The AFL’s five-day rule designed to promote player recovery following a concussion may not have been effective in 2020, a new study shows.
In 2020, the AFL announced a rule that required a player to receive medical clearance to play at least five days before a match. This medical assessment, performed by team doctors, followed other recovery milestones, thus delaying return to competition.
Recently, researchers, led by Alan Pearce of La Trobe University, compared injury and return to competition reports recorded by the AFL before and after the 2020 rule change. They found that there was no change in the number of matches missed by concussed players, and that more than half of the players who got a concussion in 2020 returned to competition in less than 12 days.
The median time for return to competition after a concussion dropped from 13 days (in 2017–19) to 10 days in 2020, despite the rule change.
“Last year, what they wanted to do was to have a medical clearance at least five days prior to the next match,” says Pearce.
“So, they thought it would extend the time players take [to recover] before they came back and played.
“But the problem was that the five-day medical clearance actually sped up the return to play timeline.”
The study, published in Sports Medicine, says this “demonstrates that the 2020 AFL policy was not successful in increasing a player’s rest and recovery time after concussion”. The authors suggest improved monitoring methods are needed to facilitate compliance to the twelve-day rule introduced in 2021.
Why were the five-day and twelve-day rules introduced to aid concussion recovery?
In 2017, an international consensus for the management of concussion in sport – called the Berlin statement – was published; it detailed a six-step plan for concussion recovery. The NRL and AFL are both parties to this consensus. But Aussie rules’ return-to-play protocols rely on self-reported symptoms, which are not always accurate.
The five-day medical clearance prior to a game attempted to counteract some of this inaccuracy and allow for more rest for players, but the study found that the opposite effect was achieved.
“There is a recommended return to play protocol – which is those six stages – and each phase needs to be 24 hours in duration before you can then progress to the next phase: being symptom free,” says Pearce.
“The NRL have…incorporated that into their return to play quite visually.”
But in the AFL, club doctors can choose to forgo some steps if the player reports no symptoms.
“Australian rules haven’t really [done the same as NRL] because they’ve got a sort of ‘out clause’ where they can say [that] if the doctor feels that the player has recovered, they don’t have to go through the full six-stage return to play protocol,” says Pearce.
“They can override them, basically.”
Now, the twelve-day rule will mean that the six steps cannot be completed in less than seven days, so that players have a longer time to recover, even if it means they miss a game. It relies on regulating the time following a concussion, instead of before a game.
“It makes it easier for the club doctor to enforce a proper return to play protocol,” says Pearce.
“The 12 days stand-down period implemented this year is not a ‘get out of jail at 12 days’. [After] that [is] when you actually have to start showing that you’re ready to return to play.
“That’s when you actually then have to start getting your medical clearance and demonstrating that you’re fully recovered.”
The next international meeting for the Concussion in Sport Group will be in October, after which the protocols may be revised to incorporate new information.
Dr Deborah Devis is a science journalist at The Royal Institution of Australia.
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