Justin Clarke and Concussion in the AFL

The recent decision by Justin Clarke to make an early retirement from the AFL at the age of 22 is an increasingly common story in professional contact sport. After being kneed in the head in a marking contest at training, Clarke was told by three separate medical experts that he should never play any form of contact sport ever again. Clarke not only joins fellow Brisbane Lions clubmen Jonathan Brown and Matt McGuire in retiring due to the effects of concussion but, in a league wide trend, others like Brent Reilly, Sam Blease and Leigh Adams.

 

Clarke, who played 56 games for the Lions, has an unusual academic aptitude compared to most footballers. Earning a score of 99.95 in his year 12 studies, Clarke has a pilot’s license and is studying aeronautical engineering and hopes to complete a PhD in supersonic research.

 

My personal interest in the concussion issue stems from my own early withdrawal from Australian Rules Football (ARF) at the age of 15. After 3 concussions in 5 games resulting in persistent nausea and dizziness it was a simple decision to quit the game.

 

This choice was made all the easier by the fact that it wasn’t a great individual or sporting tragedy for an invertebrate and thoroughly malnourished half-back to be hanging up the boots. My biggest claim to fame had been in Grade 6. Being told to tag an opposing man-child midfielder, I chased him around all day (2, 20 minute halves) for this brute to nonchalantly bag 18 goals. I resolved to commit the name, ‘Chris Judd’ to memory and didn’t have to wait long for the name to come to print. The next week I saw in The Age that he’d kicked 19 goals against Westbourne, so you know, you could say I held him.

 

Clearly however the decision to retire is a far more complicated one for a young sportsman whose dreams and talent have taken them to the top of their sport. Clarke’s story mirrors that of another young retiree, Chris Borland, formally of the NFL team the San Francisco 49ers. Borland was considered an unusually thoughtful and independent athlete, excelling in his studies and attending political demonstrations. However after receiving only a mild concussion, he retired at the age of 24. Borland had just had a breakout season and was considered one of the rising stars of the league. His decision to terminate his contract left him owing US$300,000 to his former club.

 

The key difference between Borland and Clarke is that Borland had received only a mild concussion, the kind of hit taken frequently by linebackers in the NFL. His choice was taken without personal medical advice however he had been monitoring recent developments in neuropathology.

 

These discoveries have mainly taken place over the last decade in the US and predominantly surround a brain disease called chronic traumatic encephalopathy (CTE).  It is thought that CTE could affect a very high percentage of ex-NFL players and has cast a shadow over the league. Famous ex-players have died undignified deaths. Mike Webster, a Hall of Famer and former Pittsburgh Steelers center died at age 50 from the cumulative effects of CTE. Estranged from his family due to fits of rage and pits of depression, he was found dead in his trailer. He had been self-medicating daily with a Taser gun and sticking his teeth back in with super glue. Webster’s brain was the first to be studied in 2002 (he was thought to have taken about 70,000 hits in his career) and after years of obfuscation from the NFL, in April 2015 a settlement of $1 billion was reached from a class action brought by a group of 4500 former players.

 

Previously in compensation claims made by former AFL footballers, it has been the club who has been deemed responsible for the management of injuries during the players career not the governing body. In 2011 it was revealed that two players who had quit the game due to complications from head injuries, Dean Kemp and Chad Rintoul had received six-figure payouts from their respective clubs.

 

Daniel Bell’s case was one that is now considered to have been crucial (along with the concurrent developments in the NFL) in changing the AFL’s attitude and policies towards concussion related injury claims. After being diagnosed with concussion between 8 and 10 times during his 66-game career for Melbourne, Bell was informed by a neuropsychologist that he had brain damage as a result. As the AFL rules of the time dictated, the only avenue for compensation was to submit a claim to his former club. As Bell was still a passionate supporter of the financially struggling club, he understandably felt conflicted. This situation led Bell to go public with his medical problems, the resultant response putting pressure on the AFL to smooth over the avenues to compensation.

 

More recently the AFL have tried to learn, as they so often do, from the experience of the NFL and attempt to implement not only preventative measures in the form of improved on-field rules and off-field punishments but also in compensation for concussion affected retirees.

 

In Justin Clarke’s case, he was able to prove that a specific event led to his career ending concussion symptoms and therefore is entitled to $600,000 from the AFL, 200% of his final year contract. Others who have retired from concussion symptoms but aren’t able to point to a specific event run into barriers. One example is Sam Blease who played 34 games for Melbourne and Geelong. He retired at the end of 2015 due to symptoms of depression, memory loss and migraines. Blease had received a series of hits in the AFL and VFL and his symptoms were getting increasingly worse.

 

The AFL and its insurer will not compensate a player in this situation even though the weight of scientific discovery in the last decade, in particular in the studies on CTE, show that the disease is caused by cumulative, sub-concussive (blows which don’t knock the player out but result in some immediate loss of motor skills, some bruising to the brain and a build-up of scar tissue).

 

American neuropathologist Ann Mckee studied the brain of an ex-NFL player named Lew Carpenter who had never experienced a full concussion (or been ‘knocked out’) in his ten year playing career. When he died at 78 with a strong recent history of depression, anger and withdrawal, the post mortem found that he had a severe case of CTE.

 

In ARF, think of the thousands of tackles, hip and shoulders and falls to the ground, these jarring movements shaking the brain in the skull. Some players in time may only exhibit very limited, barely noticeable damage to their brain, but others will develop CTE. In a recent study of retired footballers aged 40-55 at Deakin University who had played for at least 10 years, every player studied had some form of brain damage.

 

One study found that a higher percentage of retired ARF players had diminished motor controls and cognitive function when compared to retired NFL players. This is said to be the result of more frequent hits to the back of the unprotected head in ARF.

 

In terms of compensating a player like Blease the problem is that the symptoms of CTE and other forms of brain damage are common in many other disorders and currently (although there have been significant developments in the last few years) the only way of definitively diagnosing CTE is in post-mortem dissection of the brain. This makes it very difficult for a player to prove that their injuries are a direct result of on-field head trauma. This is mainly because a player will receive many small concussions during a career and these will most likely not be reported. There is also no absolute definition of concussion as symptoms vary between sufferers. The AFL’s current policy is that a player must miss a game to be classified as having received a concussion. This has led to underreporting. One report found that ex-players experienced much higher levels of concussion in retrospect than around the time of the event. This is most likely footy culture showing through. You gotta look tough for the boys.

 

The question then may be how much responsibility does the AFL have to players who have knowingly engaged in a full contact sport? The AFL has to this point tried to reach a compromise between maintaining the spectacle of a high-speed contact sport with the duty of care it has to players. The league has funded a neurological study of ex-players of various ages against, quaintly, a control group of umpires. They have also modified the rules of match day play such that any incidental or low grade contact with the head while attempting a tackle results in a free kick. More serious contact to the head can result in longer suspensions for the infringing player. These rule modifications designed to reduce head injuries, including concussions, may have reduced hits to the head, but the available data suggests no change in the average of less than one player per club receiving a concussion during any one AFL season. What might explain this is not only the intrinsically dangerous nature of the game, some players looking for head high contact to draw a free kick and players staying on their feet due to the introduction of the sliding rule.

 

The league still has to be careful about how it comes across on concussion. Recent comments from neurologist Paul McCrory, enlisted to the AFL’s Concussion Working Group, seemed to trivialise the issue. Referring to ‘all the carry on and hoo-ha you get from the United States’, McCrory stated that the media reports ‘overly simplified views and explanations of what concussion is: getting shaken up, the brain hitting the inside of the skull, bruising, bleeding, micro-hemorrhaging and so forth. None of that occurs.’ Technically true or not, this tends to sound a little like the self-protective comments of the NFL 6 or 7 years ago.

 

It would seem that total player safety and a thrilling experience of ARF may be mutually exclusive. The AFL is now big business and has a fine line to walk between satisfying demands for player safety and the marketability of the game. Whether we like to admit it or not, most of us go to the football to watch other men aggressively pit their strength and courage against each other, an age old tradition going back millennia.

 

With such damning evidence available on the medically adverse effects of the game what responsibility do we, the fans, have? Are we morally justified to continue to watch a game that is without doubt doing some damage to the brains and future health of its players? This is an uncomfortable idea to consider. Footy is an outlet for so many, a diversion from other parts of our lives that we might care to forget for a few hours.

 

In a way the players are like employees in an organization where the AFL is the board and the fans are the shareholders. Shareholder responsibility is to hold the board to ethical account. If this analogy holds, it would mean the fans do have some responsibility to the players and need to voice their concerns. To be honest I for one, won’t reconsider my patronage for a second. Hypocritical or not, I just love the game too much. However I will advocate for a continued commitment to an independent program of research and education of players at every level of the potential effects of their involvement on their future health.

Comments

  1. Excellent summary Noel. I struggle with the same dilemma regarding player injuries in general. More research needs to be done and any recommendations fully supported by all clubs.

    On a lighter note surely you said, “nobody kicks 19 goals on Noel Brown.”

  2. Very thoughtful and comprehensive article. Thanks Noel. You present all the clinical, moral and practical issues. Like you I don’t know what the answer – or maybe just the right balance – is. Contact sports are inherently risky (so is much of life) and it is especially difficult to know when the damage is subtle, incremental and there are multiple contributors to damage. Genetic vulnerability as with dementia, and life style factors like alcohol or dare I say, PED’s and prescription medicines. We just need to keep asking the right questions and be prepared to adjust in line with the answers.

  3. I remember reading about this young man and I think I heard him make comment about driving to uni or like and at some point completely forgetting where he was going. A horrible thing to wake up to. I also recall thinking it was a fairly brave, but insightful decision to have made early in his footy career, yet very understandable.

    I’ve never thought about responsibility as an AFL fan but certainly, I have in regard to my own kids and their peers when playing at a junior level. I know and understand what a head injury is , so reconciling this with the benefits is always a bit awkward. Much of the studies so far seem to relate to the culmulative effect, so I take some relief in that I’ve yet to produce w ‘career footballer’ to which this would apply.

    I have wondered too…is that we are now more conscious of this injury that we notice it more often, or does the style of footy played now lend itself to a higher incidence of concussion? Would the rates of serious knocks to the head, deliberate or accidental, be much the same now as they were 30/40 years ago?

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