1. concussion.
Kyle Traynor, a prop forward for Bristol
and Scotland with a history of concussion,
also doubts the validity of pitch side tests
that have been introduced. “The IRB have
introduced pitch side concussion tests and
I don’t think they are great as within 15
minutes you can’t really tell if someone is
fully concussed or not.”
Furthermore Tony Belli believes the tests
carried out do not give a definative answer
as to whether a player has a concussion.
This often allows managers to over rule
their doctors, ensuring they have the
strongest side possible out on the field. “The
tests that are currently done pitch side are
not particularly robust and it is quite easy
for a player to struggle through the tests and
still be signed as fit to play. The doctors may
be in a position where the manager says
he has spoken to the player and he seems
alright, then it is the doctor against the
manager and when you get this divergence
of opinion, the manager wins.”
Hugo Lloris, Tottenham Hotspur’s
goalkeeper, is evidence to Belli’s claims.
When playing against Everton, early on
Lloris took a blow to the head and was
suspected to have suffered a concussion.
He remained on the pitch, after it appeared
Andre Villas-Boas (Tottenham’s manager)
had over ruled his medical staff who were
getting the stretcher ready. This prompted
Taylor Twellman, an ex football player
forced to retire due to concussion, to say
“they played with Lloris’ life.” Brad Friedel
was Tottenham’s reserve goalkeeper that
day, and at the age of 42 it is plausible
Villas-Boas did not want to send him on for
tactical reasons, regardless of the potential
medical consequences for Lloris.
While football and rugby have differing
guidelines and protocols for concussion,
it is inherently wrong that a manager
is allowed to have a say in the players
wellbeing without the benefit of a medical
background.
One area where American football differs
greatly from rugby is the level of protection
that players wear. It is easy to simply think
that the more protection a player has, the
more protected he is from injury. However,
when talking about concussion it is the
complete opposite. Tony Belli explains
“Concussion is not so much the direct hit
to the head, it is the impact of rotational
forces. A helmet, even a very light one,
would change the rotational angle and
increase the impact as it increases the
weight of the head.”
While many players now wear scrum hats,
do they actually do anything to prevent a
concussion? Rory Murray doesn’t think
so. “A scrum hat has been proven to
increase the rate of concussion, thicker
scrum hats actually led to a greater number
of concussions.” The reason for this is
relatively simple. Rotational forces are
responsible for a concussion, therefore
adding weight to the head will only
emphasize these forces. While a scrum hat is
a very thin and light form of protection, the
larger helmets used in the NFL are believed
to be one of the major causes of concussion
within the sport.
Despite the hard hitting and tough nature
of rugby, the only compulsory piece of
protective equipment is a gum shield.
Players that wear a scrum hat do so at
their own discretion, but many believe the
extra layer of thin protection combined
with the adrenalin of playing test rugby can
sometimes cause players to make contact
recklessly.
Kyle Traynor wears a scrum hat when
playing and admits that this sometimes
occurs. “Generally most concussions are
suffered around the temple area and head
guards don’t really protect you there. But
once the game kicks off the adrenalin kicks
in and you’re pretty happy to fly head first
into anything.”
Scrum hats are still most popular in the
junior levels of the game, normally due to
concerned parents on the sidelines worried
for their youngsters wellbeing. Andy Long,
an ex hooker for both Northampton Saints
and England, believes that scrum hats
are especially useful for the young players
starting out. “I think scrum hats are a
good idea for kids, for the prevention of
cuts and other small knocks, but I felt that
when I wore one they give you a feeling of
invincibility so you would fly into contact
recklessly.”
Scrum hats appear to be the only way to
try and counter-act a blow to the head.
While views are conflicting, new methods
of protection need to be considered to offer
more defence against concussion, and fast.
There is no doubt that the IRB are trying to
fight against concussion, however it appears
that they simply aren’t doing enough. Look
at the 5 minute concussion assessment bin,
an area off the pitch where a doctor can
assess a player and decide if he is fit enough
to return to action. A great idea, however it
needs to be rolled out beyond the current
AVIVA Premiership and International
matches, so that anyone playing rugby from
local matches to Championship standard,
has the same level of protection.
While there are obstacles to overcome,
it is not only the professionals that need
protecting, the game needs a change of
attitude towards the injury from grassroots
level.
Tony Belli believes we need to stop waiting
for conclusive evidence and start working
with what we do know. “There is enough
of a link for us to worry about it and we
can’t dismiss it, if it hasn’t been proven that
doesn’t mean there isn’t a link. There is
enough evidence from studies to say actually
we need to be very worried about this.”
The IRB needs to step up and start
investigating ways of implementing changes
to help benefit the safety of players. The
medical understanding of concussion is so
much clearer than it was a few years ago.
Alterations need to be made based on the
evidence we have so far, before it is too late.
Rugby needs to learn from the mistakes
made by the NFL, or it could end up
following the same tragic route.
Source: Getty Images
Australia’s George Smith lies concussed against the British and Irish Lions, yet returned to
action. Getty Images.
“A scrum hat has
been proven to
increase the rate of
concussion.”
- Rory Murray
Since turning professional in 1995 rugby
union has become one of the most popular
sports in the world. The fast paced nature
of the game has made events such as the
2013 Lions tour to Australia unmissable.
While the pinpoint passes, irresistible kicks
and fancy sidesteps all add to the swagger
of rugby, the same attributes remain at the
heart of the sport: sheer aggression and
physicality.
Every year the players return bigger and
stronger looking to put their opposition
firmly on their backside. The new breed of
wingers illustrates this perfectly. No longer
are wingers built in the mould of legendary
speedsters Jason Robinson and Shane
Williams. A new breed of wingers is taking
rugby by storm, based on size and the ability
to run over a man, rather than around him.
George North, Alex Cuthbert and Matt
Banahan all serving as perfect examples.
And it is this obsession with powering over
the gain line that has seen the continued
rise of concussion within rugby union. A
concussion is brought on by a blow to the
head that causes the brain to jar or rattle
against the skull. Over the last two seasons
in the AVIVA Premiership, concussion has
been the most common injury. “I hope
I can give parents reassurance that this
(concussion) is absolutely our number
one priority at the moment in terms of
our injury agenda.” Rob Andrew, the RFU
professional rugby director, clearly thinks
the sport has a serious issue on it’s hands.
What is responsible for this sudden increase
in concussion? Rory Murray, the first
team physiotherapist at Bristol rugby club,
believes it is down to two differing aspects.
“The players are getting bigger, bigger G
forces in the tackle and the game is played
more aggressively. But also we are starting
to understand more what concussion
is, diagnosis of concussion is therefore
increasing.”
The impacts of concussion were thrust into
the spotlight last year when the National
Football League (NFL), the governing body
of American football in the USA, was sued
by 4,000 former players. The players filed
a lawsuit stemming from the belief that the
NFL knew about the dangers regarding on-
field head injuries long before taking any
action to prevent them.
It is hard not to agree with the former
players after discovering that in 2005
the NFL Mild Traumatic Brain Injury
Committee believed that if a player was
concussed in a match, they could return
to action in the same game and have no
increased risk of a serious injury. Rory
Murray clearly disagrees. “The fact is, once
you have had a concussion it makes you
inherently more vulnerable to have one
again and through much less impact.”
Furthermore Ray Easterling, an ex player,
committed suicide after retiring with the
autopsy showing the depression that led to
his death could be linked to the concussions
he suffered as a player. As a result the
league agreed to a settlement of $760
million.
“The NFL lawsuit really brought it home
in the sense that made you realise that
there was a systematic failure in addressing
concussion. The settlement is clearly
recognition that the problem hadn’t been
handled the way it should have been” Tony
Belli, a neurosurgeon at Queen Elizabeth
Hospital in Birmingham, told me of how
severe concussions are and how they need
to be treated with the utmost severity.
With rugby union and American football
sharing a similar level of high impact
collisions, this settlement has come as a
warning shot to the International Rugby
Board (IRB) that rugby needs to change the
way it deals with concussion.
The news no one wanted to hear concerning
concussion was revealed recently, when
the IRB confirmed they have found a link
between rugby union and dementia. More
specifically and worrying was the connection
found between rugby and chronic traumatic
encephalopathy (CTE). CTE is a form of
dementia that is brought on by multiple
concussions and can only be confirmed in a
person after they have died. 33 of 34 ex NFL
players that were tested postmortem were
found to have shown clear signs of CTE.
This doesn’t surprise Tony Belli. “There is a
higher incidence rate of people with CTE in
retired sportsmen, or people who have been
exposed to repeated concussion. CTE is a
form of dementia and it is associated with
suicidal ideations; in the end a lot of people
with CTE commit suicide because it just
increases depression and suicidal thoughts.”
The afore mentioned Ray Easterling’s
suicide is fully blamed on the fact he was
found to have CTE after his death.
By next year rugby union will have been a
professional sport for 20 years. The first
crop of rugby union players have recently
began to retire, therefore it is too early to
see the effects of such a physical sport on
the later life of an ex player. However Dr.
Willie Stewart, of the Glasgow General
hospital, believes he has found the first
confirmed case of dementia caused by
playing rugby. The man inflicted was aged
in his 50s and had early onset dementia,
sections of his brain were comparable
to young man who had suffered a severe
assault. Stewart told BBC Scotland: “In any
Six Nations weekend one or two players may
go on and develop a dementia they wouldn’t
otherwise have been exposed to. That is a
realistic number.”
One aspect where the IRB has become
increasingly under fire, is the administration
of pitch side concussion tests. These tests
take place during a match, and more
often than not result in the afflicted player
returning to the field. A fine example was
George Smith, when playing for Australia
against the British and Irish Lions he
suffered a severe concussion early in the
match, only to return to action five minutes
later. These inconsistencies with treatment
only worsen the consequences of suffering a
Season No. of Concussions * Most common injury
2009-10 3.9 Thigh Haematoma
2010-11 3.9 Thigh Haematoma
2011-12 5.1 Concussion
2012-13 6.7 Concussion
Concussion: Rugby ‘s
Cause For Concern?Concussion is now the most common injury in England’s domestic rugby tournament, and fast becoming the most
frequent in the sport on the global stage. With a range of insightful interviews, Nicholas Clarke looks into how the
sport is dealing with concussion.
“Within 15 minutes
you can’t really tell
if someone is fully
concussed or not.”
- Kyle Traynor
* Number of injuries reported over period of 1000 hours. Source: RFU Injury surveillance report.