How should Australian football approach concussion in women

W-League defender Natasha Prior doesn’t remember the moment it happened. She can’t recall the elbow to the head, hitting the turf, or the several minutes of waiting before she was stretchered off in a neck brace. 

Her memory is patchy, slippery — the result, she thinks, of the concussion she sustained that kept her out of football for over a year.

“For the first two or three weeks, I was locked in a dark room,” Prior told ABC Sport.

“I had to drive from Canberra to Sydney and I had to lie down in the car with a towel wrapped around my head because I kept getting motion sickness.

“There were physical symptoms like headaches and nosebleeds, feeling really fatigued, really tired. I couldn’t really concentrate. My eyes started hurting, the backs of my eyes felt so achy. The headaches felt like a migraine.” 

Prior says even simple activities like watching TV or reading were made difficult.

“But I think the biggest part for me was probably the mental health side, rather than the physical. I really suffered with mental health issues; I think I always had a little something going on, but the concussion brought it out in the worst way,” said Prior.

Concussion in women athletes has come into sharper focus in recent years, with researchers finding that brain injuries sustained during contact sport affect women differently than men.

While the underlying injury is the same — one or several jolts to the head or the body resulting in damage to the brain’s white matter, which is responsible for neural connectivity — an emerging body of research suggests women athletes are concussed more regularly and can take longer to recover than their male colleagues.

In April, former AFLW player Jacinda Barclay became the first contact sportswoman in Australia to donate her brain to the Australian Sports Bank.

Until recently, most sporting guidelines and protocols around concussion — as well as other types of injuries such as ACL tears — were based on research into men’s bodies, with the results simply transplanted onto women.

But the Barclay findings have opened up new avenues of inquiry into how concussion affects younger women.

“It’s hard,” Prior said, when asked whether she had read the Barclay story.

“I’m aware of it but I try not to read it too much because I know what might happen to me. I know, every time I play, I’m setting myself up for something like that, or letting myself get closer to what she had.

“It was a difficult decision to come back to play, one that I tossed with quite a lot. I think it was a matter of COVID hitting, working full-time, and needing an escape from the mundane life, which football gives you. But obviously there’s the risk, too; it’s a fine line to walk.

“Barclay seems to have kick-started a bit of a movement. It’s great that she donated her brain, it’s inspired a bit of a process where concussions are going to be reviewed and get taken more seriously. It’s sad that something like that had to happen for it to get noticed in women, but that’s where we’re at.”

In a footballing context, concussions are not just sustained through bodily contact, but also through the repeated heading of footballs. 

A number of governing bodies, including England’s FA and US Soccer, have begun to phase out heading at training for youth players. There are growing calls for Football Australia to do the same. 

An FA spokesperson said they “continue to closely monitor the research and are participating in active discussions on this matter, including setting up a group of subject-matter experts with diverse skill-sets and experience in concussion … to review, monitor and ensure we are abiding by evidence-based best practice including any need to continuously evolve our rules, guidelines and policies to all matters relating to concussion, including heading the ball.”

Meanwhile, the Australian Professional Leagues, which now operates both the W-League and the A-League, continues to review its own policies in light of emerging research.

Next season will see the introduction of concussion substitutes, while other initiatives such as independent “spotters” at stadiums and better technology for club doctors to review footage have also been suggested.

Currently, the same concussion protocols apply to both A-League and W-League footballers. Following clearance from a qualified medical practitioner, a player must undertake a six-stage Graduated Return to Play Program, and a minimum of 120 hours (or five days) must pass, before they can return to the field.

For Prior, that’s not long enough — particularly in light of gender-specific concussion research. She knows all too well how long recovery can really take.

“Given how short the W-League season is, I understand the rules, but it’s not enough time at all,” she said.

“Even a little knock could be a concussion, it just might not get diagnosed. I think it should be however long until a player feels comfortable, which is obviously hard in itself given the external pressure of coaches and players wanting to play, especially in a 14-week season. But I think it should be at the player’s discretion when they feel comfortable.

“If you break a bone, you’re looking at six to eight weeks, so maybe they should put concussions in line with fractures. You can’t put a cast on your head, but if they had guidelines that treated concussions like it was a bone-break, that’s probably a good place to start.”

As for her own future, Prior remains undecided, asking herself the same questions that many women athletes grapple with when it comes to their own health and wellbeing.

“I’ve got my personal reasons for wanting to play, but then I’ve got big reasons not to play,” she said.

“Am I going to be selfish with playing because I know that I enjoy it now? Or am I going to step away from it knowing that my life later on will probably be a bit brighter and probably not so forgetful with dementia?

“It’s a really hard decision because it’s short-term happiness versus long-term health.

“But I’ll definitely donate my brain; you don’t need it once you’re gone, anyway. If something bad that happened to me can potentially help someone else and make it better, not just in football but in other sports as well, then I’m happy to do that.”