More Conversations Down Under

As The Concussion Blog continues to gain recognition it seems that some of the information is being used around the world.  This can be noted in our analytics and seeing plenty of blog views from around the globe.  Not surprisingly the US has the most traffic, followed by Canada and Mexico.  The next most is the United Kingdom and Australia; presumably for our coverage of soccer and Aussie Rules.  Because of this we get vast amounts of email from around the globe, and Australia has been providing tons of information to help with the blog and insight of how things are handled in their part of the world.

Most recently I was sent the 2011 AFL Injury Report for a comparison of our numbers versus theirs.  Before we get into the actual concussion numbers it is interesting to note the most troublesome injury in football Down Under is hamstrings.  By far this muscular injury affects more players per club per season than any other.

Back to the injury report, an injury is defined as “injury or medical condition which causes a player to miss a match”.  It does not take into consideration any ailment that a player plays through or one that resolves in time for the next match.  This is not unlike the NFL and their injury listings giving rise to an actual reporting issue – one we have discussed many times.  If you look at the report they have historical perspective as well; in terms of concussion 2011 was the highest in incidence (1.1 new concussions/team/season) since 1992 (1.3 new concussions/team/season).  There was over double the incidence of concussion from 2010 (heck almost three fold since 2006) to this past year.

The primary question was how does the official numbers jive with our numbers here; the answer is we have it slightly higher.  If we use their definition of new injury/club (where club is 40 players) over the season (where season is 22 matches) then our incidence rate is 1.15 (46 concussion we found last year).  This tells me, blindly, that the AFL is finding or getting reports of the same concussions we are finding in our searches.  This would differ from the NFL because approximately 1/3 of our concussions found are not on the NFL injury lists, rather found in the press or player statements.

This still has no effect on the under-reporting of the injury; players not reporting the injury or players getting back on the field prior to them becoming an official “injury”.  The AFL report wrote this about its findings;

The AFL Medical Officers Association introduced revised Concussion Management Guidelines at the beginning of the 2011 Season which led to a more conservative approach to concussion management.

Table 10 shows consistently low incidence and prevalence for concussions which cause a game to be missed (generally one injury or less per club per season). However, there was an apparent rise in both incidence and prevalence in 2011. The rise over the last year in the AFL corresponds with a worldwide trend amongst many sports to recognise the potential long-term effects of concussion53-55 and a more conservative approach with return-to-play decisions.

The new Concussion Guidelines (in combination with the substitute rule) have led to more conservative concussion management practices, which is a significant factor in the increase, although the sensitivity of this survey cannot attribute the entire increase to this factor. The injury survey is not the best way to assess the full impact of concussion (as it only captures injuries which cause missed playing time), but can be used in conjunction with other specific studies.

Whilst additional research on concussion in the AFL is already underway56, any change to the definition of concussion for the survey should be avoided so as to not affect the ability to detect long-term trends. There are many occasions and reports from other codes of football where retired players concede that on occasions when they received concussions they did not report the symptoms to team medical staff. AFL players are strongly encouraged by clubs to report all instances of suspected concussion, and research to date has suggested the current AFL practices are consistent with the best available standards56. This has been demonstrated by several other sports using the new AFL Concussion Guidelines as a benchmark for adjusting their own approach to concussion management68.

The AFL remains strongly committed to player welfare and has introduced several law and tribunal changes in recent years to reduce the risk of head and neck injury such as a reduced tolerance of head-high contact, stricter policing of dangerous tackles, and the introduction of rules to penalise a player who makes forceful contact to another player with his head over the ball.

Although the AFL is a good “observation ground” for concussions the other “favorite collision sport” in Australia is rugby, notably the National Rugby League (NRL).  We have found a resource to track those injuries as well, however they are 12 weeks in this year so we will have to wait until next season to begin our survey of the NRL and rugby.  In the following post we will look at a few papers about concussion is rugby.

Like I said we are getting more information from Down Under, and every bit is valuable.  Here is an associated article by Bradley J. Partridge regarding concussions titled 2011 Hit and Miss (AJOB Neuro).

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