The AFL should limit the number of contact training sessions and hire independent doctors to assess players who suffer head knocks to reduce the risk of concussion.
That's what Victorian State Coroner John Cain recommended as he handed down his findings into the death of former AFL player Shane Tuck on Monday.
Tuck had been hearing voices, had suicidal thoughts and was forced to stay in a psychiatric ward in the years before he took his life in July 2020, the inquest was told.
Judge Cain said it was accepted Tuck received repeated head knocks in his 173 games for AFL club Richmond and while competing as a professional boxer.
The 38-year-old was diagnosed with a severe form the degenerative brain condition CTE after his death.
Judge Cain did not make findings into the nature of Tuck's death, instead looking at preventative measures in sport to reduce concussion.
He recommended the AFL limit the number of contact training sessions players participate in before, during and after the regular season from 2025.
The sporting body should also employ independent medical practitioners to attend every AFL and AFLW match to help club doctors assess players after head knocks.
They should jointly decide whether the player be removed from the game but if there was a disagreement, the independent advice would win out, Judge Cain said.
The AFL should also develop and implement baseline neurological testing for each player to do at the start of each season, the judge said.
The data would be linked to the player's clinical profile to monitor for any changes and be used more widely by the league for medical research.
Judge Cain said the AFL should continue to assess the use of mouthguard accelerometers and protective helmets as other ways to measure and limit concussion from head knocks.
The AFL said it would take time to review the recommendations.
"The AFL has a team of people specifically working on initiatives to improve brain health in our sport," its statement read.
"We will continue to strengthen protocols and the education of clubs and players as to why this issue is taken so seriously."
Judge Cain commended the AFL for its work in recent years to implement concussion protocols and alter rules of the game.
He advised the AFL to work closely with the Players' Association around education, which the organisation welcomed.
"We look forward to discussing the coroner's recommendations in more detail with the AFL," AFLPA legal general manager Megan Comerford said.
"It remains clear that more work needs to be done to protect, care for and support current and past players who have, and will continue to, put their bodies on the line so the industry can prosper."
The coroner made eight recommendations in relation to professional and amateur boxing.
Tuck became a professional boxer in South Australia after his AFL career ended in 2013, competing in four professional boxing bouts in Victoria.
Judge Cain recommended sparring be limited in training to reduce repetitive head knocks and boxers should undertake baseline neurological testing annually.
The Department of Jobs, Skills, Industry and Regions should extend the Victorian Professional Boxing and Combat Sports Board's oversight to amateur boxing so all rules and advice were standardised, the judge said.
He advised the department to work with its interstate counterparts to develop a national database of registered boxers where evidence-based approaches would be applicable to everyone.
A Victorian government spokeswoman said the state welcomed the coroner's report and would closely consider the recommendations.
Judge Cain extended his sincere sympathies to the Tuck family, who did not attend court on Monday.
He noted Tuck's sister Renee previously said the family would never be "fully healed or set free from the experience of Shane being taken away".
The Tucks are among the more than 70 former players and their families who are suing the AFL, claiming the league knew of risks of harm related to concussion management.
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Australian Associated Press