By Peter Schwab 7:00 AM Thu 07 Apr, 2011 - afl.com.au
THE LAW implemented by the AFL before round one to manage concussion has received almost unanimous support, although there are still some who will argue over the degree of uncertainty or some apparent inconsistency of application.
But on the evidence so far it seems the rule is working well.
Richmond’s Jack Riewoldt clearly wanted to return to the field of play last Friday night, but Richmond medical and coaching staff got it right and kept him off, despite the player's protestations.
Maybe Riewoldt’s concussion played a large part in his overreaction when it was finally decided his night was over, but after the match Damien Hardwick was quick to support his star forward’s passion.
So too, Riewoldt himself, who tweeted that he had had a sleepless night, and that he fully understood and supported the medical staff’s decision.
The interest this week will be in whether, in the opinion of that same medical staff, Riewoldt has passed all of the required testing protocol to play against Hawthorn.
Time will tell, but be assured whatever the medical staff decide it will be the right answer for the player, the club and the game.
AFL club doctors, more than anyone else, have the qualifications and experience to make such decisions, and at the heart of their call is best-practice management process, where the critical element is the welfare of the player, both in the short-term and long-term.
The impact of concussion has been highlighted by this new rule, but also its lifetime implications have never more evident than in the reporting of former NFL player Dave Duerson’s death in February this year. Duerson, a two-time Super Bowl champion, took his own life at the age of 50.
Depressed, he shot himself through the heart while decreeing that his brain could be preserved for clinical study on the effects of his disease chronic encephalopathy (CTE), a degenerative condition associated with dementia and depression and which Duerson was convinced had resulted from the multiple concussions he had suffered as a defensive back in his decade-long NFL career.
While an extreme example, it does highlight the complexity of concussion and its potential implications on anyone who plays a contact sport.
Closer to home, former Melbourne player Daniel Bell, who was delisted at the end of 2010, told The Age recently he was suffering brain injury as a result of what he claimed were multiple concussions from football in his junior years and again during his 66 games (2004-2009) as an AFL player.
The disturbing fact that came with Bell’s revelation, and the one that has the greatest implications and applications for community football, was the number of times he had suffered concussion in those formative years.
If multiple concussions can cause long-term brain damage then Bell may well have been suffering some form of brain injury before he played with Melbourne. There is no doubt the number and severity of his concussions while in the AFL has certainly made it much worse.
There is, in both these situations, a clear message for all footballers and in particular junior players. Do not stay on the field if a hit to the head leaves you dazed and confused. It may only be minor, but don’t take the risk.
Management of a head injury is complex enough for trained people, but it is very difficult for non-medical personnel; often at community football matches, medical professionals just aren’t available.
All players at all levels of the game who have suffered a hit to the head will need urgent medical assessment to ensure there is no underlying structural head injury.
At junior matches there is often a parent present who can take charge of their child, or demand their child be removed from the ground to allow the parent to then take control of the medical process. This process should be a fundamental of the management of junior footy, and should never be discouraged, either directly or by inference.
The following key components of managing concussion as outlined by the AFL Medical Officers Association remain the best guide for those at community football level, particularly in cases when trained medical personnel may not be available:
Make a quick diagnosis of any player with symptoms such as confusion or headache after a knock to the head
Referring the player for medical evaluation, and
Ensuring the player has received medical clearance before allowing them to return to a graded training program
The diagnosis of potential concussion can be complex for the untrained, so it is best always to err on the side of player welfare and to never take risks when it comes to any form of hit to the head.
Get the player off the field immediately for assessment, seek medical advice and follow the correct protocol before allowing the player to resume training and playing. It goes without saying that no player with concussion should ever be returned to the field of play the same day they have received the concussion - as is now, formally, the case in the AFL.
The four groups of people at community level that have the biggest duty of care in the way the game is played are administrators, coaches, players and umpires.
AFL administrators have shown by regular variations to the laws and their interpretation in recent years that contact to the head must be reduced, and coaches and players have varied their approach to the ball as a consequence, and umpires have done their part by following strict interpretations, with no leeway.
These laws have flowed through to junior levels, where even more stringent interpretations may be applied. As the Daniel Bell case well exemplifies: you can never start the duty of care too early.
The views in this article are those of the author and not necessarily those of the AFL or its clubs
Last Modified on 09/05/2011 11:56
