invalid and incompetent."

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