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The Pies had skipped away to a 39-14 lead against the Roos just before half time. Play was on centre-wing of Etihad Stadium and the bulky, curly-haired forward, Ben Brown was on the end of a handball. Moments later the 200-cm frame had his arms pinned with the ball by Pies ruckman Brody Grundy. To stop Brown from wriggling out of the tackle, Grundy slung him to his left and Brown hit his head on the ground, unable to soften the fall with his hands as they were pinned around his waist. Brown lay on his back motionless and moments later was stretchered off the ground and treated for concussion.

Concussions continue to happen in football. In fact it’s on the rise. In 2015, games missed through concussions reached a 10-year high, according to AFL’s annual injury survey. Ever since the Boston University discovery of Chronic traumatic encephalopathy (CTE) in NFL players, where the link between contact sports and continuous head knocks can lead to long term brain damage was verified, other sports such as soccer, wrestling and hockey are finding ill effects from head contact too.

There’s no evidence to confirm that there is a direct link between playing AFL and CTE, but a study released in 2016 showed that 1-in-10 retired players suffer from the effects of concussion. Players are cutting their career short on the advice of medical specialists warning them to avoid further head knocks. Then there’s the lawsuits like the NFL’s $1 billion class action settlement for retired players diagnosed with brain trauma. All of this makes treating and diagnosing concussion, a serious business.

It’s naïve to think CTE won’t exist in AFL players. As fans, we tend to isolate these kind of matters to sports like NFL where players use their heads noticeably as battering rams. But the AFL is no different. Joel Selwood became the master of ducking the head into large bodies before the AFL shut it down. Also, concussions in AFL can happen in just about any situation: an errant elbow, a spoil, a pack marking contest, tackling, a fend off. Football is game of 360 degrees and anything at anytime that concerns arms, legs and limbs  can happen. Case in point: Toby Greene’s accidental fly-kick to the face of Luke Dahlhaus against the Bulldogs on the weekend.

And now there’s growing pressure for sports leagues like the AFL to make sure their sport is safe for players, not just at the elite level but top down all the way to juniors. We’re still in the infancy stage of learning about concussions. The problem for the AFL is that understanding concussion, how to better diagnose it (and rapidly), how to spot it and treat it isn’t straightforward. And there are no easy answers for now.  

While there is no silver bullet to all of this, the AFL has made some progress. During the pre-season the league trialed an earpiece sensor to monitor head impacts to understand the decisions behind players returning to the field after a knock to the head. Since 2000, there have been 10 rule and tribunal changes to curb striking to the head, sling tackles and charging. And they held a symposium this year that looked at the latest research and the future of treatment and diagnosis delivered by experts, doctors and scientists. With players such as Matt Maguire, Angus Brayshaw (indefinite break), Sean Dempster and Sam Blease calling time on their careers earlier than expected, the league had to make strides toward showing they are at least open to change. The wheels are turning in slow motion but at least they are turning.

There’s plenty the AFL can digest from what other sport leagues are doing in the fight against concussionother than research, which takes time and needs continual funding. The Canadian Football League, for example, uses the K-D Test, where they regularly send player information to McGill University labs so that researchers can better understand diagnosis and treatment of concussions. The NHL and NFL use league spotters who report player hits that could be a concussion candidate to league heads. The NFL has trialed eye exams that assess head trauma. But most of what seems realistic revolves around education on tackling techniques, tweaking rules for safe play and keeping up with the latest scientific protocols. These are areas the AFL needs to up their game in and the focus needs to be finding answers to accurately test for concussion and they must seek a gold standard in treatment protocol.

The problem right now for the AFL is that testing methods for concussion aren’t standardized and every code swears by their current protocols. I spoke to a North American doctor for a concussion feature I wrote for VICE, and he told me the problem with current standards is that it takes two people to correctly diagnose a concussion: the first is the doctor who needs to be up to date on the latest concussion research and the second is the player, who needs to truthfully detail the symptoms. If either of those are out of sync, it can lead to an incorrect diagnosis. What we need is a method that produces concrete evidence – like results from a blood test – so that doctors are confident in the diagnosis because if not, the consequences are disastrous. The doctor I spoke to also said, a second concussion before recovering from a first concussion can cause irreversible brain damage in some cases, and even death in exceedingly rare cases. Getting the diagnosis right the first time is critical.

Football has become cut throat. Since the early 2000s, clubs have become more professional and have explored different measures in order to get a jump on their rivals. We’ve seen flooding evolve. We’ve seen the Lions try using intravenous drips to rehydrate players. We’ve seen the Pies start training in high altitude as studies showed it had great impacts on performance. And more teams are now looking for international athletes, for any type of skill or fitness edge. But with higher expectations comes this pressure to succeed. And this trickles down to junior football. Kids want to be like their idols – work hard, play hard. When it comes to concussion or heavy knocks, players want nothing more than to address it quickly and get back on the field. And there’s probably been cases where players have ignored concussion symptoms in order to stay on the ground.

The AFL hasn’t experienced a public death from head trauma yet, not like the NFL or other sports , but Greg Williams is the closest connection to CTE we have. He publicly said his concussions have given him memory loss and mood swings and said the league is in denial about CTE’s connection to football. If there was any skepticism about Williams’ symptoms, a Vancouver lawyer who is handling a class action case on behalf of retired CFL players, confirmed their behavioural patterns: aggression, paranoia, depression, anxiety, and suicidal thoughts. She told me it’s not uncommon for those affected to draw the curtains closed in the middle of the day because they fear they’re being watched. “The answer seems to be that some people are affected by one hit as badly as others are affected by 50,” she said. Williams won’t be the first or last footballer to admit to CTE-like symptoms from that era. It’s only a matter of time before more step forward as the science and education around it evolves and retired players become more aware of their symptoms.

The only sure thing about the future of treating and diagnosing concussion is that there is no sure thing. Its future is muddy at best. Doctors around the world are in labs, feverishly trying to come up with solutions to accurately pinpoint a concussion the first time round. But even then they rely on funding to get there which is not easy to come by. It feels like we’ve come a long way in the concussion dialogue but truth is, it’s taken us 20 years to reach this far, which isn’t far at all. The AFL knows a lot more about concussion than ever before, but they’re only just scratching the surface. How they navigate through the unknown will determine what the future holds for our game.