Right: Dakota Duke, a 14-year-old footballer, had a stroke on the field after suffering a neck injury. Her mother called for helmets to be made compulsory in junior football.
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Arguments in favour of introducing helmets
1. There has been an increase in head injuries among AFL players
The AFL's annual injury survey has showed that injury rates in 2011 saw a marked change in the types of injuries sustained in AFL competition.
The trends in both injury incidence and prevalence remained in line with 2010 results but the 2011 year saw a statistically significant fall in hamstring injuries and all leg muscle strains, matched by an increase in the incidence of PCL knee injuries and concussion.
Long-term studies reveal an entrenched pattern of head injuries associated with Australian Rules football. Concussion is a relatively common injury with six to seven concussions per team per season.
In a recent survey of former players carried out for the Players' Association, of those former players who sustain serious injury almost seventy-five percent reported sustaining at least one concussion during their career, and four out of five of those said they had suffered multiple concussions.
2. Head injuries sustained in Australian Rules football can cause serious long-term harm to players.
Experience in the United States with those playing in their National Football League is beginning to suggest that head injuries incurred while playing contact sports such as Australian Rules football can cause life-long harm to players and may hasten their deaths.
Post-mortem evidence of chronic traumatic encephalopathy (CTE) in the brains of American National Football League players who suffered concussions while playing has intensified concerns about the risks of playing Australian Rules football. Chris Nowinski, the co-director of Boston University's Centre for the Study of Traumatic Encephalopathy, has stated he is convinced Australian footballers would suffer from the same brain condition - CTE - that has now been proven in high-profile United States sportsmen due to multiple head knocks.
Mr Nowinski has stated, 'This disease has been found in boxers, ice hockey players, a soccer player, American football players ... so to assume this couldn't be caused by head traumas that occur in Australian rules football would be na‹ve.'
CTE is a degenerative brain disease caused by repeated head trauma and characterised by the depositing in the brain of injury-related proteins. CTE produces symptoms similar to those of early-onset dementia. It has also been associated with other forms of intellectual impairment and with depression. Some NFL players with post-mortem evidence of CTE have committed suicide.
An increasing number of AFL players is seeking compensation for brain injuries. For example, former Melbourne player Daniel Bell is currently seeking compensation from his old club after he was diagnosed with brain damage. He claims the injury has been linked to a history of concussions he sustained during his career. A neuropsychologist found his cognitive function has deteriorated significantly.
Bell, aged 25, played 66 games with Melbourne and now struggles to remember words and names when he is tired or he feels strained. Club doctor Andrew Gaff found Bell had received between eight and 10 concussions during his time at Melbourne. Bell himself believes he may have suffered as many as 25 concussions.
West Coast premiership player Dean Kemp and Adelaide premiership player Chad Rintoul are two other former AFL players who have won injury compensation after repeated concussions ended their careers. Former Adelaide player Scott Stevens was forced to retire in 2011 with the after-effects of concussion and ex-Fremantle player Daniel Gilmore has also sought compensation.
Such instances have led to growing community and medical concern. A recent article published in the Medical Journal of Australia has concluded, 'Australia's football codes need to attend to the cumulative effects of years of chronic or subtle brain injuries among their players at the elite and amateur levels. There is a medical and ethical imperative for all football codes to minimise the risks of head injuries and concussion among players.'
3. The number of concussions and subconcussions is under-reported
It has been claimed that there are a variety of factors that are likely to contribute to the under-reporting of head injuries in the AFL.
Firstly, it has been suggested that some players may fail to report an injury received.
There is said to be pressure upon players to continue playing. Football is often their principal livelihood and to continue to be selected they may well believe that they must appear fit and ready to compete.
It has also been suggested that many players, at all levels from junior players to elite professionals, may not realise they have been injured until they begin to experience serious symptoms. This claim is made in particular in relation to sub-concussive injury. Bob Cantu, a neurosurgeon from Boston University, has stated, 'These are injuries where the accelerations are not at a level to produce symptoms that we recognise as concussion symptoms, but sub-concussive blows can cumulatively lead to damage to the brain.'
The latest available AFL injury data indicated that the concussion rate at the elite level was about one newly concussed player per team every two seasons, but it is feared that this figure is misleading because a concussion was only recorded if it caused a player to miss a future match.
It is also feared that the tougher concussion guidelines of the AFL and NRL may encourage under-reporting. Nathan Gibbs, team doctor for the AFL's Sydney Swans, says a player who is dazed by a blow to the head but recovers quickly can be categorised as non-concussed even though his symptoms suggest concussion. The temptation, he believes, will be for team doctors to classify mildly concussed players as non-concussed, rather than order them to sit out the game.
The probably significant incidence of under-reporting of brain injuries has been used as an argument in favour of protective head-gear. It is claimed that under-reporting means it is not always possible to allow players to recover from a brain injury before they play again. It is argued that what is required is a highly pro-active approach, one which includes the use of helmets, and which is designed to prevent injuries occurring in the first place.
4. There are some helmets that can reduce the likelihood of head injury
There have been persistent claims that helmets are ineffective in preventing brain injury in contact sports. However, developments in helmet technology have produced some better helmets which can achieve the desired effects.
Novel technologies are being used in the helmets of American football players to detect and prevent concussions by measuring the impact force of sustained blows.
Testing has been done on a number of soft-shell, padded helmets of the type needed for Australian Rules football. The testing involved an artificial head with internal sensors that measured the shock absorption of the helmets during drop-tests simulating the impact energy likely to produce a concussion.
It was found that only one of the seven helmets tested was likely to reduce the risk of head injury and this helmet had the thickest padding and foam density. Based on the laboratory results, most padded helmets were not thick enough or firm enough to significantly reduce injury risk, but one was adequate.
Those who support the compulsory introduction of helmets into Australian Rules football have been very encouraged by this result. They argue that it demonstrates that claims that helmets cannot protect from head injury are incorrect and that what is required is the proper establishment of a set of standards for AFL helmets so that those that are purchased are effective.
5. Education is needed as part of any program to reduce the risks associated with Australian Rules football
It has been claimed that education has to be part of any program designed to reduce head injuries among AFL players at any level of competition.
There is reported to be resistance to the wearing of helmets because of cost, discomfort and reduced vision and hearing. Where helmets have been trialled it has been difficult to gauge their effectiveness because of only partial compliance. Even were helmets made compulsory it would still be necessary to promote their wear by stressing the dangers of head injuries and the benefits that helmets offer.
It has also been claimed that it would remain necessary to continue to promote safe play in order to counter the compensation effect that occurs when players believe that they are safe because they are wearing a helmet and therefore play with greater vigour and take more risks.
The AFL has taken a variety of measures to increase community and player awareness of the risks of concussion and of the advantages of helmet use. These measures include updated Community Management guidelines; the development of joint AFL-AFLMOA position statement on helmets and mouthguards; the updating of relevant sections of AFL and Community website to provide detailed information on AFL rule changes, research projects, and health and wellness programs and policies; the inclusion of a concussion awareness module as part of coach accreditation; pre-season education workshops conducted by club doctors with AFL playing groups; laws of the game briefings with AFL club match committees and player leadership groups; face-to-face education of parents and community level players about symptoms of concussion to be potentially incorporated into current suite of broader community education sessions and the development of player and parent concussion information sheets.