The Concussion Crisis in Australian Rules Football
It’s a brutal game, and retired players are suffering the consequences of hits to the head. But the league there is following a familiar playbook, one used by the N.F.L.
The Melbourne Cricket Ground is considered the home of Australian Rules Football.Alana Holmberg for The New York Times
MELBOURNE, Australia — Australian rules football is one the world’s most violent sports. Thirty-six players careen across a massive field, where they are exposed to blindside hits and errant elbows, bruising shoulders and airborne knees. Their protection is a mouthpiece and sometimes a padded cap. Collisions can be cringe-inducing. Concussions are common.
So when retired players in their 30s and 40s started complaining about memory loss, struggles with paying attention and anger management, Alan Pearce tried to help. A neurophysiologist, he began to measure the former players’ brain waves to determine if their brains were functioning properly.
The players “were saying, ‘I just thought I was getting old, but I’m only 47,’” Pearce said.
The Australian Football League took note. In 2015, it gave Pearce 30,000 Australian dollars (about $20,000) to help cover the cost of more tests. But after Pearce spoke on a television program about the cognitive struggles of former players, Paul McCrory, a neurologist who was once closely aligned with the league, told him he had crossed a line. Soon after, Pearce lost his lab space, hindering his research.
A decade after retired American football players struggling with neurological problems forced the N.F.L. to confront its traumatic brain injury crisis, a narrative that will be very familiar to sports fans in the United States is playing out on the other side of the world.
Retired players from the A.F.L., which will hold its Grand Final on Saturday, are coming forward with horrific tales of cognitive deterioration in what should still be the prime of their lives. At the same time, the league in which they endured so much damage is attempting to avoid culpability by playing down any link between head hits and brain trauma even as it tries to make the game safer by changing the rules of the sport and adding concussion protocols.
More than 100 retired A.F.L. players are accusing the league of failing to protect them from the known dangers of repeated collisions and of resisting calls to pay for their health care costs.
“We have retired players now in their 50s and 60s with structural damage to their brains — exactly what has happened in the States — but we have a position of continual denial from the A.F.L.” said Peter Jess, a player agent and advocate for the players. “The A.F.L. is throwing everything at this.”
The A.F.L. declined to make its chief medical director, Peter Harcourt, or another executive available to discuss the league’s strategy for dealing with its retired players.
In a statement, the league said it was “on the public record in acknowledging that neurodegenerative disease is associated with head trauma.”
Also in the statement, Andrew Dillon, the league’s general counsel and general manager for game development, said, “The A.F.L. is committed to world-leading management of head trauma in sport.”
“At every stage,” he added, “our decisions have been guided by research, and we have had a conservative approach, putting players’ health first.”
With players contemplating litigation, Jess met informally with the A.F.L. in recent weeks, but talks stalled. Several former players feel the league is more focused on helping active players rather than retirees.
The debate over the health of retired A.F.L. players has grown louder in recent years as a growing list of younger players, citing repeated “head knocks,” have retired after just a few years in the league. Retired players, who for years were loath to criticize the league that made them famous, have also begun to speak out about their health.
“They’ve got their heads in the sand,” John Barnes, a 16-year veteran of the A.F.L. and its predecessor, the Victorian Football League, said of the A.F.L. leadership. “Until one of their sons gets knocked out and can’t remember anything, they won’t change.”
During the past decade, the A.F.L. has increased penalties for dangerous tackles and going after players on the ground. It also began discouraging players from using their heads as weapons. To some, this was the league acknowledging the game was too dangerous.
“If it wasn’t the case that head knocks were serious, then why did they change all the rules to make the game safer?” Barnes said.
A Brutal Game and Its Consequences
As a ruckman and a forward, Barnes’s job was to play in the middle of the field and jump for loose balls as bodies flew at him from every direction. Flying elbows left him bruised and battered after every game.
“You’d come off the field with a broken nose, two cuts above your eyes, your jaw would be sideways but wouldn’t be broken, and you’d have five eggs on the back of your head,” Barnes said. “If you’re scared, you can’t play footy. That’s just how it was. Dog eat dog mentality.”
The hits to the head took their toll, he said, because players felt they had to shrug off concussions to stay in the lineup. Barnes, now 50, began having seizures when he was 42. They come without warning. He will drift in and out of consciousness for about five minutes and regain his memory in 20 minutes or so. Doctors have said his epilepsy was caused by repeated hits to the head.
He must wait six months without a seizure before he can drive again, so his wife, Rowena, takes him to his job as a garbage collector in the morning and picks him up in the afternoon. She watches him shower in case he falls and hits his head. Barnes’s memory has slipped, too. He will leave the gas on after he stops cooking. He puts cereal in the refrigerator and milk in the cupboard. His medication makes him agitated.
“Life will never ever be the same for us, and we know in our hearts it has to do with the concussions he suffered playing footy,” Rowena Barnes said.
While retired players like John Barnes stew, the A.F.L. has taken steps to make the game safer. It has strengthened penalties for hits to the head. Cameras are used to spot potential concussions.
Identifying concussions is complicated, though. In Australian rules football, play is continuous for 20-minute segments or longer, unlike in American football, which has stoppages after every down.
The frequency of concussions has ticked higher in recent years as the league has become more adept at spotting them and as more players report them. Last year, there were almost 7.5 concussions per 1,000 player game hours in the A.F.L., up 11 percent from the prior year.
But Nathan Gibbs, a former team doctor who tracked concussions on the A.F.L.’s Sydney Swans for 14 years, said the real rate was about two and a half times higher than the A.F.L.’s published figures, which would make it comparable to the N.F.L.’s.
“I think there is a lot of pressure not to report concussions,” Gibbs said.
The A.F.L. said that its figures had come from 18 clubs and that one club could vary from the average. It added that club employees could be punished for the mismanagement of injuries.
Pushing Back
For a league confronting mounting complaints about safety and brain injuries, McCrory was both a surprising and fitting choice to serve as a leading medical consultant for the A.F.L.
A former team doctor now affiliated with the influential Florey Institute of Neuroscience and Mental Health in Melbourne, McCrory represents the A.F.L. at a working group of doctors from the N.F.L., World Rugby and other collision sports who share research.
McCrory has played down the dangers of repeated head hits, saying the news media have distorted the dangers of concussions and created “a sense of fear” about Australian and American football. At a lecture in 2016, he said sports like rugby and boxing were more dangerous than American football.
“For all the carry on and hoo-ha you hear from the United States, it actually has the lowest rates of concussion of any of these sports,” he said.
McCrory declined to speak with The New York Times. The A.F.L. said McCrory currently has no formal role with the league.
Pearce, the neurophysiologist, said skeptics like McCrory see a player who is holding a job and conclude that his headaches cannot be linked to concussions he may have suffered.
They “are playing the game that if there’s no evidence, it doesn’t exist,” Pearce said in an interview this year.
Biffs and Bumps
The A.F.L. celebrated on-field violence for decades. In 2001, the league’s broadcast partner produced a show called “Biffs, Bumps and Brawlers” that highlighted players knocking each other out and throwing fists. Greg Griffin, a lawyer working with the retired players, said the videos are evidence the league promoted big hits for profit.
“It was Circus Maximus, which was Nero killing the Christians,” Griffin said. Griffin credited the league with making the game safer after 50 years of allowing virtually uncontrolled hits to the head, “but they’ve done it because they realized they lost the Australian public in terms of encouraging their children to play this game.”
David Parkin, a longtime coach who estimates that he had a dozen concussions during his 10-year playing career, said players understood that they had to play through concussions and that coaches regularly put concussed players back into games.
“I was a serious offender and consistently during competition tried to pressure medical staff to get players back in the game,” he said. “That’s the absolute fact.”
Another fact is retired players have been excluded from the national workers' compensation plan since the 1970s, after a player was paralyzed in a game. Club directors realized that they were personally liable if a player sued his team. So the sports minister in Victoria successfully lobbied the state government to exclude professional athletes, including footballers, from receiving workers' compensation. Other states passed similar legislation.
Lawmakers promised to find a way to compensate former players, then didn’t follow through. Sports executives are now free from personal liability, yet injured players still cannot file claims.
If the retired A.F.L. players sue the league, they will face some of the same hurdles as N.F.L. players have. They would need to show that their former team doctors deliberately neglected their “duty of care” and that the hits they absorbed as pro players directly led to their current medical problems.
“What percent was their playing career, and how much was it postcareer,” said Jack Anderson, who teaches sports law at the University of Melbourne. “Was it play? Was it training?”
Substantiating the claims with medical records can also prove difficult. In Victoria, where most A.F.L. teams play, doctors are required to keep records for only seven years after a patient turns 25. This makes it difficult for older players to document their injuries.
“We’re reaching back 20, 30 years,” Anderson said.
While they plot a legal strategy, some former players are pledging their brains to the country’s only sports-specific brain bank so future generations can learn from their misfortune. Michael Buckland, a neuropathologist in Sydney, spent years looking at the brains of people with multiple sclerosis and other diseases before he read about chronic traumatic encephalopathy, or C.T.E., the degenerative brain disease found in athletes who played collision sports that can only be diagnosed after death.
“To me, it looked like a new pathology they were describing, so I was hoping to see if we could find it in Australia,” said Buckland, who opened the brain bank last year.
Not surprisingly, the A.F.L. has not offered to help finance Buckland’s research, but he did not expect other scientists to criticize his work by suggesting that there is no hard evidence that head injuries can lead to C.T.E.
“I don’t think I really knew what I was getting myself into,” Buckland said. “Some people are clearly unhappy about it.”
Buckland’s first diagnosis, of a 77-year-old former Australian rules football player with dementia, was negative for C.T.E. In June, he was involved in research that showed two rugby players were found with C.T.E. The diagnoses, which were done by a different department at Buckland’s hospital, shook the rugby world. A fourth diagnosis, of an ex-boxer who committed suicide, was also positive for C.T.E.
Buckland said that in the years ahead, more diagnoses are sure to come back positive.
“It’s got to be here, given the sports we play in Australia,” Buckland said.
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