A RESPECTED medical journal has recommended sports consider rule changes to ensure the gameday treatment of players suspected of suffering concussion occurs "without affecting the flow of the game or unduly penalising the injured player’s team."

The statement is sure to influence the AFL Commission's thinking as it considers allowing clubs to temporarily use the substitute while a player is being assessed for concussion in 2013.

Concussion conference slated for March

The AFL Medical Officers Association recommended the Laws of the Game Committee consider a concussion sub for 2013 believing that the new conservative concussion guidelines – to be released this week – needed a structure to support them to work in practice.

The Laws of the Came Committee referred the decision to the Commission after meeting last Wednesday and the AFL has remained tight-lipped since.

The Commission is expected to make a decision next week on the issue.

On Tuesday, the British Journal of Sports Medicine released the Consensus Statement on Concussion. The document arose from a November conference in Zurich held to discuss concussion in sport.

The 2008 Zurich document underpinned the AFL's concussion guidelines and this document will inform the AFL's new concussion guidelines.

Significantly, the consensus statement urged caution should be taken in relation to the controversial chronic traumatic encephalopathy (CTE) and found that a "cause and effect relationship has not as yet been demonstrated between chronic traumatic encephalopathy (CTE) and concussions or exposure to contact sports".

The authors acknowledged the media pressure arising from a focus on CTE and said a strategy was needed to ease the fears that arose in relation to it, particularly among parents and athletes.

An interview a fortnight ago with former AFL champion Greg Williams put concussion firmly on the agenda and heightened concerns about the potential effect of head knocks on players later in life.

It is a major issue among former NFL players.  

The consensus statement found that assessment of a concussive injury should be made using a SCAT3 and other sideline assessment tools.

The AFL will introduce the use of video footage in evaluation to ensure doctors are aware of what state the player was in soon after a head knock.

The consensus statement reaffirmed that players with diagnosed concussion should not return to play on the day of the injury.

It recommended that "physical and cognitive rest until acute symptoms resolve and then a graded programme of exertion prior to medical clearance" was the cornerstone of concussion management.

The consensus statement also found there was no good evidence that mouthguards or helmets ward off concussion. The possibility that the use of a helmet may lead to behavioural change that causes players to adopt more dangerous playing techniques has also been raised as an issue.

The conference on concussion in football to be held at Etihad Stadium on March 20-21 will attract the world's leading experts on the issue of concussion in sport.

It will detail the best practice management of concussion at elite and community level, put concussion research into practice and implement outcomes from the 2012 Zurich International Consensus Conference on Concussion in Sport.