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Concussion and the future of rugby

A bit pressed for time but would like to quickly thank everyone who has responded. At work right now so can't get into the deeper stuff, perhaps if I get a chance later I will try to address your comments in a little more detail.

However, I will just pick out this 'easy' one:

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.

I was always under the impression that a scrum cap was to protect the ears, not the head. If a gridiron football player with his bigarse hard helmet gets a concussion, then how's a bit of fancy foam going to protect a rugby player's noggin? I wonder if the caps give a false sense of security?

das
 
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 play well below level 4 and have tackled and ran at some absolutely huge people. There is no shortage of physicality and there is no shortage of competition. If you're not those two things, then what the hell are you doing on a rugby pitch, at any level?

Frankly, I imagine the majority of cases of injured players playing are at the players' insistence. People without the appetite and resilience to want to play through the injury barrier don't really reach pro rugby levels.
 
Good article I found while doing some research for another thread.


Rugby's ticking timebomb! Fears grow as evidence links brain damage and dementia to increasing number of serious head injuries suffered by top players

The sight of Toby Flood lying unconcious on the Welford Road turf surrounded by anxious medics on Saturday provided another unwanted reminder of the dangers rugby players face on a match-by-match basis.

The 28-year-old Leicester and England fly-half, whose last competitive game saw him knocked unconscious during the Aviva Premiership final at Twickenham in May, required 12 minutes of on-field treatment yesterday before he was taken from the pitch on a stretcher and rushed to Leicester Royal Infirmary, his neck in a brace and still requiring oxygen.


Ulster lock Dan Tuohy received a yellow card for his actions, and could yet face further sanction after his forearm appeared to make contact with Toby Flood's head. Mercifully for Flood, early indications last night appeared to show no more serious short-term damage than a nasty gash above his left eye and a sore head.
But the consequences for his long-term mental health are less clear.
With the new Aviva Premiership season about to get under way this week, urgent calls have been made for more to be done to protect players from the frightening consequences of head injuries.
Concussion is the most common injury suffered at the top level of English rugby, with statistics showing one player concussed in every five Premiership matches. But there are growing concerns that concussed players are being allowed to stay on the field or being returned to play after only a perfunctory examination.
The captain: Lewis Moody

article-2408067-0E492E1900000578-93_87x84.jpg

Former England captain, nicknamed Mad Dog for his combative style. Retired from rugby in 2012
I have been out cold five times, but towards the end of my career I was getting other forms of concussion far more frequently. It got to the stage that whenever I had a blow to the head I had the feeling for a minute or so that the game was going in slow motion. I had a couple of really bad ones for England against Australia in 2010, when I was stumbling around the pitch for several minutes, and against Tonga in 2007. I got knocked out twice in that game and that was the only time I had really severe migraines afterwards. The big problem is when it happens in a big match and the club and player want to play on. I have played on in games when I have been knocked out cold. The doctor will come on and ask a series of questions such as 'say the months of the year backwards' and crucially they will say 'are you OK?' As a player you will do whatever you can to stay on. Concussion is viewed as a minor injury you can run off in a couple of minutes. We need to change that mind-set.


Despite a clear link being established between repeated concussion and early-onset dementia, depression and other neurological diseases, rugby's governing bodies have been accused of 'playing Russian roulette' with players' long-term health by not implementing more stringent safety procedures.
The man making that claim is Dr Barry O'Driscoll, a former Ireland international who resigned as the IRB's chief medical officer last year in protest at the introduction of the controversial Pitchside Suspected Concussion Assessment (PSCA), a protocol which aims to establish whether a player has been concussed during a game.
O'Driscoll, whose nephew is Ireland rugby great Brian O'Driscoll, said: 'It is going to take a tragedy for the reality to hit home.'
He believes the protocol's controversial insistence on the assessment being completed within five minutes of a player leaving the field, is 'completely discredited'. He added: 'There's absolutely no justification for the five-minute rule. It is a completely unjustified experiment, and it is playing Russian roulette with rugby players' health.
'We have to protect the players from themselves because they will pay for it later in life. Hips and knees can be replaced, but we only have one brain. If players show signs and symptoms of concussion they should not go back on the field for another seven days. It is not difficult to implement. It is what every other professional sport insists on but rugby thinks it is a law unto itself.'
O'Driscoll's son Gary, who is Arsenal's chief medical director, shares his father's concern and refused to consider being part of the Lions medical team for a third time for this summer because of his worries over the handling of concussion. 'I pulled out because I did not feel comfortable with it,' he said. 'I have big concerns about the way the IRB are going about it.'
Earlier this month Dr Willie Stewart discovered the first evidence of Chronic Traumatic Encephalopathy (CTE) in a former rugby player. Since then a further 10 potential cases have been presented to the Glasgow neuropathologist.


'If we liken this to a marathon, then the gun has only just gone off,' said Dr Stewart. 'It would be foolish to think rugby is immune to brain damage.' The IRB insist they are doing everything they can to mitigate risks to players - and strongly refute Barry O'Driscoll's position - but fears remain that there could be a ticking time-bomb of mental-health issues for a sport in which collisions are all too common.
The RFU's head of sports medicine, Dr Simon Kemp, said yesterday that the union were committed to delivering best practice in the handling of concussion cases. But he also said: 'We understand that there is no proven causal relationship between head injuries sustained while playing rugby union and the reported cases of CTE and early onset dementia.'
The player: Bernard Jackman

article-2408067-003DE05100000578-310_87x84.jpg

Former Ireland and Leinster hooker who retired in 2010 after being concussed 20 times in the last three years of his career
When you're playing, there's a feeling of invincibility. You're so focused on your goals and your team goals. Concussion can't get in the way of that. It was an honour to play for my country and for Leinster and I have some fantastic memories, so I feel the toll on my body was worth it. But what if in a few years' time I am diagnosed with dementia or another brain disease. Will it have been worth it then? I now suffer not only from pain like a migraine, but from longer-term problems like mood swings. There's a culture in rugby where concussion isn't taken as seriously as it should be by the players. Other players often joke and laugh about it. You enter a strange place called 'self-denial'. You accept that this is a normal part of your working life. The headaches, the sickness which follows, you know you have to get on with it, so you pop tablets more frequently than you know you should. I've heard more about head injuries in the last 12 months than ever before. I've read that the effects of concussions are cumulative, how one concussion leaves you more vulnerable for a second concussion and so on. I'm the living evidence of this.


The now notorious George Smith affair in Australia, which saw the Wallaby flanker allowed to return to the field just moments after leaving it barely able to stand up following a sickening clash of heads with Richard Hibbard in the third Test against the Lions, followed closely on from the disquiet over the incident which saw Flood remain on the field for several minutes during the Premiership final despite being knocked unconscious in a tackle by Courtney Lawes.
Senior figures at the International Rugby Board, the game's rulers, privately admit to being 'devastated' at the decision by Australia's team doctors to allow Smith back on to the field when he was clearly concussed. The incident drew widespread criticism and an added focus on the IRB's concussion protocols.
Former Scotland winger Rory Lamont, who retired last year through injury, said: 'The current IRB concussion protocol is simply dangerous. I don't know what research the IRB used for this trial but it is seriously flawed. Everyone sawSmith wobbling his way off the field, clearly concussed, and then come back on. There is no way a player should be allowed on the pitch after a head knock. It's insanity. We are seeing reckless disregard for players' welfare right now.'
Lamont also claims some players intentionally underperform in pre-season cognitive tests - taken to establish 'baseline' data against which further tests can be compared - in order to pass them later in the season if they go on to sustain a brain injury which impacts their mental agility.
The outcry over Smith's reintroduction in Sydney led to calls for the five-minute rule to be scrapped. But the IRB insist the global experiment has been 'highly successful' while promising to review the findings of the past year.
'The IRB are interested in protecting players,' said Dr Martin Raftery, who succeeded O'Driscoll as the IRB's chief medical officer. 'We are trying to move forward in a scientific, logical fashion. The inference that the IRB have made up this PSCA rule without thinking about it is ridiculous. We spent months and months developing it and looked at all the research available and were advised by independent experts. We have the support of player associations on this.'




Pioneering research on American Footballers published last year by Boston University in the United States demonstrated a clear link between successive concussions and degenerative brain diseases later in life. There is mounting evidence to suggest professional rugby players are being exposed to similar risks. The findings in the US led to more than 4,500 former players suing the National Football League. Last week the NFL agreed to pay out almost £500million in compensation to former players, deceased players' families, as well as funding further research into concussion-related illnesses.
The doctor: Willie Stewart

Neuropathologist at Glasgow's Southern General Hospital
I have seen the same pathology in a former rugby player in his fifties as that described in American footballers and boxers. It used to be called Dementia Pugilistica but it's now known as Chronic Traumatic Encephalopathy. It came as no surprise to see a former rugby player with this pathology. No game which involves repetitive head injury can be immune to this. The big questions now are: How many people will be affected? How many times does someone need to be hit? Are there other factors like genetics that might increase the risk? The size and athleticism of players now is considerably advanced from the Seventies and the frequency and severity of contact has increased. We might assume that players would be at greater risk today but that would only be an assumption. I expect there will be more cases out there. Whether there are many more, I couldn't say. In the past two weeks I have been notified of 10 people who died of dementia after playing rugby or are currently living with early onset dementia. That doesn't prove anything - there are many reasons why people get dementia - but at least in a couple of those cases the families who got in touch have always believed their father had dementia because of playing rugby. I have seen the George Smith incident and I don't think anybody within the game would support people coming back on to the pitch with concussion. That was an aberration and I don't think we should assume it will happen every week. I'm sure it's not what the rugby authorities want to happen. We're currently setting up a study looking at living people who have been exposed to head injuries and monitoring them over a number of years to try to test if there is any neurological impairment. From that we hope to be able to add information in terms of how many times someone needs to be hit, how hard, and the frequency required to trigger dementia.


The Boston research revealed that degenerative brain disease (CTE) had been found in 30 former NFL players, who, before they died, had shown symptoms similar to those found in boxers suffering from 'punch-drunk syndrome'. Former American Footballer and Harvard graduate Chris Nowinski - co-founder of the Sports Legacy Unit - was at the forefront of this research along with his colleague, Dr Robert Cantu.
'There is evidence of a concussion problem in rugby similar to that in the NFL,' said Nowinski, who suffered multiple concussions during his own playing career. 'It is not just an American Football problem, this has been found in boxers and ice hockey players. When you engage in something that involves repeated brain trauma with force, it opens the door to serious problems.
'At some point that damage turns into a disease. The damaged proteins have the ability to spread to other healthy proteins and damage them as well. It is like a crack in a windshield that keeps spreading by itself.'
Within rugby, there is serious concern over the pressure allegedly exerted on team doctors by coaching staff to pass players fit when they should be removed from the field. 'It takes a strong or experienced medic to turn around to a director of rugby or head coach and say "This player is coming off",' said recently retired Scotland captain Rory Lawson. 'I've no doubt that less experienced medics feel intimidated by their seniors.'
While Test matches governed by the IRB will see independent doctors on hand in the changing room capable of over-ruling team medics, this season's Aviva Premiership will have no such provision.
'In the five-minute test, the medic asks the player four or five questions when they are back in the dressing room,' said Barry O'Driscoll. 'They then have to stand for 20 seconds with one foot in front of the other without falling over. If they are able to do that, then they will ask them, "How do you feel?" That's ludicrous because at the top level these guys are real warriors - they are never going to say, "Can I stay off?" I suggested to the IRB five years ago that when you have a concussive incident the independent match doctor should go on. They have these at every game and they can overrule a team doctor. He is completely independent and he is the guy who should go on the field. If he says, "This is concussion", then the player comes off. The pressure comes off the team doctor and you get an objective, clinical view.'
There is also evidence that players are attempting to deceive medics into believing they are fit to play on. David Barnes, rugby manager at the Rugby Players' Association, has invited Nowinski to address the union's board next month and is anxious to educate players about the risks of playing on with concussion.
'We have come a long way in how concussion is managed but it remains a big area of concern,' said Barnes. 'I've dealt with a number of players who have had to retire with head injuries and it is alarming when you speak to those guys and realise what they are going through.'
Earlier this year, the family of former NSW Waratahs coach Barry Taylor, who had died after developing dementia at the age of 57, donated his brain to Boston University for research purposes. Taylor suffered multiple concussions during a lengthy playing career but, according to his wife, 'just played through them'.
Dr Willie Stewart said: 'Just as we discourage people from playing on with a damaged knee, so we should strongly discourage people playing on with a damaged brain.'
Toby Flood's injury yesterday demonstrated all too clearly the dangers rugby players at all levels face in today's highly competitive arena.


Read more: http://www.dailymail.co.uk/sport/ru...-injuries-suffered-players.html#ixzz2f0yAS2bU
Follow us: @MailOnline on Twitter | DailyMail on Facebook

It's probably easier to read from the site, but thought I'd post it here in case the article url stops working. Lots to think about here.


das
 
Sorry for the double post, but just saw this on CNN:

First soccer, rugby players diagnosed with CTE

By Stephanie Smith, CNN
updated 12:04 PM EST, Fri February 28, 2014

(CNN) -- The disease that carves an insidious path through the brain seems to be doing the same through sports.
Chronic traumatic encephalopathy, the degenerative brain disease associated with concussions, has been identified in both a soccer and a rugby player, according to a review in the journal Acta Neuropathologica.

The brain tissue of people found to have CTE displays an abnormal build-up of tau -- a protein that, when it spills out of cells, can choke off, or disable, neural pathways controlling things like memory, judgment and fear. CTE can be diagnosed only after death.

According to Dr. Ann McKee, a neuropathologist who has examined dozens of brains found to have CTE, the brain of the soccer player -- Patrick Grange -- displayed diffuse disease.

"There was very severe degeneration of the frontal lobes with widespread tau pathology in the frontal, temporal and parietal lobes," McKee, director of neuropathology at the Bedford VA Medical Center, said in an e-mail. "He is one of the youngest players to have shown this much disease."

Grange played with the Chicago Fire Reserve MLS team and the Albuquerque Asylum semi-pro team, according to his obituary. He died in 2012 at 29 after being diagnosed with amyotrophic lateral sclerosis, a rare, incurable neurodegenerative disease. About 13% of the 103 CTE cases uncovered by McKee and colleagues also showed evidence of progressive motor neuron disease.

"(Grange) had no known genetic predisposition for ALS," said McKee, professor of neurology and pathology at the Boston University School of Medicine. "And no family members have been diagnosed with ALS."

An autopsy showed that Grange had Stage 2 CTE with motor neuron disease, according to a statement from Boston University.

His case is interesting because it raises questions about the relationship between heading the ball and CTE.
"The fact that Patrick Grange was a prolific header is important," Chris Nowinski, co-founder and executive director of the Sports Legacy Institute, said in an e-mail. "We need a larger discussion around at what age we introduce headers, and how we set limits to exposure once it is introduced."

Heading would seem to be innocuous compared with the brutal hits that can be dealt in a football or hockey game, but the damage, according to studies, can add up. Headers in soccer are associated with microstructural damage to brain tissue and memory problems; and an Italian study linked them with ALS.

Similarly, researchers found Australian rugby union player Barry "Tizza" Taylor died in 2013 of complications of severe CTE with dementia at age 77. Taylor played for 19 years in amateur and senior leagues before becoming a coach, according to Boston University.

"Cognitive problems, memory loss, attention difficulties and executive dysfunction were first noted in his mid-50s, followed by depression and anxiety, worsening explosivity and impulsivity," the statement said. By his mid-60s, the statement said, Taylor was "physically and verbally abusive" and "paranoid."

CTE is most commonly associated with football and boxing, but the disease has been found in the brain tissue of hockey players, wrestlers and, recently, in a Major League Baseball player.

With the most recent findings, it would seem that virtually no sport is immune.

http://www.cnn.com/2014/02/28/health/cte-soccer-rugby/index.html?hpt=hp_t2


das
 
Man dies at age 77.

Double the life expectancy of a human not 100 years ago.

I still don't really understand the "controversy" surrounding concussion.
Hitting your head hard isn't good - that shouldn't be news to anyone.
 
Man dies at age 77.

Double the life expectancy of a human not 100 years ago.

I still don't really understand the "controversy" surrounding concussion.
Hitting your head hard isn't good - that shouldn't be news to anyone.

Well, no, that's incorrect. People hundreds of years ago didn't die young, rather the average life expectancy was low, but only due to increased infant mortality. People regularly lived beyond 70, but it is skewed lower.
 
Man dies at age 77.

Double the life expectancy of a human not 100 years ago.

I still don't really understand the "controversy" surrounding concussion.
Hitting your head hard isn't good - that shouldn't be news to anyone.

It's a delayed effect, sure, but it's a major contributor to a large number of players. It's also not confined to people in later life; these kind of mental issues (mood swings - which have in a couple of cases resulted in suicides, memory loss, dementia, etc.) can occur as a result in early middle age. There are cases where NFL players who aren't even 40 are gettting memory loss; it's not just "oh, I'm going to die age 89 instead of 90 so what".

Sure, someone dying at 77 wouldn't be a huge deal if it weren't from a hot-issue illness but it's a big deal because it's the first one found, not because it's the only one. There's bound to be other guys out there and they will include some players who are only just retired, for sure - hell, the footballer in that article you quoted was 29!

Now, the stats for pro-level rugby are that for every minute you play, you're roughly half as likely to get a concussion as in the NFL (and about double as likely as in ice hockey). Given that they've got hundreds of cases of NFL players in their 40s, 50s having dementia from this then you've got to admit half of that is still a huge number.

There is an element of risk to anything in life, but that just means being aware and keeping it as low as possible not taking an "oh, of course it's dangerous" attitude. Look at Formula 1; during the '60s and '70s people died regularly because it was "of course it's risky" but it was actually down to factors that were entirely controllable - poor barriers meaning people hit immovable objects like trees, marshals not having fireproof overalls so drivers choked to death in burning cars, cars not designed with safety in mind - and once they began to improve those, by the '80s the fatality level reduced and from '86 nobody died until '94. After Ratzenberger and Senna, they introduced neck restraints and made changes to the cars and no driver died until DiVillota died of complications from her crash the other year. If people had kept dying at the rate they did in the '70s then over the last 20 years there would have been 18 deaths not 3 - and that doesn't even factor in people driving in other championships who have benefitted from the safer tracks.

Now, with this it's harder to track, harder to fix and it won't be possible to make improvements that dramatic, sure. But people deserve to actually be able to have a proper life, so whatever improvements can be made are definitely worthwhile.
 
I couldn't disagree with any of that.

But I'm not saying that people shouldn't be aware of the dangers of concussion.
What I'm saying is that I don't understand how the new evidence can really be that shocking to anyone.

Surely everyone (particularly people who grow up playing contact sports) understands anecdotally that hitting your head really hard is not good for you.
Most sportsmen have seen the state old boxers are in.
 
It's how common it seems to be and how early its setting in. All boxers take repeated hits to the head so it's obvious, in other sports people expect a few accidental ones so for it to be hundreds of people rather than a handful is surprising.
 
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Also, you have more people becoming active in these sports, often on an amatuer (or youth) level where precautions are not being taken to prevent or properly treat concussion. Here in the States sports on a middle or high school level are often the worst, with some Nazi-like coaches pushing kids to perform at adult professional levels in bodies unable to take the strain. So, while all of this may be old news, I think it could work as a wake-up call not just for the pro sports, but ESPECIALLY for those who are involved in youth sports. This would include parents who may now think twice before allowing their kids to participate in sports all willy-nilly without checking first to see what precautions are being taken to reduce the chance of concussion, or - perhaps even more importantly - that the coach and team physio/doctor knows the signs of a concussion, RESPECTS the signs of a concussion, and won't force a concussed player to continue to play. It's been known to happen.


das
 
That's one of the main reasons I think the idea to have replacements during the concussion check is so important. It blows my mind that the level of medical provision at youth games isn't put on a much higher priority across all sports, really.
 

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