Shedding light on sport’s deadly secret

When we meet Dr Linda Iles at the Victorian Institute of Forensic Medicine, she is clearly favouring one leg.

Turns out her plans for a marathon hike in the Snowy Mountains were thwarted when she fell off a ladder in her accommodation on day one. Instead, she managed to walk 50 kilometres in three days on her injured ankle, proving that she is crazy determined and that doctors should never be allowed to treat themselves.

Dr Linda Iles, head pathologist at the Victorian Institute of Forensic Medicine.Credit: Wayne Taylor

You don’t have to be a brain surgeon to know you should rest an injured leg, which is surprising as Iles is a rare type of brain surgeon.

Iles is the head of Forensic Pathology Services and is an expert on forensic neuropathology, performing up to 200 post-mortem brain examinations a year.

As a medical student in Tasmania, she found a love and a flair for pathology, and spent much of her spare time at the R. A. Rodda Museum in Hobart.

A specialist medical training facility, Rodda has about 2700 specimens that were harvested from autopsies and medical procedures. The samples were collected from 1953 and 1985 and came from 147 people. Trouble is, many may have been taken without their families’ consent. Tasmania’s Coroner’s Office is investigating the issue.

Iles is troubled by the sample collection process, having learnt so much in the museum, but looking through a “contemporary lens” now sees it as intrusive.

That need for balance is at the forefront of some of her present work relating to the post-death diagnosis for chronic traumatic encephalopathy (CTE), a concussion-related condition that has (wrongly) been considered a risk only to elite professional sportspeople.

While it has been found in the brains of those involved in AFL, rugby, hockey, motocross and boxing, studies have now found victims of long-term domestic abuse are also at risk.

Further research shows members of the military who have been subjected to repeat bomb concussions can be victims.

While it is considered a professional sport condition, researchers say there are more victims from amateur sport, where concussion protocols are less strict. Iles says many cases go undiagnosed even after death.

In many ways researchers are flying blind. They rely on the living, people who believe they may suffer from the condition, offering to donate their brains to science.

Others may be referred by the coroner after a suicide when the family believes CTE could have been the cause of a person taking their own life.

One of the first former players to offer to donate his brain was Hawthorn premiership captain David Parkin, who says he may be the most concussed player in the game’s history, having been knocked out 13 times in his 15-year career. He said he retired after losing consciousness for more than 24 hours after being hit on the field.

Parkin, who played more than 200 games and coached three clubs (winning premierships at two), went on to be a razor-sharp commentator, academic and author. After suffering memory lapses recently, he now has regular brain scans to monitor his cognitive capacities.

He says that while the game has been cleaned up, the risks are greater because players are subjected to more collisions.

“I played in the back pocket and was involved in about 5 per cent of the game. Now players are involved in 90 per cent of the game.”

Having sat on AFL concussion panels, he says the sport must confront the condition. “I don’t know the answers. I’m not sure anyone does,” he says.

Captain David Parkin leading Hawthorn out in 1971, a premiership year.

He once attributed his repeated concussions to having a “glass jaw”, an expression used for boxers who were knocked out frequently.

In fact, 100 years ago, CTE was known as punch drunk syndrome, relating to boxers whose brain injuries left them stumbling and slurring words as if permanently intoxicated.

In boxing, a fighter may have the reputation of having a “good chin”, meaning they can take a punch, but as the constant damage from repeated blows in fights and training mounts, one day it is gone. Then their jaws turn to glass. The same has been seen in other sports, including AFL, in which multiple concussions make the victim more susceptible to apparently minor blows.

Iles says the big bang concussion cases, in which an athlete is knocked out cold, while dangerous, are not the cause of CTE, which has its origins in repeat head trauma that results in mini-concussions or no concussions at all.

“It is about repetitive exposure,” Iles says. And there is no safe level because “some people are more vulnerable than others”.

She says it may take decades for the damage to become obvious. “The brain doesn’t mend very well.”

In many sports, the mantra is you train as you play. Boxers spar to prepare for a fight, footballers have contact match practices and soccer players head hundreds of balls to prepare for that one golden cross into an open goal.

A University of Glasgow study found former professional Scottish soccer players suffered degenerative neurological conditions at more than three times the rate of the general population, while goalkeepers – who rarely head the ball – had no added risk.

When a side isn’t tough enough, the coach may order a physical training session with the dreaded words: “Bring your mouthguards.”

There are about 60 suicides a month in Victoria, but only in a handful of cases will an autopsy be ordered, and the complex diagnostic procedure be conducted for CTE.

Geelong legend Graham “Polly” Farmer was found to have had CTE.Credit:

Iles says that in about 15 cases a year the brain is sent to the Sports Brain Bank in Sydney for analysis.

In other cases, initial tests can be conducted in Melbourne at the request of relatives who believe the victim may have been suffering the condition. Iles says that some cases have been referred by country police who know the victim suffered repeat head knocks playing sport.

In Melbourne, there are four or five confirmed cases a year, but Iles knows there will be many more for which the symptoms are put down as conditions such as dementia or where relatives do not wish to have the victims’ brains dissected – the only way to confirm CTE. “So we just don’t know how many cases there are,” says Iles.

AFL players Graham “Polly” Farmer, Shane Tuck and Danny Frawley and AFLW player Heather Anderson were found to have CTE via post-mortem brain examination. Tuck played more than 150 games but also boxed and was knocked out after his football career. Tuck, Frawley and Anderson took their own lives.

“The consequence to the individuals is devastating,” says Iles. “Loved ones suffer [from the character changes] for years.”

There is hope of a breakthrough. Auckland University researchers have discovered a unique pattern of inflammation in the brains of CTE sufferers, opening the possibility of a simple blood test within 10 years.

AFL doctors are now empowered to remove a suspected concussion victim from the field, and players have been compulsorily retired after repeat bouts. Years ago, doctors were expected to patch up players so they could play, with little consideration of the athletes’ long-term health.

Despite major changes in concussion protocols in the AFL, and a massive cultural shift in which players have a duty of care to their opponents, old, dangerous acts are still valued.

The player who recklessly flies into a pack against the flight of the ball, the star who returns to the field with their head swathed in a bandage while supporters scream for players to “put your head over the ball”.

One AFL coach, who took on a suburban club, was concerned the women players were leading with their heads when they tried to gather the ball in a pack. He taught them how to turn their bodies using their hips to protect their heads. The result? They began to concuss opponents who weren’t similarly trained.

In year 12, I changed schools and turned up at Heidelberg High School, where one of the most popular students was Craig “Snaggles” Stewart.

Big, good-looking and charismatic, Stewart, we thought, was a certainty to be picked up by Collingwood in the AFL, but as a school footy star he didn’t have tickets on himself.

Calm and with a dry wit, he had friends in all the cliques that any school develops.

Craig Stewart (right) trying to smother a kick in 1983. Credit: Age archives

Snaggles was not selected for Collingwood and went to Preston in the Victorian Football Association, where he won the goal kicking. Then Collingwood had second thoughts. He played for the Pies for many years, before moving to Richmond, playing a total of 150 games.

I would see him every few years at school reunions, various social functions and at Il Duca, an Italian restaurant near the MCG we both liked.

To me, he didn’t seem to have changed, and remained smooth, funny and a natural people person. But through friends, I had heard he had changed, that he had become withdrawn and “was losing the plot”.

Craig made a fortune and then lost it, then was sucked into investing hundreds of thousands with the wrong crowd. For a smart guy, he made a series of inexplicably dumb decisions.

I was still shocked when he died in 2023. An analysis of his brain at the Australian Sports Brain bank showed he had early-stage CTE.

If you or anyone you know needs mental health support, call Lifeline on 131 114 or Beyond Blue on 1300 224 636.

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