The harrowing Four Corners episode broadcast yesterday exposed the devastating impacts of chronic traumatic encephalopathy (CTE) and its link to contact sports, primarily Australian rules football. The report, along with recent media coverage, suggests the crisis of long-term brain damage in AFL players may be deepening, with an increasing number of diagnosed CTE cases in brains donated to the Australian Sports Brain Bank. CTE can only be diagnosed after death. The report also reveals a concerning proportion of donated brains come from cases of suicide, some disturbingly young. These young victims raise questions about whether Australia's contact sports, including the AFL, are taking the most effective approach to reduce CTE risk.
The Dangers of Early Exposure
A key moment in the program is the story of Nick Lowden, a promising Victorian footballer who took his own life at 23. He was posthumously diagnosed with Stage II CTE, considered significant to brain health. His mother said her family had never heard of CTE and were unaware of the potential long-term neurological effects of repetitive head impacts. Unlike Alzheimer's disease, which mostly occurs in older people, CTE has been found in athletes as young as 20 in Australia (Lowden being the second youngest at 23). In the US and UK, where American football, soccer, rugby, and ice hockey are popular, CTE has been found in junior athletes as young as 17 and 15 respectively. These ages indicate early exposure to repetitive brain trauma is a risk factor for developing CTE.
Should We Have Seen This Coming?
There is a popular perception CTE is a new disease, but its first published case was in American footballer Mike Webster in 2002. History shows concerns about repetitive head impacts and concussions have been discussed in international medical literature since at least 1928, with Australian physicians discussing it as early as 1936. The huge spike in public concerns about sporting brain trauma in the early 2000s tends to obscure decades of prior scientific research. It is reasonable to ask whether Australian football authorities were aware of this research and, if so, whether they responded appropriately. These questions have been tested in international class actions and will soon be tested in the Victorian Supreme Court in a class action brought by former professional and amateur football players against the AFL.
AFL Response and Current Measures
AFL executive Laura Kane, who oversees player health and concussion, told the ABC: "The safety of our players playing our game all the way from grassroots to our elite competition is our number one priority." But she added: "Our job is not to communicate every single aspect of risk that exists in our game. Our job is to govern our sport … and it's a responsibility shared by everyone who works in contact sport." The AFL and other leagues have tried to minimise concussion risks by changing rules to reduce dangerous tackling and high contact, and mandating compulsory rest time after a concussion. However, these measures primarily address concussion, not CTE directly.
Are Contact Sports Unsafe?
Latest research indicates CTE risk is attributed not to concussions per se, but rather the thousands of undetectable sub-concussive impacts experienced in normal play—including bumping, tackling, and incidental collisions during training and competition. Finding ways to reduce sub-concussive impacts is the next frontier for contact sports in Australia. In 2023, the Concussion and CTE Foundation released its CTE prevention protocol, primarily advocating making all contact sports non-contact until age 14, based on evidence it would remove potentially six to eight years of contact exposure in children.
International Precedents and Policy Changes
Some sports have already introduced strategies to limit overall contact: World Rugby has limited full-contact training to 15 minutes per week; the NRL has introduced contact training limits; the AFL recently announced contact training limits will be introduced next year; and in soccer, the UK's Football Association is phasing out headers for children under 12 in both training and games, as heading is linked to concussion and CTE risk. These changes are for all levels of sport, although details of the AFL's policy are yet to be released.
Do We Have the Will to Change?
We do not argue contact sports should be banned. They provide physical, psychological, and social benefits to players and the community, and Australians have the right to engage in risky activities. However, evidence is growing that these sports can damage young brains in ways that cannot be prevented by the current focus on concussion. If a parent of a young athlete asked whether we would recommend their kids play contact sport, our answer would be: "Not in their current form—but we would be happy to have them play a modified non-contact version such as touch rugby or AFL Nines." Low-grade, sub-concussive impacts are part-and-parcel of football gameplay, and an accumulation of these impacts over several years may cause just as much long-term damage as diagnosable concussions. It is time for the conversation around brain trauma in sport to acknowledge these risks and let players and parents make more informed choices.
If this article has raised issues for you, or if you're concerned about someone you know, call Lifeline on 13 11 14.
