Sporting codes are being urged to adopt more stringent concussion protocols with the release of landmark government guidelines calling for longer return-to-play periods and better processes for managing head injuries.
The Australian Sports Commission (ASC) released new advice on Thursday, in partnership with the UK and New Zealand governments, partly addressing recommendations from a Senate committee report last year.
The ASC’s new Concussion and Brain Health Position Statement includes a recommended return-to-play framework for elite sport for the first time and calls for professional athletes to avoid contact activities until they have been symptom-free for at least 10 days.
Professional sporting bodies have previously developed their own return-to-play protocols, but they differ in the duration of the stand-down period and the precise recovery stages.
The AFL imposes a minimum 12-day return-to-play graduated process after a concussion, but players are able to move through the first five days as long as symptoms have “not worsened” according to the code’s flow-chart – potentially leaving only seven symptom-free days.
The NRL allows players to apply for an exemption from its 11-day return-to-play policy in situations where they are symptom-free the day following the concussion and cognitive testing has returned to normal.
AIS chief medical officer, Dr David Hughes, said each sport would have to decide on timeframes for themselves.
“We think they should have 10 days [without symptoms], other people might disagree, but the truth is, that question about how long should the symptom-free buffer be … no one knows the answer to that really, and it’s a matter of judgment,” Dr Hughes said.
The ASC statement this year notes: “Mandatory stand down times need to strike a balance between being long enough to ensure recovery, but not so long that athletes are disincentivised from reporting concussion.”
A 2020 survey reported that 17% of NRL players did not report a likely concussion to medical staff during the 2018 and 2019 seasons.
The updated guidelines are not mandatory and sports can choose to adopt them or not, but they help inform best practice in an environment where sports are mindful of the risk of litigation.
The major professional codes received the statement on 8 January.
Another major change is extending the minimum stand-down period following a concussion in community sport to 21 days, including 14 days without symptoms.
That brings all grassroots sport into line with the existing return to play timelines recommended for children.
Previous guidelines for adult community sport had been less prescriptive, and did not explicitly recommend waiting 14 days without any symptoms before returning to play.
The update addresses three of the recommendations in the Senate committee’s report, including one of its most contentious: the development of return-to-play protocols that can be applied across all sports.
Although the new guidelines do not address another recommendation calling for “binding return to play protocols”, Victorian Greens senator, Janet Rice – who chaired the Senate inquiry – said they are “a huge step forward in Australian sport”.
“As we heard time and time again during the inquiry and in over 90 submissions, the dangers of concussions are clear: people’s lives have been shattered and families have lost loved ones because of the impact of chronic traumatic encephalopathy [a brain disorder linked to repeated head injuries],” Rice said.
“This new framework will provide much-needed reassurance to parents and make community sport safer.”
ASC chief executive, Kieren Perkins, said the new statement was developed partly in response to the report.
“This is a significant step in the right direction and I’d like to thank the Australian government for its continued support regarding this serious issue,” Perkins said.
“We share the community’s concern about concussion in sport, particularly among young people.”
Dr Hughes said managing all instances of concussion requires “an abundance of caution”.
“The AIS wants everyone involved in sport to remember, when considering an athlete with possible concussion, ‘if in doubt, sit them out’,” Dr Hughes said.
In addition to calling for longer return to play timelines, the advice also encourages schools and community clubs to consider appointing a “concussion officer”, similar to the role of a “fire warden”, to ensure agreed concussion protocols are followed.
The updated information also includes more resources for physiotherapists, who often diagnose concussions and manage return-to-play procedures in both community and elite sport.
Dr Corey Cunningham, president of the Australasian College of Sport and Exercise Physicians, said having a consistent framework helped understanding across sport.
“There’s been a lot of new developments and the resources include the role of physiotherapists in dealing with concussion and why some concussions take longer than others, and why concussions can be different,” Dr Cunningham said.
“We want to raise awareness that if in doubt, you’ve got to sit them out, get some medical attention, get some medical support, and then return to play safely.”
Officials, mindful of potential liability over handling of head trauma, have been responsive to developments in medical literature around concussion in recent years.
The new statement also encourages sports to adopt a holistic approach to the long-term brain health of current and former athletes.
“Sporting organisations should provide education for athletes, about how to optimise cognitive reserve and diminish their chances of poor brain health in later life,” it states.
The updated guidance from the government is currently being considered by the sporting sector.
Australia’s major sporting codes provided the following statements acknowledging the proposals, but have not endorsed the ASC’s new guidelines.
Australian Football League:
“The health and safety of players at all levels of our game continues to remain our number one priority. The AFL acknowledges the newly released position statement released by the Australian Institute of Sport and the work and input by Concussion in Sport Australia and its constituent organisations, the Australian Institute of Sport, Australasian College of Sport and Exercise Physicians, Australian Physiotherapy Association and Sports Medicine Australia. Each year we review our concussion guidelines for elite and community football and that process for 2024 is ongoing.”
Australian Rugby League Commission:
“Concussion, head trauma and the health and safety of all participants at all levels of sport is an incredibly important issue for all sports. The Australian Rugby League Commission is in the process of analysing the guidelines provided and will carefully consider how they may be applied to rugby league.”
Cricket Australia:
“Ensuring the safety of every cricketer is paramount. Accordingly, after widespread consultation, we have concussion and protective equipment guidelines that are appropriate for our sport. This includes a conservative approach to managing concussion. We acknowledge the work being done by Concussion in Australian Sport in the management of sport-related concussion and will continue to consider all relevant information to ensure our protocols remain appropriate and fit for purpose”.
Football Australia:
“Football Australia is dedicated to player safety, and while we find value in AIS’s guidelines, we believe in a tailored approach for effective concussion management in football.”
Netball Australia:
“Netball Australia takes head impacts and concussion extremely seriously. Our number one priority is to protect the health and wellbeing of all people who participate in our game. Netball Australia updated its concussion policy last year, which is constantly reviewed in line with evolving scientific evidence. Netball Australia is working through a review process of the AIS guidelines and how they could be applied to the sport.”
Rugby Australia:
“Rugby Australia has been engaged with the AIS in relation to its 2024 Concussion and Brain Health Position Statement. Concussion, head trauma and the health and safety of all participants at all levels of sport is an incredibly important issue for Rugby Australia – player safety has always been, and remains our number one priority. We welcome the extremely valuable input on this issue by Concussion in Sport Australia (and its constituent organisations, the Australian Institute of Sport, Australasian College of Sport and Exercise Physicians, Australian Physiotherapy Association and Sports Medicine Australia). Rugby Australia remains in dialogue with Concussion in Sport Australia regarding the position statement.”
