Dire consequences of head injuries among footballers are causing alarm about how they are assessed

It was not the sight of New South Wales skipper Boyd Cordner leaving the field late in the first half of State of Origin I at Adelaide Oval after receiving a head knock that was shocking.

The Roosters forward undergoes concussion assessments as regularly as Donald Trump’s staffers take COVID-19 tests. This was his fifth head injury this season alone.

It was Cordner’s return to the field that surprised and disturbed those of us who aren’t privy to his concussion test results or medical records, but who fear for his future nonetheless.

Perhaps we should have been prepared to see Cordner running on wobbly legs, still eating up the metres in the crazy, brave way that is both valiant but, we fear, also potentially self-defeating.

In justifying Cordner’s selection last month, Blues coach Brad Fittler said: “The people championing [caution] over concussions, sometimes they’re very aggressive with their dialogue. I’m happy to hear it. But sometimes I think also we need some balance as well.”

These are the words of a coach with apparently staunch faith in the medical system. One who bristled after Origin I in the face of repeated questions about the decision to send Cordner back into the fray.

“Mate, I’m a coach,” Fittler said.

“There’s protocols and we’ll follow the protocols.”

In this instance that protocol was the head injury assessment (HIA) test that Cordner passed. But even with that box ticked, an uncomfortable question lingered after his reappearance on Wednesday night.

Would Cordner have been sent back out if his replacement, Cameron Murray, had not injured a knee in his first hit-up? Did precaution give way to a literal-minded interpretation of the rules with the game on the line?

This is in no way to suggest Fittler or anyone in the Blues camp ignored medical advice or acted in any way outside the rules available to them.

But what kind of system allows a player who had reportedly suffered four concussions in 10 weeks to re-enter one of sport’s most ferocious contests soon after suffering yet another?

The answer seems to be a system devised to answer the wrong question.

One calibrated to determine how quickly players can be patched up and sent back out again, not one that defaults to immediate caution in the hope of long-term recovery.

Are players ever right to go back on?

Like Fittler, Cordner’s club coach at the Sydney Roosters, Trent Robinson, has seemingly grown tired about questions about his star forward’s fitness and, no doubt, also the attached imputation that he is putting a beloved player in harm’s way.

In this way a system that allows for instantaneous game-day evaluations of the impact of head injuries that we now know can have debilitating lifelong consequences can make victims of coaches too.

From the box or in the sheds, the coach asks one question: is he right to go back on?

If the medical advisors are allowed to give the green light, then Fittler, Robinson and any other coach is entitled to believe the game has developed a protocol that provides foolproof guidance.

Except the game has not done that because it simply cannot. As the incidences of serious head trauma among veteran footballers from various codes multiply and the cases of suicide linked to these conditions increase, we are clearly only at the “treating cancer with leeches” stage of head injury research.

Accordingly, the system allowing players to return to the field involves as much guess work as some of the answers they give from “gaga land” during their HIA tests.

But it is not the nature of the HIA questions that are at fault, it is the fact we are asking them at all. Surely for all we do know about concussion, we have reached the stage that if we think a player needs to be assessed for a head injury, then he is no longer fit to continue in that game.

And if further tests are needed at training to determine if he can play the next game? Then he is not eligible for that one either.

McCartin’s potential AFL return

An AFL forward wearing protective headgear kicks through the ball at the MCG. An AFL forward wearing protective headgear kicks through the ball at the MCG.
Paddy McCartin suffered several concussions during his playing career at the Saints.(AAP: Julian Smith)

As the Blues consider Cordner’s fitness for the rest of the Origin series, AFL clubs are weighing up the possibility — and the advisability — of recruiting former number one draft pick Paddy McCartin, who was delisted by St Kilda after suffering a series of head injuries.

Again, it is presumptuous to make any judgement on McCartin’s potential return without a thorough knowledge of his personal medical history — or as much a judgement as can be made against the still uncertain science of head trauma.

But what we can say is if McCartin’s return is driven by his nagging sense of nonfulfillment, and clubs are assessing him on his youthful promise rather than his more recent medial history, then you must fear for his welfare.

It was only a few weeks ago that former North Melbourne and Melbourne forward Shaun Smith received a $1.4 million insurance payment for the “total and permanent disablement” caused by accumulated head knocks.

Soon after Smith’s settlement, his daughter Amy was recruited by North Melbourne’s AFLW team as a father-daughter selection with the blessing of her stricken father. Smith’s son Joel plays for Melbourne.

Even offspring so intimately acquainted with the dire consequences of repeated head injuries have not been deterred from taking the field.

This is both heartening and also yet another reminder why we need protocols that protect those who suffer repeated concussions from their own competitive instincts.

Host Kelli Underwood and the Offsiders panel will analyse all the latest events and major issues in sport at 10:00am Sunday on ABC TV.