Australian football has the highest rate of concussion of any team sport in the world, but players – including children – continue to be put in serious danger of brain damage in every single game, writes Brian Hennessy.
Australia is a sport-obsessed nation, with AFL the most watched sport.
For its first 86 years, the VFL/AFL was a domestic Australian football competition based around Melbourne. In 1977, former player Allen Aylett was narrowly elected President of the VFL on a platform of establishing a national competition, which commenced with the South Melbourne Swans moving to Sydney in 1982. Today, the AFL is one of the most successful sporting leagues in the world. The AFL itself (not including member clubs) has an annual revenue of over $1 billion dollars, with some two thirds of this from TV rights. It pays no tax on this revenue. Former CEO Gillon McLachlan declared, on his departure in 2023, that the sport was in “rude health”. The current CEO, Andrew Dillon, said recently that the game is in “unbelievable shape”.
The inconvenient truth confronting the AFL is that the sport is a high risk, dangerous activity and that sport generally has now transitioned to an era with a strong focus on safety: boxing is now marginalised (remember TV Ringside before colour TV), Formula One has gone from 15 deaths per decade to less than one and batsmen in cricket now wear helmets. Further, concussion, until the 1990s thought to be fully reversible, is now recognized as being able to cause lifelong damage to the brain leading to early onset diseases including Alzheimer’s, Dementia, Parkinsons, MND or seizures. No one signs up for permanent, progressive brain damage. Not all risk can be removed from sport, but sport must not be allowed to destroy lives.
Credible research studies have identified that Australian football has the highest rate of concussion of any team sport in the world.
(Source: completeconcussions.com)
It also has the highest average number of significant head impacts per player per match (29), while Rugby and American football both have 14. Repeated sub-concussive head impacts can lead to Chronic Traumatic Encephalopathy (CTE), degenerative and irreversible brain damage for which there is no diagnosis, until after death, or cure. The problem is people don’t know they have CTE. Hospitalisations due to concussion in junior AFL have doubled in the past decade and are the most prevalent injury in the sport (Australian Institute of Health and Welfare). Unfortunately, GPs and hospital emergency departments around Australia do not have consistent diagnosing/reporting protocols for TBI from sport and so the full extent of the problem is unknown.
Australia has long been a world leader in public health (seat belts, tobacco, sunburn, guns, vaccinations) but there is one key area where experts, including Concussion Legacy Foundation (CLF) founder Dr Chris Nowinski, say we are lagging other developed nations: sport-related traumatic brain injury (TBI). According to the ABS, over 750,000 Australians have a brain injury with two out of every three acquiring their injury before the age of 25. Most concussions in teenage years occur playing sport. Children need a brain for life. Research by the Murdoch Children’s Research Institute from over 90,000 children who were concussed, shows us that children take twice as long to recover compared to adults: ‘Children with concussion cannot be managed as adults’. In Australia, by age 16, over 20% of children will have sustained a concussion. Further, up to 90% of concussions in community football are unreported.
Experts state anyone who has played AFL or rugby for five or more years at any level is a candidate for CTE. Published independent global studies show that contact sport athletes are at least 68 times more likely to develop CTE than those who did not play contact sports. If you pay lip service to concussion and CTE, the result is dead men walking.
Suicide is the leading cause of death among young Australians. The risk of attempted suicide is three to four times higher in patients with severe TBI compared with the general population.
Medical authorities are alarmed: as The Royal College of Pathologists of Australasia’s (RCPA) ground-breaking ‘Position Statement on CTE’ in late 2023 stated:
‘There is an urgent need to prevent chronic traumatic encephalopathy (CTE), particularly for children/adolescents. We are continuing to expose boys and girls, and young men and women, to lifelong devastating harm when we already have significant evidence as a community. The RCPA recommends that low or no contact versions of sports are played by juniors. This particularly applies to school sports.’
In 2023, a study by Macquarie University researchers looked into the academic performance of thousands of students across the country who had been admitted to hospital with a concussion. They found 77% of those who sustain a severe head knock are less likely to finish Year 12.
Dr Bennet Omalu, on whose work the movie Concussion was based, says kids shouldn’t play contact sports until they’re 18:
“Letting kids play football is akin to child abuse.”
Chris Nowinski has stated, “There is no reason for children to play adult forms of contact sport.” Nowinski’s position is that Australia needs to stop “hitting kids in the head” and move faster on implementing concussion education, rule changes, and long-term care for athletes to catch up with international standards.
The Basic Concussion Principle is “If in doubt, sit it out”. With TBI, there is a huge amount of doubt!
Australian parents are voting with their feet. In 1990, soccer and AFL had about the same number of participants in Australia. Now soccer has three times as many players as AFL and basketball has double..
In the USA, Flag football is the fastest growing team sport in the nation, with far more players than contact NFL football, whose numbers are declining rapidly (studies indicate 96% of NFL elite players have CTE), and Flag will be included in the 2028 LA Olympic Games. Tackle football has 23 times the number of high severity head impacts compared to Flag. Every 2.6 years of playing tackle football (from juniors up) doubles the risk of CTE.
In the UK, the Government has now mandated consistent concussion protocols across all sports, a concussion passport for all contact sports participants and in 2025 appointed an Independent Football Regulator to sustain the sport into the future.
Currently, safety in sport in Australia is poorly regulated. Self-regulation by peak football bodies has not been successful. Every sport does its own thing. Why doesn’t the AFL take concussion seriously? Concussion is bad for business.The AFL has dropped the ball in its fundamental obligation: to provide a suitable duty of care for players. With all the money in the sport why have the players been left behind in obtaining a safe workplace? Peak football bodies have a conflict of interest between entertainment dollars (rivers of gold) and player health care.
The AFL says it has made over 30 changes to rules to address concussion (CTE is ignored). Unfortunately, concussions are not reducing at elite level, where AFLPA surveys indicate well over 30% of all AFL players suffer a concussion each year, and they have been increasing at junior/community level. There are inadequate penalties for non-football acts.
73% of past AFL players have daily problems linked to concussion. Many of yesterday’s heroes cannot remember the highlights of their careers, have lost their families, cannot hold down a job, have problems with loss of identity, anger, anxiety, depression, early onset dementia and worse, and often find it difficult to obtain support from the AFLPA.
AFL neglect of past players is creating a sporting underclass, many suffering in silence, many with very poor quality of life. Professional sportspeople in Australia have no legal, insurance or income protection for TBI. So, the situation is that participants in AFL football, the world’s most dangerous team sport in terms of TBI, have the least protection/support of any group in the entire Australian workforce.
The AFL has a poor history in managing concussion. For two decades, its main advisor, Dr Paul McCrory, denied there was a link between hits to the head and concussion. A program he managed to test 550 past players produced no results. AFL return to play protocols (12 days) are arbitrary and out of date, as is player testing. The AFL “Big Tobacco” culture is to deflect/deny/delay/distort the reality of TBI. It controls the narrative via a daily flood of media which crowds out the crisis.
In the current class action by past players against the AFL, the AFL defence claims “players themselves” were responsible for their ‘health and wellbeing, and that players knew the risks of injuries before taking the field’.
TBI (Concussion and CTE) is the number one problem for collision sports around the world. It is the silent killer that destroys families. Unfortunately, the management of TBI in Australia is like the Wild West: it is seriously out of control. The recent Senate Inquiry into Concussion and CTE in Sport heard all the heart-breaking stories but took no decisive action.
Where to from here?
The medical science freight train is about to hit the AFL: within 5-8 years CTE will be able to be diagnosed in the living. And concussion will be diagnosed in real time. Once children are diagnosed with CTE from participation in AFL or Rugby it will be a very different future for these sports. Children will stop playing these sports. Children need a brain for life. Parents won’t play chicken with their children’s brains. (Note: the Keith Titmuss death in NRL is the canary in the coalmine.)
So, what to do for a better future? The AFL must address its biggest issue: making the sport safer. Save the player, save the game. Prevention is better than cure because often there is no cure for brain damage.
A plan to make the sport safer, without diminishing its public appeal, could include the following:
An independent national sports health and safety commission be established: consistent best practice TBI testing and RTP protocols applicable across all sports*.
A national TBI data strategy: consistent approaches by all GPs/ED, TBI passport for all participants of collision sports*
AFL: non-contact versions for all juniors (ie. AFL Superkick for 8-12s, AFL9s for 13+).
Non-contact training for all players during preseason and then limited contact.
Order-off rule in matches for non-football acts (per Scott Pendlebury); no sling/high risk tackles.
AFL to establish best practice concussion management systems: systemic best practice scan testing program for all players. Confirm brain normalisation before RTT.
National TBI sports safety awareness program for parents, clubs, schools*.
Proper care for past players (free lifetime health insurance/testing, workers compensation, income protection, duty of care liability, injury insurance)*.
Consistent TBI/concussion testing/training centres be established in all states*
(*Government action required)
John Hennessy is a former VFL/AFL corporate planner who was involved in taking the game national in the 1980s regarding ground rationalisation, teams in Sydney and Brisbane, and establishment of the VFL Commission. As at February 2026, John is now a board member of the Community Concussion Research Foundation, a non-profit charity.
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