AFL Chief Medical Officer Dr Michael Makdissi

The AFL has released new concussion guidelines as it faces increasing scrutiny of its handling of head injuries, with two class actions against the league expected to be lodged this week.

The updated rules require all AFL and AFLW players who have sustained a concussion to satisfactorily navigate a 11-step ‘return-to-play’ program over a minimum 12 days before they can be medically cleared to return to full contact training, followed by a return to the field [link here].

The 11-step program consists of three stages involving rest, recovery, and then a graded return to training and playing, with each step requiring a minimum 24-hour period to be completed.

If any symptoms recur, the player must return to the previous step, and players can only enter the final stage once they’ve completed testing that demonstrates clinical recovery.

The guidelines have also adopted a more conservative approach under certain circumstances.

These cases include young players, where there is a history of learning disorders or mood disturbance, or a history of multiple concussions – particularly those with prolonged recovery or previous concussion in the same season – and where there is a high symptom burden.

Neurological testing

Among other rules in the AFL Guidelines for the management of sport-related concussion (SRC), all new players must undergo screening to determine the number of previous concussions sustained and their history of prolonged recovery from concussion.

Every player is also recommended to have annual preseason baseline testing that may include neurological assessment, SCAT5 and a screening cognitive test.

The new guidance also suggests that players have a more extensive baseline assessment, including tests of domains commonly affected by concussion e.g., cervical spine, vestibular, oculomotor, etc, formal neuropsychological testing and/or structural MRI.

The AFL has also released a strategic plan on how it will evolve its concussion management and research activities over the next five years, which includes promoting a culture of education and prevention within the league and supporting affected players for life.

The new strategy follows findings of an independent review, led by senior barrister Bernard Quinn KC, released last year that suggested the AFL’s previous research program was “underfunded and under-resourced and suffered from a lack of governance, stewardship and coordination” [link here].

The AFL commissioned the review to investigate the work of internationally recognised neurologist Associate Professor Paul McCrory, who helped shape the league’s concussion guidelines before later being accused of plagiarising material in several journal articles.

The review ultimately concluded that while the instances of plagiarism were an “embarrassing blemish to his reputation”, they did not affect or taint the work he had undertaken for the AFL.

AFL chief medical officer and sports medicine physician Dr Michael Makdissi said the updated concussion guidelines and strategy reinforced the league’s commitment to improving healthcare education, recognition and management of head injuries, and prevention of concussion.

“The guidelines reinforce the importance of players passing through each of the steps safely (i.e. rest, recovery and a graded return), without a recurrence of symptoms, rather than simply progressing through a schedule,” he said in a statement this week.

Legal challenge

Meanwhile, two law firms have announced landmark class actions against the AFL on behalf of former players who claim to have experienced “serious damage” caused by concussion.

Melbourne law firm Margalit Injury Lawyers said that its class action, lodged in the Supreme Court of Victoria on Tuesday, would allege that its lead plaintiff former Geelong player Max Rooke sustained “permanent, life-altering injuries … due to the negligence of the AFL”.

It has been reported more than 60 former players and family members have signed up, seeking up to $1 billion in compensation from the AFL for concussion injuries sustained in their careers.

Griffins Lawyers has also announced a separate class action this week.

Its lead plaintiffs are former Melbourne player Shaun Smith, former Adelaide player Darren Jarmen and the family of former Richmond player, the late Shane Tuck, who died in 2020 at the age of 38 and was posthumously diagnosed with chronic traumatic encephalopathy.