Concussion and the future of rugby

[dasNdanger]

As many here may know, there's growing concern about American football players and the long-term effects of concussions they received while playing the game. Some former pro players have even brought a suit against the NFL for not taking enough precaution to protect players from traumatic brain injury. One serious consequence of concussion - chronic traumatic encephalopathy http://en.wikipedia.org/wiki/Chronic_traumatic_encephalopathy - has been diagnosed post-mortem in several former NFL players. This is causing people to take a serious look at the effects of brain injury on players, with an eye first and foremost on the youth and junior leagues. It's likely that the safety of professional players will soon come under scrutiny. Some are suggesting that this will have a major, game-changing impact on American football. Time will tell how it all plays out.

But what about rugby? What are the concerns regarding the long-term effects of concussion? Has CTE been diagnosed in former rugby players as well? I understand that some precautions are being considered in the junior leagues, but what about the professional players? Will the game need to be drastically changed on the eve of its international re-birth in order to protect players from traumatic brain injury? What can be done now to see that players are not put at unnecessary risk for long-term brain injury?

I am very curious about this, and it's the main reason I joined the forum. I want to know what sort of discussion - if any - about concussion concerns has taken place in rugby nations (in the US the talk only involves American football, so I feel a bit out of the rugby loop here, so any feedback is much appreciated).


das

 

[Peat]

The concern over concussion is nearly as big here.

We don't have any suings, or post-mortems yet, but we are very much aware that it's doing damage - and possibly more than acceptable.

A great deal of the problem is that the vast majority of cases go unreported. I think one pro player reckoned he'd had 40 or 50 of them and reported about 4. Even when they are reported, they aren't taken as seriously as you like. We recently changed from minimum rest periods to cognition tests, to be more accurate. Great, until you consider pro players routinely underperform so they can get back into action quicker.

So there are steps to solve it underway, but the problem is every step forwards is met by players and coaches who are desperate to win and cunning about it. An example is that in the JWC, they're trialling a system where players can be temporarily replaced while a player is assessed for signs of concussion. Nothing's happened yet, but it seems a matter of time until a team takes advantage of this to get a player a breather/sub a player back on, the same way the blood sub rules were taken advantage of.

But yes. It is a serious concern, if not quite as big in American Football.

 

[dasNdanger]

Thanks for the feedback.

I've always known that concussions are dangerous, but it's only recently that I've learned just how bad they can be. My concern about rugby players goes a few years back when Leon MacDonald got a bad concussion (not sure if he was playing as an All Black or Crusader at the time - I'm thinking it may have been an international match, just not sure). It was a while ago and I don't remember all the details, but I do remember it was raining, and he collided with another player - it may even have been a teammate - and he crumpled to the ground. Then, slowly, he tried to pick himself up, but blood was just gushing from his head. He laid his head back down on the wet turf, and waited for help. Not long afterwards I think he had another concussion, and there was talk of him getting out of the game then, but he kept playing. Although I didn't see him much in his later years as a player, I always worried about him because that was one nasty head-clash, and everytime the word 'concussion' came up during a match, my thoughts always went right back to MacDonald.

I know many other players have had serious head injuries, as well, and while I love the action - and the impact - of the game, I do have to question whether it's worth the risk sometimes. Sadly, I just don't see how to make it safer without fundamentally changing the game.


das

 

[Zed]

There have been quite a few high profile cases in recent years, Elton Flatley had to retire at 28 because of concussions and Berrick Barnes had the same problem last year, although seems better. I wear head gear, but have been concussed twice. Dasndanger, you'd probably come up against some big boys over in NZ, in Perth there are a lot of big islanders/maoris and that doesn't help with concussions! Our relatively mobile Samoan prop is 135kg and that's mostly muscle! I wouldn't like to play against him.

 

[dasNdanger]

There have been quite a few high profile cases in recent years, Elton Flatley had to retire at 28 because of concussions and Berrick Barnes had the same problem last year, although seems better. I wear head gear, but have been concussed twice. Dasndanger, you'd probably come up against some big boys over in NZ, in Perth there are a lot of big islanders/maoris and that doesn't help with concussions! Our relatively mobile Samoan prop is 135kg and that's mostly muscle! I wouldn't like to play against him.

Oh, wow...yeah, I remember Flatley. That's a shame. Since my rugby coverage is spotty here in the States, I sometimes lose track of players, especially the ones who move around a lot. Every now and then I'll hear a name and realize they're no longer playing the game, but I usually don't find out why (unless it's an obvious age retirement).

Between you and me, I hope I never have to come up against a 135kg Samoan, seeing as how I'm of the fairer sex, and - ya know - old.


das

 

[Peat]

There's a lad in Ulster who took a year out of the game after picking up a few too many head injuries in short succession...

And there's also a guy who reputedly spent a lot of the season missing or on the bench because he was recovering from concussion but still spent some minutes out on the pitch. When he probably shouldn't have. If you believe internet gossip. Which I may do.

 

[dasNdanger]

For brain health some things I'm pondering...

1. Replacements. I'm thinking more replacements for injury will be needed - not many, not like a whole second squad, but perhaps two more wouldn't hurt, as long as they are earmarked for injury only, and not strategy. I understand the risk of blood bins being abused for a bit of freshing up, but somehow a balance has to be found. Just not sure how that will happen unless there's a whole revamp of how injuries are perceived, and handled.

2. The player mindset and self-deception. With a limited pool of replacements guys who get head-bashed on the pitch are likely to tough it out, even if they can't see straight. Not only will they do this because there's no one to take their place, but because of that diehard rugby pride. I think there will have to come a time when players realize that it's not a weakness to admit they're hurt. Learning to be honest with oneself is probably one of the hardest things for a man to do when he's hellbent on finishing out a game.

3. The medics. I wonder how many medics feel pressured to let a player stay in the game when he clearly should be pulled. A hamstring is one thing, but a head injury is quite another. Of course, not every cut on the brow means a concussion, but when a medic suspects that there may be an underlying problem he or she just might have to make a hard call. Rugby players are like cats, they hid their pain well. Medics need to put common sense above emotion - when in doubt, pull them out. I'm sure some do, but I've seen more than one woozy player insist on staying on the pitch.

I'm sure management plays a big part, too, but I really don't know much about how the internal structure of rugby works. I'm just going by what I see, and even there I certainly don't have or know all the facts. So I'm putting this out there for anyone to add to, disagree with, or whatever. Hopefully in the process it will help me understand the workings behind the scenes a bit better, too.


das

 

[Feicarsinn]

Bernard Jackman's book gives a decent insight into concussion in rugby. If you're interested in the subject I'd recommend it.

 

[dasNdanger]

Bernard Jackman's book gives a decent insight into concussion in rugby. If you're interested in the subject I'd recommend it.

Thanks! And yeah, I am interested...if the book isn't too thick.



das

 

[Peat]

das - You could have a hundred men waiting on the bench, and players will continue to play if they can, because it's playing instead of not playing. If players are to be hauled off, there needs to be an independent medical figure with the authority to say "I'm not happy, this player is leaving".

 

[RedruthRFC]

Great topic, it has surprised me for some time (possibly since hearing about Bernard Jackman's IIRC 17 concussions in a season) that this problem isn't being taken more seriously.

My primary interest is in level 4 rugby here in England. This season just gone, I witnessed a player sustain a cartoon style concussion (clash of heads, both players hit deck, wait, player gets up, player's knees buckle, hit deck again) early on in a game. He played the full game, after which I spoke to him, by this time he was highly photosensitive and experiencing a banging headache. He said he played on because there was nobody suitable to replace him, despite the fact that his club's physio was fully aware of what was wrong with him, sure enough, he was back out playing the next week. I spoke to him after another game more recently and again he was complaining of photosensitivity and commented that "I've only had three concussions this season - it's not too bad".

I agree with your second post dasNdanger, a combination of bravado and a sense of duty makes players unwilling to come off. However, I do wonder if players were made fully aware of the potential consequences of playing with a concussion whether they would still be so keen to play on, the same applies to coaching staff who might put pressure on players to play on / the next week.

I'm not sure if I agree that any "medic" would act in the team's interest before an individual player's, in fact I would go as far as to say that any individual who does should be struck off. In an ideal world, every game would have an independent doctor in attendance who would agree to report any suspected concussion to the referee, who could order the player concerned off the field and make a report to the responsible union so that the player isn't allowed to play for four weeks (or whatever the current recommendation is) unless that player provides evidence of being concussion free. However the reality is that this isn't feasible in the lower level game, so I don't really know how this should be dealt with.

With regard to increasing the number of players on the bench, I can see an argument for this, but again, at lower levels teams struggle to get a side out with a minimal bench, so requiring a larger bench isn't going to be practical.

 

[TrueSlawter]

I've only ever had the one concussion and if im honest I hope its the last. As for players continuing on I've seen it a few times where a guy gets a bad knock to the head the coach looks over them (no physio's at youth level and below) and he continues the game or gets taken off 10 odd mins later when its clear he has no clue as to where he is or what he is doing.

 

[admartian]

I've always been under the impression that the nature of rugby (meaning, lack of using padding and helmets as a "neutraliser") leads to less concussions. No doubt they happen, but I think they're less (or as has been suggested within the thread, less reported, rather) of an occurrence.

 

[RedruthRFC]

I've always been under the impression that the nature of rugby (meaning, lack of using padding and helmets as a "neutraliser") leads to less concussions. No doubt they happen, but I think they're less (or as has been suggested within the thread, less reported, rather) of an occurrence.

I remember this kind of argument back in the late nineties when there was a spate of players wearing "body armour", i.e. that padding leads to players throwing themselves into contact harder / differently than they would otherwise believing they are safer when in reality they are no better protected. IIRC the IRB stepped in and limited the amount of padding that players are allowed to wear. Maybe the same is the case with scrum caps.

I would be interested to know if there have been any studies done into the effectiveness of scrum caps at preventing injury. I stopped playing before they came back into fashion, had they been popular when I was playing, I would have worn one, but only because it's easier and more effective than taping the ears down, not in the belief that I would be any safer, although maybe the opposite would have been true.

Another study that would interest me (although one that I'm sure hasn't been done) is to see if there is any correlation between players penalised for using their heads to clear out and players who wear scrum caps.

 

[Saintjay]

I remember this kind of argument back in the late nineties when there was a spate of players wearing "body armour", i.e. that padding leads to players throwing themselves into contact harder / differently than they would otherwise believing they are safer when in reality they are no better protected. IIRC the IRB stepped in and limited the amount of padding that players are allowed to wear. Maybe the same is the case with scrum caps.

I would be interested to know if there have been any studies done into the effectiveness of scrum caps at preventing injury. I stopped playing before they came back into fashion, had they been popular when I was playing, I would have worn one, but only because it's easier and more effective than taping the ears down, not in the belief that I would be any safer, although maybe the opposite would have been true.

Another study that would interest me (although one that I'm sure hasn't been done) is to see if there is any correlation between players penalised for using their heads to clear out and players who wear scrum caps.

The documentry "Head Games" is worth watching. It is about the amount of brain injuries in U.S college football. Lots of the film talks about how the players are taking hugh knocks and being told to dust off and get back out onto the field. Even with helmets the damage the players and coaching is causing is pretty horible.

I am not sure how up to date this is but you had about 2000 ex-NFL players lawsuits pending because of the risk of dementia etc. The players were never made aware of the risks and just told to play on. It would not surprise me that the pending legal action may have made the IRB sit up and take notice before it finds it-self in the same boat. I am not surprised to hear similar tales of rugby players just getting on with it despite the possible problems in later life.

 

[Canadian_Rugger]

I have had a number of concussions playing a sport and its not rugby. I received 2 concussions playing ice hockey, at the time people didn't know the dangers of concussions nor did I. I remember I was 16 playing in a tournament in Canada, tournaments are usually played over a 4 day period, and the first game I received a very big hit about 5 feet from the boards did a complete flip and landed on my head. Was very dizzy and had a headache the rest of the day but I still played that night. Another time I got checked from behind and went into the boards head first and ended up leaving the game. I never missed a practice though and played another game 4 days later. We didn't know the dangers of this back then and many kids that received concussions simply played through them like I did. Knowing what I know now I am wondering how much permanent damage my decisions to play caused.

I know that in Canada contact is thrown into ice hockey at age 11 and I now know of kids having to leave the sport as early as age 16 because of this. I actually stopped playing hockey at age 17 because of successive injuries, all of which were results of dirty play. I began playing rugby at age 16 and have not had, other than the normal knocks and bruises, any real serious injuries. As far as I am concerned Ice Hockey and American Football are the two most dangerous sports for concussions due to the speed and intensity of the hits. Rugby is a contact sport; however, Ice Hockey and American Football are collision sports. You don't have people blind-siding you in rugby and you don't have players travelling upwards of 45km/h on a pair of blades trying to literally take your head off.

On top of this rugby is a gentlemans sport, an aspect which I think is often overlooked. I don't think you will ever see the concussion problems at the amateur levels of rugby that you do with other professional sports. The problem in rugby lies solely at the professional game. I think players are playing far too many games, and the IRB and the respective national unions need to sort out how many games players are playing. I think a lot of injuries are occurring due to fatigue and over-playing. If rugby sorts this out I think you will see injuries diminish substantially.

 

[RedruthRFC]

On top of this rugby is a gentlemans sport, an aspect which I think is often overlooked. I don't think you will ever see the concussion problems at the amateur levels of rugby that you do with other professional sports. The problem in rugby lies solely at the professional game. I think players are playing far too many games, and the IRB and the respective national unions need to sort out how many games players are playing.

It depends on where you're drawing the "pro" line, but the player I mention in my original post is playing level 4 rugby in England, I know he gets "something for his troubles" but he also holds down a full time job. In England at least, there are plenty of big guys playing highly competitive games at level 4 and maybe lower (level 4 is the lowest level I watch regularly).

I think a lot of injuries are occurring due to fatigue and over-playing. If rugby sorts this out I think you will see injuries diminish substantially.

This is the case with many injuries, but not concussion - you're either concussed or you're not.

 

[Canadian_Rugger]

I will elaborate on my point a littel bit more. I think the demands of the pro game right now are too high. Players are being forced to play injured due to the small rosters and the number of games players are forced to play. Not to mention how generally crappy pro rugby contracts are. You get a concussion and sit out a couple of games, you are spent goods and the team can and will release you at the end of the season.

 

[lynam1104]

There was a study done in the Aussie uni's that showed scrum caps were ineffective in prevent concussion, as were double padded scrum caps.

 

[snoopy snoopy dog dog]

In my opinion, there players are asked to play too often. The new protocol on concussions (5 minutes to diagnose a problem) are a step in the right direction but I think something must be done to reduce the number of games players play and perhaps introducing rolling substitutions needs to be looked at too.