Head injuries (including concussion) are an inherent risk of participating in the major collision sports played in Australia (rugby league, rugby union and Australian Rules football). Protocols introduced by the governing bodies of these sports are ostensibly designed to improve player safety but do not prevent players suffering from repeated concussions. There is evidence that repeated traumatic brain injuries increase the risk of developing a number of long term problems but scientific and popular debates have largely focused on whether there is a causal link between concussion and chronic traumatic encephalopathy (CTE). We argue that the governing bodies of collision sports played in Australia have used uncertainty about CTE to justify a “wait and see” approach instead of attempting to prevent repeated head injuries. This stance is difficult to defend when these governing bodies claim to give a high priority to protecting player welfare.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Langlois, J.A., W. Rutland-Brown, and M.M. Wald. 2006. The epidemiology and impact of traumatic brain injury: A brief overview. The Journal of Head Trauma Rehabilitation 21(5): 375–378.
NRL. The Management of Concussion in Rugby League http://www.nrl.com/About/ReferenceCentre/ManagementofConcussioninRugbyLeague/tabid/10798/Default.aspx. Cited 2012 23rd August.
Finch, C.F., A.J. Clapperton, and P. McCrory. 2013. Increasing incidence of hospitalisation for sport-related concussion in Victoria, Australia. The Medical Journal of Australia 198(8): 427–430.
Abrahams, S., S. Mc Fie, J. Patricios, M. Posthumus, and A.V. September. 2013. Risk factors for sports concussion: An evidence-based systematic review. British Journal of Sports Medicine 48: 91–97.
Guskiewicz, K.M., M. McCrea, S.W. Marshall, R.C. Cantu, C. Randolph, W. Barr, et al. 2003. Cumulative effects associated with recurrent concussion in collegiate football players: The NCAA Concussion Study. JAMA 290(19): 2549–2555.
Shively, S., A.I. Scher, D.P. Perl, and R. Diaz-Arrastia. 2012. Dementia resulting from traumatic brain injury: What is the pathology? Archives of Neurology 69(10): 1245–1251.
Graves, A.B.., E. White, T.D. Koepsell, B.V. Reifler, G. van Belle, E.B. Larson, et al. 1990. The association between head trauma and Alzheimer’s disease. American Journal of Epidemiology 131(3): 491–501.
Molgaard, C.A., E.P. Stanford, D.J. Morton, L.A. Ryden, K.R. Schubert, and A.L. Golbeck. 1990. Epidemiology of head trauma and neurocognitive impairment in a multi-ethnic population. Neuroepidemiology 9(5): 233–242.
Salib, E., and V. Hillier. 1997. Head injury and the risk of Alzheimer’s disease: A case control study. International Journal of Geriatric Psychiatry 12(3): 363–368.
Guo, Z., L.A. Cupples, A. Kurz, S.H. Auerbach, L. Volicer, H. Chui, et al. 2000. Head injury and the risk of AD in the MIRAGE study. Neurology 54(6): 1316–1323.
Fleminger, S., D.L. Oliver, S. Lovestone, S. Rabe-Hesketh, and A. Giora. 2003. Head injury as a risk factor for Alzheimer’s disease: The evidence 10 years on; a partial replication. Journal of Neurology, Neurosurgery, and Psychiatry 74(7): 857–862.
Lye, T.C., and E.A. Shores. 2000. Traumatic brain injury as a risk factor for Alzheimer’s disease: A review. Neuropsychology Review 10(2): 115–129.
Nemetz, P.N., C. Leibson, J.M. Naessens, M. Beard, E. Kokmen, J.F. Annegers, et al. 1999. Traumatic brain injury and time to onset of Alzheimer’s disease: A population-based study. American Journal of Epidemiology 149(1): 32–40.
Bazarian, J.J., I. Cernak, L. Noble-Haeusslein, S. Potolicchio, and N. Temkin. 2009. Long-term neurologic outcomes after traumatic brain injury. The Journal of Head Trauma Rehabilitation 24(6): 439–451.
Lee, Y.K., S.W. Hou, C.C. Lee, C.Y. Hsu, Y.S. Huang, and Y.C. Su. 2013. Increased risk of dementia in patients with mild traumatic brain injury: A nationwide cohort study. PLoS ONE 8(5): e62422.
Fann, J.R., B. Burington, A. Leonetti, K. Jaffe, W.J. Katon, and R.S. Thompson. 2004. Psychiatric illness following traumatic brain injury in an adult health maintenance organization population. Archives of General Psychiatry 61(1): 53–61.
Guskiewicz, K.M., S.W. Marshall, J. Bailes, M. McCrea, R.C. Cantu, C. Randolph, et al. 2005. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery 57(4): 719–726. discussion -26.
Guskiewicz, K.M., S.W. Marshall, J. Bailes, M. McCrea, H.P. Harding, A. Matthews, et al. 2007. Recurrent concussion and risk of depression in retired professional football players. Medicine and Science in Sports and Exercise 39(6): 903–909.
Lehman, E.J., M.J. Hein, S.L. Baron, and C.M. Gersic. 2012. Neurodegenerative causes of death among retired National Football League players. Neurology 79(19): 1970–1974.
Partridge, B. 2014. Dazed and confused: Sports medicine, conflicts of interest, and concussion management. Journal of Bioethical Inquiry 11(1): 65–74.
White, P.E., J.D. Newton, M. Makdissi, S.J. Sullivan, G. Davis, P. McCrory, et al. 2014. Knowledge about sports-related concussion: Is the message getting through to coaches and trainers? British Journal of Sports Medicine 48(2): 119–124.
Partridge, B., and W. Hall. 2013. Conflicts of interest in recommendations to use computerized neuropsychological tests to manage concussion in professional football codes. Neuroethics 7: 63–74.
NRL. NRL Mailbox: Player safety and concussions 2012 [cited 2014 9th July]. Available from: http://www.nrl.com/nrl-mailbox-player-safety-and-concussions/tabid/10874/newsid/66477/default.aspx.
Crawley, P. 2014. Wake-up call: Rugby league concussion culture has to change says head doctor The Daily Telegraph. Available from: http://www.dailytelegraph.com.au/sport/nrl/wakeup-call-rugby-league-concussion-culture-has-to-change-says-head-doctor/story-fni3fbgz-1226852942110.
Kaye, A.H., and P. McCrory. 2012. Does football cause brain damage? Medical Journal of Australia 196(9): 547–549.
ABC. Hard Knocks 2012. Available from: http://www.abc.net.au/4corners/stories/2012/05/10/3499950.htm.
Carlisle, W. 2014. Concussion games (ABC Background Briefing). Available from: http://www.abc.net.au/radionational/programs/backgroundbriefing/-v2/5497562#transcript.
McKee, A.C., D.H. Daneshvar, V.E. Alvarez, and T.D. Stein. 2014. The neuropathology of sport. Acta Neuropathologica 127(1): 29–51.
Omalu, B.I., S.T. DeKosky, R.L. Minster, M.I. Kamboh, R.L. Hamilton, and C.H. Wecht. 2005. Chronic traumatic encephalopathy in a National Football League player. Neurosurgery 57(1): 128–134. discussion -34.
Omalu, B.I., R.L. Hamilton, M.I. Kamboh, S.T. DeKosky, and J. Bailes. 2010. Chronic traumatic encephalopathy (CTE) in a National Football League Player: Case report and emerging medicolegal practice questions. Journal of Forensic Nursing 6(1): 40–46.
McKee, A.C., T.D. Stein, C.J. Nowinski, R.A. Stern, D.H. Daneshvar, V.E. Alvarez, et al. 2012. The spectrum of disease in chronic traumatic encephalopathy. Brain 136: 43–64. doi:10.1093/brain/aws307.
McKee, A.C., R.C. Cantu, C.J. Nowinski, E.T. Hedley-Whyte, B.E. Gavett, A.E. Budson, et al. 2009. Chronic traumatic encephalopathy in athletes: Progressive tauopathy after repetitive head injury. Journal of Neuropathology and Experimental Neurology 68(7): 709–735.
Gardner, A., G.L. Iverson, and P. McCrory. 2013. Chronic traumatic encephalopathy in sport: A systematic review. British Journal of Sports Medicine 48: 84–90.
Lane, S. 2012. US concussion study may not apply to AFL: Doctor: Sydney Morning Herald; [cited 2012 3rd August]. Available from: http://www.smh.com.au/afl/afl-news/us-concussion-study-may-not-apply-to-afl-doctor-20120603-1zq6h.html.
Walter, B., Proszenko, A. 2013. Brains trust debates shoulder charge rule Newcastle Herald.
Raftery, M. 2013. Concussion and chronic traumatic encephalopathy: International Rugby Board’s response. British Journal of Sports Medicine 48: 79–80.
McNamee, M., and B. Partridge. 2013. Concussion in sports medicine ethics: Policy, epistemic and ethical problems. The American Journal of Bioethics 13(10): 15–17.
Thanks to Dr Lynley Anderson and Dr Andrew Gardner for providing useful insights, feedback and suggestions on this paper. Brad Partridge is supported by a National Health and Medical Research Council Postdoctoral Fellowship (2011–2014).
About this article
Cite this article
Partridge, B., Hall, W. Repeated Head Injuries in Australia’s Collision Sports Highlight Ethical and Evidential Gaps in Concussion Management Policies. Neuroethics 8, 39–45 (2015). https://doi.org/10.1007/s12152-014-9217-0
- Chronic traumatic encephalopathy
- Traumatic brain injury
- Rugby league
- Australian Rules football
- Rugby union