Subsequent Injury Risk Following Concussion in Australian Football League (AFL) Male Athletes: Is It a Case of a Player Being 'Luckless'?

Background

Sports-related concussion (SRC) is associated with elevated subsequent musculoskeletal (MSK) injury risk, yet no study has examined whether a mandatory post-concussion rest period mitigates this risk in professional Australian rules football. The aim of this study was to compare subsequent injury risk following SRC in Australian Football League (AFL) male athletes across two periods: a discretionary return-to-play period (2016 to 2019) and a mandatory 12-day non-competition period (2021 to 2024).

Methods

Injury data were extracted from publicly available AFL injury reports across eight seasons (n = 4351 players). Risk ratios (RRs) with 95% confidence intervals were calculated using log-binomial methods, with pooled estimates derived via the Mantel-Haenszel approach.

Results

Across both periods, SRC significantly increased overall MSK injury risk compared to MSK-first injury risk (2016 to 2019: RR:1.59 [95%CI:1.31 to 1.92]; p < 0.001; 2021 to 2024: RR:1.56 [95%CI:1.28 to 1.91]; p < 0.001). Upper and lower limb injury risks were similarly elevated across both eras. Notably, the risk of subsequent concussion was significantly elevated during 2016 to 2019 (RR:3.14, p < 0.001), whereas no statistically significant elevation was demonstrated during 2021 to 2024 (RR:1.30, p = 0.324).

Conclusions

During the 12-day rest period, subsequent concussion risk was no longer significantly elevated, while MSK injury risk remained increased, suggesting longer recovery periods may be warranted for full neuromuscular recovery following SRC.