Right: Player and coach Graham 'Polly' Farmer, died in late 2019 after battling dementia for a number of years, Post mortem investigation showed Farmer had been suffering late-stage CTE (Chronic Traumatic Encephalopathy)
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Arguments in favour of preventing children from playing Australian Rules football
1. Australian Rules football is a dangerous sport
Those who argue that Australian Rules football is too hazardous a game to be played by children point to a variety of data indicating the serious risks, particularly of brain injury, associated with the sport.
An Australian Institute of Health and Welfare publication, 'Australian sports injury hospitalisations 2011-12' indicated that around one-third of all sports injury hospitalisations were associated with playing various codes of football. Australian Rules football had the highest population-based age-standardised rates of injury hospitalisation (18 cases per 100,000 population). This data was drawn from some 36,000 people aged 15 and over who were hospitalised as the result of an injury sustained while playing sport in the twelve months surveyed.
A similar study released five years later, 'Hospitalised sports injury in Australia, 2016-17' found that almost 60,000 people were hospitalised for sports injuries during the twelve-month period considered. This was a nearly 100 percent increase over the rate of injury five years earlier.
For males, the sports that most frequently led to hospitalisation were football (all codes -38 percent) and the case was the same for women with football resulting in 15 percent of hospitalisations. Recent studies have particularly highlighted the brain damage that can result from contact sports such as Australian Rules football. Dr Chris Nowinski, co-founder of the United States-based Concussion Legacy Foundation, has recently stated with regard to Australian Rules football, 'Tackling is dangerous. There's no safe way to do it. There are fair ways to do it, but there's no safe way to bring another man - or woman - to the ground and stop their momentum at the same time.'
Speaking of the effect of American grid iron football on participants, neuropathologist Dr Omalu has stated, 'The human brain is 60 to 80 percent water. The human brain floats freely inside your skull, and the human brain has no reasonable capacity to cure itself, so when you have a blow to your head, there is no regeneration. In the game of football, some of these blows to the head are equivalent to a car crash at 13 miles per hour...
Each and every impact you have causes microscopic injuries in your brain...And it's final, there is no cure, and it is progressive. So, sub concussive blows are accumulated upon each other. There is no safe blow to the human head. Every impact to your head can be dangerous. That is why you need to protect your head from all types of blunt force trauma.'
Of particular concern in the Australian context is recent evidence that Australian Rules footballers are developing CTE (chronic traumatic encephalopathy), as a result of playing the sport. Chronic Traumatic Encephalopathy (CTE) is a degenerative brain disease found in people with a long history of head trauma - not so much a handful of big concussions but rather hundreds (or thousands) of smaller impacts over a number of years. CTE was first diagnosed in 1928 in boxers, under the name dementia pugilistica (also known as 'punch drunk syndrome' and later 'slug nutty') but it gained renewed attention in 2005, when pathologist Bennet Omalu found CTE in the brain of an American footballer, former Pittsburgh Steeler Mike Webster.
CTE often manifests as a kind of dementia showing cognitive impairment, depression, short term memory loss, emotional instability, substance misuse and suicidal thoughts or behaviour; however, it can only be conclusively diagnosed post-mortem. Once a person who has pledged their brain dies, they are sent to a mortuary where their brain is removed and weighed then fixed in formalin to preserve the tissue before autopsy.
Three recent postmortems have revealed that three prominent AFL players have suffered with CTE. In February 2020, stage three CTE was officially diagnosed in a former AFL player - the revered player and coach Graham 'Polly' Farmer, who died in late 2019 after battling dementia for a number of years. In August 2020, a postmortem revealed that St Kilda champion player and coach Danny Frawley was suffering with stage two CTE when he died the year before as a result of an apparent suicide.
Friends have suggested his mental health struggles were related to the head knocks Frawley had received on the football field. In January 2021, it was reported that former Richmond footballer Shane Tuck, who committed suicide six months before had the most severe case the Australian Sports Brain Bank has yet seen of CTE. This cluster of diagnoses has triggered mounting concern among health professionals regarding the head injuries Australian Rules footballers are receiving.
2. Australian Rules football is particularly dangerous for children
Opponents of Australian Rules football for children argue that damage to the brain has particularly harmful consequences for young people whose brains are not yet fully developed.
Forensic and neuropathologist, Dr Bennett Omalu, first discovered CTE in the brain of a high-profile American football player in 2002. Dr Omalu has stressed the high level of risk that playing contact sports poses for children, arguing that it greatly increases their chances of developing CTE. Dr Omalu is urging contact sports to reconsider junior competitions.
Dr Omalu has stated, 'It's been very well established that playing high impact, high contact sports is not good for children.' He has further explained, 'When you're building a skyscraper, at the foundation phase it's very important, because that's when you're building the intricate support structures of the building. The same applies to the brain of a child. Your brain is not yet fully developed until you're about 18 - 25 years old.'
Dr Omalu has criticised the emphasis that is placed on temporary enjoyment, that sees adults discounting the potential for serious long-term harm to children's neural development. He has stated, 'What is wrong with us as a modern society? Do we uphold and place the excitement of sports above the humanity of our children?'
Tex Redmund, writing for The Roar in July 2017, has explained the severity of the harm that Australian Rules football can cause to young players. Redmund has stated, 'A brain injury actually has a more devastating impact on a child than an injury of the same severity has on a mature adult.
The cognitive impairments of children may not be immediately obvious after the injury but may become apparent as the child gets older and faces increased cognitive and social expectations for new learning and more complex, socially appropriate behavior.
These delayed effects can create lifetime challenges for living and learning for children, their families, schools and communities. Some children may have lifelong physical challenges.'
Given the potential for long-term brain damage, evidence of a recent rise in the incidence of head injuries among junior players is seen as grounds for concern. A 2019 study among footballers aged 15 to 17 has found that cases of concussion rose threefold from 0.5 to 1.5 per club per season on average between 2009-2011 and 2015-2017. Academics have said the numbers of concussions recorded were probably the tip of the iceberg, because the study did not include injuries from training sessions, pre-season games or finals. The number of concussions was likely to be even higher because many junior players did not seek medical treatment.
According to a 2019 study by the Murdoch Children's Research Institute, concussion is the third most common injury for junior footballers. But junior football players may not be aware of what it means to have a concussion and how CTE properly develops within an individual.
Murdoch Children's Research Institute's director of clinical sciences research, Vicky Anderson, has stressed the evidence of enduring damage demonstrated by those young players who come to the Institute for further investigation. She has indicated that 25 per cent of adolescents who visited the clinic had ongoing symptoms such as headache, fatigue, balance problems and depression or anxiety. Dr Omalu has referred to the lifelong adverse consequences that can result for children who suffer concussion. Referring to two Swedish studies, one published in 2014 and the other in 2016, which examined the health consequences of suffering a single concussion that resulted in hospitalisation. The studies tracked over one million children for 41 years. The researchers found that among the consequences of such an injury were a greater likelihood to die before the age of 42; two to four times the risk of committing suicide as an adult; and about two to four times the risk of developing a major psychiatric illness as an adult. In addition to this, there was a greater likelihood of diminished intelligence, of addiction and of violent or criminal behaviour.
It has also been noted that the earlier a child begins playing contact sports and suffering head trauma, the greater is the likelihood of adult-onset disease and the earlier that onset is likely to be. An analysis of the first 211 football players diagnosed with CTE at Boston University found those who started tackle football before age 12 could have a 13-year-earlier onset of the cognitive, behavioral, and mood symptoms associated with CTE. It was also discovered that athletes who played contact sports for more than nine years had a six times greater risk of developing Lewy body disease, a cause of Parkinson's, than those who played eight or fewer years. Both of these findings have been seen as reasons for precluding children from contact sports such as football.
3. Rule changes and helmets do not sufficiently reduce the risk
Opponents of children playing high contact sports such as Australian Rules football argue that such games are inherently unsafe and that no modification to rules or use of equipment such as helmets can reduce the danger to an acceptable level.
It is generally acknowledged that though risks in contact sports may be able to be reduced by changes in regulations, these risks cannot be eliminated. The NRL's Head of Football, Participation, Pathways & Development, Luke Ellis, has stated that though the game is structured to be as safe as possible for all junior players, 'sometimes, head knocks are inevitable'.
This point was quantified by Forensic and neuropathologist, Dr Bennett Omalu, who has stated, 'If a child plays rugby or football for only one season, there is a 100 percent risk exposure for that child to suffer permanent brain damage. This is the truth of science.'
Dr Omalu has further argued that claims that football can be made safer are misleading. He has stated, 'Let me ask you, can you make fire safer? I suppose you could make it safer by putting it in a lighter. A lighter is safer than a matchstick, right? But would you give your 5-year-old child a lighter to play with?'
Dr Chris Nowinski, co-founder of the United States-based Concussion Legacy Foundation, has recently stated regarding Australian Rules football, that no changes in regulations could adequately reduce the risks associated with the sport. Dr Nowinski has stated, 'There are universal changes that can be made. If we just talk about tweaking the rules at the pro level, we're not going to stop CTE. The risk accumulates over an athlete's entire career.'
Dr Nowinski has further stated that improving how Australian Rules deals with concussions to reduce their number and ensure that players are out of the game for a longer recuperation period after receiving a concussion will not be sufficient to significantly reduce the risk of CTE. He has stated, 'We don't have any evidence to support the idea that changing how we treat concussions will significantly change CTE outcomes. If you have 30 per cent fewer concussions because of rule changes, but you still have as many hard blows to the head, you're not going to see a big difference.'
Dr Nowinski has concluded, 'Tackling is dangerous. There's no safe way to do it. There are fair ways to do it, but there's no safe way to bring another man - or woman - to the ground and stop their momentum at the same time.'
Equally, claims that helmets might improve the safety of Australian Rules for both young and older players have been widely disputed. In October 2012, Australian Science published an article titled 'Helmets won't cure football's concussion headache'. The piece included the overall judgement, 'There is no evidence that wearing padded helmets would be either beneficial or detrimental for children [playing Australian Rules football.'
The AFL has similarly stated, 'There is no definitive scientific evidence that helmets prevent concussion or other brain injuries in Australian football.
Some experts believe that younger players who wear a helmet may change their playing style, and receive more head impacts as a result. Accordingly, while there is no scientific evidence either way, helmets are not recommended for the prevention of concussion.'
It is widely accepted that helmets are of little to no use in the prevention of concussion or other percussive brain injury. Concussions are caused when the brain moves inside the skull, tearing connective tissue and striking the interior of the cranium. Regular helmets only protect the skull from fractures and do not prevent the brain from rattling inside the head. Thus, both young and old players can receive the type of injury that causes CTE even while wearing a helmet.
4. Children are unable to make an informed decision regarding the risks they face when playing Australian Rules football
It has been argued that children are too young to make an informed decision about the risks they face when playing contact sport such as Australian Rules football.
Forensic and neuropathologist, Dr Bennett Omalu, has argued that there is an ethical and legal difference between adults, who should be able to make informed decisions about their lives, and children who have not yet reached a point where they have the experience and maturity to be able to do so. Dr Omalu has stated, 'As physicians, it is our role to educate and inform an adult about the dangers of, for example, smoking. If that adult decides to smoke, he is free to do so, and I will be the first to defend that freedom. In the same way, if an adult chooses to play football, ice hockey, mixed martial arts or boxing, it is within his rights.
However, as a society, the question we have to answer is, when we knowingly and willfully allow a child to play high-impact contact sports, are we endangering that child?'
Dr Omalu concludes, 'Our children are minors who have not reached the age of consent. It is our moral duty as a society to protect the most vulnerable of us.
The human brain becomes fully developed at about 18 to 25 years old. We should at least wait for our children to grow up, be provided with the information and education on the risk of play and let them make their own decisions. No adult, not a parent or a coach, should be allowed to make this potentially life-altering decision for a child.'
Dr Omalu notes that laws have been put in place to prevent children from harming themselves by smoking cigarettes or consuming alcohol, with age restrictions to prevent minors from purchasing them. He argues that the same sort of approach needs to be taken to the playing of sports which are harmful to children and about which they are not yet old enough to make informed decisions. He suggests that authority figures such as parents, coaches and doctors should insist on young men and women not playing contact sports as minors.
Dr Omalu has also noted that football is so culturally revered in some countries that children are particularly unable to make an unbiased decision about the safety of playing it. Dr Omalu has stated, 'Many... kids have been raised in cultures where football is elevated to a level of religion. So, their thinking of football is not objective, it is emotional, it's a habit. That's called conformational thinking...'
Dr Chris Nowinski, co-founder of the United States-based Concussion Legacy Foundation, has also claimed that children are in no position to appreciate the danger they face from a condition such as CTE. He has stated, 'You just don't start hitting children in the head...We're crazy to have children who...don't even understand what CTE means playing by the same rules as adults.'
A number of those involved in either training or studying junior footballers who have suffered head trauma have noted that these young players lack the knowledge and the maturity to recognise the dangers posed to their health.
Jamie Boland, who has coached junior football across all age divisions for almost 30 years at the Macleod Junior Football Club, has stated, 'I find that 16-year-old boys, 14-year-old and under, when they get concussed, they will not come to the coach, they will not go to the trainer.' Neuroscientist Dr Alan Pearce, who specialises in the research of sports related concussions, has observed that boys get a feeling of pride and toughness when they get hit in a game of football and feel it shows their coaches and peers that they are a determined athlete.
Observations such as these have been taken to demonstrate that children do not have the experience or the judgement to determine whether they should risk their physical and mental health in a high contact sport such as Australian Rules football. They also indicate that children do not know how to respond appropriately when they are injured.
The Australian Capital Territory has already implemented legislation under the Controlled Sports Act 2019 to protect young participants. It currently applies only to combat sports such as boxing and other high-risk activities. This law requires the registration of officials (from promoters to medical personnel); the registration of contestants subject to appropriate medical advice; and rules which prohibit dangerous techniques and establish age requirements.
The minimum age for contestants to compete in a registered event is 18 years old. Those concerned about the health impact on young competitors of Australian Rules football and other high contact sports argue that young players should be protected in the same way from these activities that they are from combat sports and that a minimum age requirement should be established.5. There are other safer games that children can play
Those who argue that children should be prevented from playing contact sports such as Australian Rules football note that there are many safer alternatives.
Statistically, the safest sports are those with the lowest rates of injury. The Colorado School of Public Health ran a study in which they tracked more than 150 schools across the United States. Those sports which were found to be among the safest were swimming, tennis, golf, volleyball and track and field (athletics). These are all individual activities. In terms of team sports, one of the safest was found to be baseball. None of these sports is without any risk; however, all have a far lower risk of repeated head injury than contact sports such as football.
Basketball is another team sport which while having a high risk of lower body injury, especially to ankles and knees, does not have the high risk of head injury seen in football.
A more wide-ranging United States study of sports suitable for children is the Aspen Institute's Healthy Sport Index. The Healthy Sport Index promotes itself as combining 'the best available data and expert analysis to identify the relative benefits and risks of participating in the 10 most popular high school boys' and girls' sports. The tool is a product of the Aspen Institute Sports & Society Program, developed in partnership with Hospital for Special Surgery (HSS) and with the guidance of an advisory group of medical doctors, researchers and other specialists whose experience spans a range of disciplines, sports, and athlete populations.'
The Index rates sports against three criteria, physical activity, psychosocial value, and safety. When an equal emphasis is placed on all three criteria, the ranking of sports suitable for male children is cross country, swimming, track and field, soccer, tennis, basketball, wrestling, baseball, lacrosse, and football. When equal weighting is given to all criteria, the ranking for female children is swimming, cross country, tennis, volleyball, soccer, basketball, track and field, softball, lacrosse, and cheerleading. Interestingly, football is not listed for girls at all (as the game is not open to females in the United States) and football comes last for boys both when the criteria are equally weighted and when safety is preferenced.
According to the 2016 to 2017 data on sports related hospital admissions in Australia the safest sports to play are golf, water skiing, fishing, hockey (all types), adventure and extreme sports, dancing, racquet sports, fitness and gym, swimming and diving, surfing, running, athletics and track and field, and recreational walking.
Forensic pathologist, Dr Bennett Omalu, recommends non-contact sports such as swimming, track and field, volleyball, basketball, table tennis, lawn tennis and badminton. He has stated, 'There are so many of them. There is still a risk of accidental injury. You have to play safe.'
Dr Omalu believes that it is only a matter of time before society will cease to endorse sporting competitions which cause serious harm to children and adults. He has stated, 'Attitudes are changing. Participation in [American] football is dropping, quite drastically, by 10 per cent in one year...
We are dealing with human life here. In the next generation or two, mankind won't be playing sports like rugby or football or ice hockey or mixed martial arts.
It just doesn't make sense to be damaging the brain of a human being. In a game like rugby, in every play there is a blow or impact to the head. The human species evolves, it's part of who we are to change. Society evolves, we move forward...
That means maybe by the time my generation passes away. The children being born today, with all that we know today now, I don't think they will embrace these violent sports the way we did.'