Callum EPQ edit feb 10

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“To What Extent, and Why, are the Effects of Concussion Neglected
in Sport, Especially in Football, Rugby and American Football? And
Which of These Sports Puts the Players at Most Risk?”
In order to discuss concussion in Football, Rugby and American Football we must first define
what the term ‘concussion’ covers. The word ‘concussion’ comes from the Latin verb
‘concutere’ and means to ‘shake violently’. The British Medical Journal (BMJ) states that:
“Concussion may be caused by a direct blow to the head, face, neck, or elsewhere on
the body with an ‘impulsive’ force transmitted to the head. Concussion typically
results in the rapid onset of short lived impairment of neurological function that
resolves spontaneously. Concussion results in a graded set of clinical syndromes that
may or may not involve loss of consciousness.”1
Typical features of concussion are confusion, amnesia and unawareness of surroundings;
including symptoms such as headaches, nausea, dizziness, displaying unusual or
inappropriate emotions and fatigue.2
We should also be aware of Second Impact Syndrome (SIS); a condition which, although
disputed by some, is widely considered to be the cause of many head injury related deaths.
West J Emerg Med. Feb 2009; 10(1): 6–10. describes SIS as occurring in:
“Cases in which a second mild head injury in children caused massive cerebral
edema”.
McCrory (professor at Melbourne University) points out that:
“SIS is a condition representing ‘diffuse cerebral swelling,’ a consequence of
traumatic brain injury with diffuse brain swelling” and he states that it is well
recognized in children.
He also says that:
“While there is argument over the incidence of SIS, many authors agree that the
syndrome is rare. While this may be comforting to emergency physicians (EPs), SIS
must still be taken seriously as the consequences could be grave.”3
1 3/10/14 http://bjsm.bmj.com/content/36/1/6.extract
2 3/10/14 http://bjsm.bmj.com/content/36/1/6.extract
3 3/10/14 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672291/

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FOOTBALL
Incidence of Concussion
In Football concussion occurs due to either making contact with the ball using the head
(referred to as ‘heading’ or ‘a header’ from here on) or making direct contact with another
player (usually the head, knee or elbow).
A study undertaken by the Division of Orthopaedic Surgery, Duke University Medical Center,
Durham, North Carolina, found that over two years, a study of 26 athletes presented 29
concussions.
“17 (59%) concussions in men and 12 (41%) in women, resulted from contact with an
opponent's head (8, 28%), elbow (4, 14%), knee (1, 3%), or foot (1, 3%); the ball (7,
24%); the ground (3, 10%); concrete sidelines (1, 3%); goalpost (1, 3%); or a
combination of objects (3, 10%).”4
This shows a reported incidence rate of 0.6/1000 athlete-exposures in men and 0.4 per 1000
athlete-exposures in women. Although the study is limited because was only performed on
26 athletes, it is still useful in that it provides an exhaustive list of ways in which concussions
occur and provides good raw statistics.
Neglect of Reporting of Concussion and Effects on Players
Although the most widely played sport in the world, there is very little information around
regarding the risks of concussion and how to avoid them in Football. We would expect little
information to come back from undeveloped countries but would also expect to see more
from developed ones. Even though Football is classed as a limited contact sport, unlike
Rugby and American Football which are classed as full contact sports, we would expect the
sheer numbers taking part would result in a higher reported incidence of concussion.
There is some evidence that leads towards the conclusion that concussion is a risk factor in
Football. In the case of Jeff Astle, who played for England, the coroner ruled the cause of his
death, ‘an industrial disease’, which suggested that
"repeated heading of balls during his professional career was the cause of his
subsequent neurological decline."5
However, there is also a large amount of contradictory evidence that states the opposite,
the case of Billy MacPhail for instance. ‘ former Glasgow Celtic player, who in 1998 lost a
4 3/10/14 http://www.ncbi.nlm.nih.gov/pubmed/9548117

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legal battle to claimbenefits for dementia that he said, was due to heading the old style
leather football’6
‘In a series of retrospective studies including retired Scandinavian soccer players, cognitive
deficits were noted. The results of these studies are flawed, with appreciable
methodological problems. These problems include the lack of pre-injury data, selection bias,
failure to control for acute head injuries, lack of blinding of observers, and inadequate
controls. The authors conclude that the deficits noted in these former soccer players were
explained by repetitive trauma such as heading the ball. However, the pattern of deficits
seen is equally consistent with alcohol related brain impairment—a confounding variable
that was not controlled for.’7
Concussion is a less divisive issue in Football than in Rugby or American Football due to
fewer exposures per player per playing hours to concussion causing injuries. Footballers
head the ball, which is rarely travelling fast enough to cause the impacts necessary for
concussion to occur and accidental head traumas also occur rarely.
An article in the Independent picks up on the fact that Football still has a long way to go
when it comes to concussion protocols. Currently, players with suspected concussion are
taken to the side-line and are assessed by the team’s doctors. While this occurs, the game
continues without the player; leaving one team a player down until he has been checked
over. This puts immense pressure on the teams’ doctors to get the player assessed and back
on the pitch (or subbed off) as quickly as possible. As the article points out
"After 17 minutes and 10 seconds of the World Cup final, two of Germany's medics
reached Christoph Kramer, who was lying in the Argentina penalty area after his
head collided with Ezequiel Garay's shoulder seconds earlier. Within 30 seconds, he
was walking along by the side-line and, by 18 minutes and four seconds, the game
had re-started and Kramer was back on the field. From assessment to return, the
total time was 54 seconds. Fifteen minutes later, the player was being helped from
the field by the same two medics."8
The first person to notice the concussion was the referee, who was quoted as saying
"Shortly after he'd been struck by Garay, Kramer came to me, asking 'ref, is this the
final?'," revealed Nicola Rizzoli. “I thought he was joking so I asked him to repeat the
question, and he said: 'I need to know if this is really the final.' After I said 'yes', he
was a bit stunned and said: 'Thanks, that's important to know'."
8 3/10/14 http://www.independent.ie/sport/soccer/other-soccer/concussion-rule-isnt-perfect-but-its-a-start-
30623029.html

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This should have been the sign to get the player off the pitch and off for a full concussion
assessment.
RUGBY
In Rugby there are myriad ways in which concussions occur. The main ones are; the player
being tackled is hit in the head, either legally or illegally, with the tackling player’s elbow,
shoulder, knee or head; the tackling player is hit in the head with the tackled player’s knee,
hip, elbow or head; or any player is hit in the head whilst in a ‘ruck’. This could be with a
knee, head, shoulder, elbow or even whole body.
In Rugby, the numbers of concussions vary according to, for instance, in matches or training,
time of year, whether the player is a back or a forward and if the player is carrying the ball
or tackling.
‘Concussion incidence rates vary from 0.0 to 40.0/1000 playing hours. Concussion accounts
for 29% of all injuries associated with illegal play, but only 9% of injuries sustained in legal
play.’9 This source is particularly useful as it results from the analysis of 199 separate
incidences.
Neglect of Reporting of Concussion and Effects on Players
Rugby, like American Football, is a game based around physical competition. However
Rugby is a far more global sport; played professionally on every continent except Antarctica
and the governing bodies seemto be more aware of, and are adapting to, the risks of
concussion more than any other sport.
A study undertaken at the San Giovanni Battista Hospital, University of Turin by P Boffano (a
regular contributor to journals of Craniofacial surgery and Maxillofacial surgery); in to Rugby
players’ awareness of concussion; interviewed four amateur rugby teams on what they
knew about the warning signs and the symptoms of concussion, and about the protocols
surrounding returning to play. The results were that
“Twenty-five athletes reported that they had not been informed by anyone about
symptoms of concussion and its consequences. Among these, 7 players thought they
could return to play immediately after a concussion during the very same match.”10
So the conclusions drawn by P Boffano and his team were that
9 10/10/14 http://bjsm.bmj.com/content/early/2014/04/10/bjsports-2013-093102.abstract
10 10/10/14 The Journal Of Craniofacial Surgery [J Craniofac Surg] 2011 Nov; Vol. 22 (6), pp. 2053-6.

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“The surveyed group in this study presented a general lack of knowledge
of concussion. Rugby athletes and coaches must be made aware about signs and
symptoms of concussion to suspect this injury. It would be desirable
that rugby players are educated regarding the potential risks of playing while
symptomatic.”11
This is also particularly important when regarding youth rugby. As young people’s brains are
developing, they are more susceptible to debilitating brain injuries. So education about
concussion should be focussed on for young Rugby players in particular. But, a study from G
Sye, SJ Sullivan and P McCrory at Kennedy Road Physiotherapy, Napier, New Zealand about
High school age rugby players’ knowledge of concussion protocols and its effects found
otherwise. Of the 477 players interviewed, only half were aware of the concussion
guidelines and only 60% knew the minimum time taken before returning to play. The
players had found their information from
“teachers/coaches (239 responses), medical personnel (200), and other players
(116)” “Of those players who suspected that they had been concussed (296/477,
62%), only 66 returned to play after medical clearance.”11
The conclusions drawn by G Sye, SJ Sullivan and P McCrory were that
“This sample of high school players showed a limited knowledge of the concussion
guidelines covering their sport, and even when concussed did not follow
recommended protocols. This indicates the need for an increased focus on player
education.”12
We do also find similar statistics amongst professional Rugby players however. A study in to
concussion history and reporting in professional Irish players by MR Fraas, GF Coughlan, EC
Hart and C McCarthy on 172 players from 4 professional clubs, all between the ages of 20
and 29 (average 25), with between 7 and 19 years of playing experience (average 13.5);
found that
“Forty-five percent of players reported at least one concussion during the 2010-2011
season, but only 46.6% of these presented to medical staff. The relative proportion
of concussions was higher for backs than forwards; however, the severity of injury
was greater for forwards. Scrum-halves (12.0%) and flankers (10.9%) accounted for
the majority of concussions reported.” 13
11 10/10/14 British Journal Of Sports Medicine[Br J Sports Med] 2006 Dec; Vol. 40 (12), pp. 1003-5.
12 10/10/14 British Journal Of Sports Medicine[Br J Sports Med] 2006 Dec; Vol. 40 (12), pp. 1003-5.
13 10/10/14 Physical Therapy In Sport: Official Journal Of The Association Of Chartered PhysiotherapistsIn
Sports Medicine[Phys Ther Sport] 2014 Aug; Vol. 15 (3), pp. 136-42. Date of Electronic Publication: 2013 Sep
12.

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The conclusions that MR Fraas, GF Coughlan, EC Hart and C McCarthy came to were that
“The self-reported rate of concussion in elite rugby union players in Ireland is higher
than reported in other countries or other sports. Many concussions remain
unreported and, therefore, unmanaged. However, recent changes
in concussion management guidelines by the International Rugby Board may impact
future reporting practices of players.”14
Some see the current neurological tests as being somewhat to blame, certainly at higher
levels of the game. This is because they are widely known as being easy to 'cheat'. An article
in the New Zealand Herald, containing a long interview with ex-England and All Blacks
player, Shontayne Hape, states as such. He says that he
“manipulated baseline pre-season cognitive tests and under-reported concussion
symptoms during his 13-year professional career, something that was never
detected by the clubs or national bodies he played for"15 and that "You have a test at
the start of the season but the boys [fellow players] all know how to beat it. You
don't do the test to your full ability. You know that when you get knocked out you
are not going to be as good and that if you don't beat your score you can't come
back. Everyone wants to come back, so you beat it."16
Hape has since retired due to medical advice relating to ongoing severe concussion
symptoms, contracted whilst playing for Montpellier in 2013, leading to symptoms such as
light and sound sensitivity, constant migraines, irritability, memory loss and depression.
The same article backs up this testimonial with an interview with Dr Rosamund Hill, a
concussion expert. A quote from her stated
"I have heard that from senior-level players, who I will not name, that you don't
want to do too well in the pre-season testing because it doesn't give you much room
if something happens,"
One international player, who Dr Hill evaluated at the 2011 Rugby World Cup two days after
he had been knocked unconscious in a match, had claimed to be free of concussion
symptoms. Dr Hill said
14 10/10/14 Physical Therapy In Sport: Official Journal Of The Association Of Chartered PhysiotherapistsIn
Sports Medicine[Phys Ther Sport] 2014 Aug; Vol. 15 (3), pp. 136-42. Date of Electronic Publication: 2013 Sep
12.
15 10/10/14 http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11264933

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"He didn't look well and I didn't believe him". "The problem is you can't rely on the
player in that position to be completely honest."17
Another article, on ESPN News, interviewed Rory Lamont, a Scotland international, who,
throughout his playing career has been knocked out a total of 10 times and has been 'all but
knocked out' on dozens more occasions. He describes the current tests in detail.
Firstly, Cogsport (COG) test which is a computerised assessment measuring cognitive
function using tests of memory, concentration and speed. To pass the test you must match
your baseline score which is taken at the start of each season and is seen to be you at your
optimum level of cognitive function. This is easily cheated. By not putting in total effort
whilst setting the base score it is extremely simple to then breeze through the test while
concussed, thus allowing you back to play sooner.
The second test is the Pitchside Suspected Concussion Assessment (PSCA). A PSCA can be
requested by the player's team doctor and the match referee if they suspect that a player
may have suspected concussion. The Match referee will signal, via a comms device and hand
signal of three taps to the head, that a PSCA has been called. The PSCA is carried out at pre-
agreed place, medical room or alternative if not easily accessible, with a temporary
replacement taking the field. The substitution will become permanent should a player fail
the test, while temporary replacements are not allowed to take kicks at goal. The PSCA must
be completed inside five minutes - commencing with the player leaving the field at the half-
way line and ending with presentation to the reserve official after being cleared to play.
The PSCA incorporates the Maddocks Questions (cognition), a balance assessment and a
'symptoms and signs' assessment.
Maddocks Questions are: At what venue are we today? Which half is it now? Who scored
last in this match? What team did you play last game? Did your team win the last game?
One failed Maddocks question, four balance errors and the presence of one or more signs
will see the player removed from the game.18
This all sounds positive bur there is a debate surrounding its effectiveness. Lamont states
that
"The problem with the PSCA is a concussed player can pass the assessment. I know
from firsthand experience it can be quite ineffective in deciding if a player is
1710/10/14 http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11264933
18 10/10/14 http://www.espn.co.uk/scrum/rugby/story/208943.html

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concussed. It is argued that allowing the five-minute assessment is better than zero
minutes but it is not as clear cut as one might hope."19
This is because in many cases, concussion takes between 5-15 minutes to become
symptomatic in the first place. If there is any level of certainty that a player is concussed he
should be immediately sat out for 24 hours as per guidelines "if in doubt sit them out"
Despite their flaws these tests are often being used on concussed players, who, if they have
affected the results or are able to bluff their way through the assessment are then given
licence to play on, risking long term brain injury from Chronic Traumatic Encephalopathy
(CTE) or even death from Second Impact Syndrome (SIS).
Lamont also states that
"There must be a drive to minimise human error in concussion diagnosis, to do this
we need to utilise any tool available that will minimise the pressure on pitch side
medical staff who have an incredibly difficult job. Having an independent medical
expert using television footage to catch and immediately flag any possible
concussions would result in many more concussions being identified. If it is clear on
video that a player has been concussed then they should immediately be removed
from the field of play with no need for PSCA, reducing the pressure on pitch side
medics."20
AMERICAN FOOTBALL
American Football is somewhat similar to Rugby in that concussions occur in the tackle area,
this can be due to the tackled or tackling player making contact with the elbow, shoulder or
knee of the opposing player. However, unlike Rugby, in American Football the major cause
of concussion is head to head contact. This can occur in the tackle area or whilst making a
block (defensive move) and the high incidence of head to head contact is a result of the use
of helmets. Unlike Rugby where no helmets are worn (scrum caps are not used for
concussion prevention, these are ineffective) the wearing of helmets in American Football
reduces the feeling of vulnerability and leads to players engaging in head to head contact.
The incidence rate of concussion in high school American Football is described as being:

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“consistently shown in studies to be the highest concussion rate (6.4 concussions
per 10,000 athletic exposures).”21
Neglect of Reporting of Concussion and effects on Players
During the course of writing this essay, concussion has come closer to the forefront of the
public consciousness. There was a public outcry on social media when Philadelphia Eagles
running back, LeSean McCoy was concussed playing against the Washington Redskins on
21/09/2014. He was tested for concussion but within five minutes, was back out next to the
pitch, having cleared the concussion protocols, and was then back on the field. There was a
backlash on Twitter including some evident distrust of the National Football League (NFL) to
be honest about concussion and there were questions about the ethics of coaches letting
McCoy play, especially when he seemed “sluggish and unproductive”.22
The following statement was posted on @NFLConcussions (which is a well-regarded account
on Twitter that tracks concussions in the NFL):
“If McCoy suffered a concussion; this would mean at least 80 NFL players have
suffered concussions this year” 23.
As this statement was made three weeks in to the league, with a season lasting 17 weeks,
extrapolation would seem to show 453 concussions happening each year, not including full
contact training sessions that occur outside of the 17 week period, meaning that there is a
huge, surely unacceptable, incidence and therefore massive under reporting.
We know that concussion has been an issue in American Football for many years partly
because of the development of helmets, when a game such as rugby does not require them,
and partly because ex-American Football players, now into old age, are reported to be
experiencing symptoms.
This is evidenced in the ‘League of Denial’ – a book about traumatic brain injury in the NFL.
Although this source is likely to be biased, to be inflammatory and intended to push opinion,
there are good statistics quoted (see Appendix 1.1). The book states that
“the NFL has spent two decades appearing to bully doctors, mislead players, and
conceal links between football and brain disease”24
Particularly Chronic Traumatic Encephalopathy; which can lead to an inability to perform
simple tasks and answer simple questions; even being quoted as the cause of death in the
2111/10/14 http://prevacus.com/concussions-101/statistics/
22 11/10/14 http://www.forbes.com/sites/dandiamond/2014/09/21/did-lesean-mccoy-have-a-concussion-
eagles-star-takes-hit-to-head-fans-erupt/
23 11/10/14 http://www.forbes.com/sites/dandiamond/2014/09/21/did-lesean-mccoy-have-a-concussion-
eagles-star-takes-hit-to-head-fans-erupt/
24 11/10/14 http://www.forbes.com/sites/dandiamond/2013/10/08/league-of-denial-portrays-nfl-as-villains-
but-who-will-care/

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case of former Pittsburgh Steeler Mike Webster. From this report we also understand that
the NFL used
“physicians like rheumatologist Elliot Pellman, who had no real competence in
assessing or treating brain trauma, to set the league’s health and safety strategy.”⁹
A successful law suit was carried through against the NFL however the settlement was only
worth $765 million. This is less than 0.5% of the NFL’s annual revenue.25 Over 4500 ex-
players and their families took up the cause and this small amount is meant to cover all care
costs for all ex-players. This is nowhere near sufficient; particularly as there is little to no
subsidised health care in the US. Compensation for individuals is capped at $5 million, which
in theory sounds good however in reality this is to cover 20 years’ worth of medical bills, at
an average of $20,000 per player. The funding has been split up, up to $75 million for basic
medical exams for players; $675 million to compensate former players and their families for
cognitive injuries; and $10 million on new research into concussion care. ¹⁰ The NFL earned
$9.5 billion in revenue and is reported to be expected to make $25 billion per year within
the next 15 years.
Although there has been a resulting acknowledgement of the risk of concussion to players
this deal is seen as only having benefits for the league; in four main ways:
1) “Lots of headlines now; fewer headlines later” ¹⁰
2) “No risk of discovery” ¹⁰ so as there was no evidence gathered for a trial, there was
no risk of discovery of incriminating material.
3) “$765 million is a lot smaller than the potential alternative, some analysts predicted
they could face a multi-billion dollar penalty”¹⁰
4) “and the NFL doesn’t have to admit any guilt” because a document exists, in the
settlement, that states, even though the NFL has paid out, this “doesn’t mean the
NFL hid information or did what the plaintiffs claimed in their complaint. It does not
mean that the plaintiffs’ injuries were caused by football or that the plaintiffs would
have been able to prove that their injuries were caused by football”¹⁰.
The fact that even after being shown practically incontrovertible evidence that concussion
has damaged the lives of many former players the NFL still denies that American Football
was the cause gives credence to those who claimthat there is a culture of denial and
neglect in American Football today.
So, why are the incidence and effects of concussion being understated?
Many of the answers to this question are the same across the three sports.
25 11/10/14 http://www.forbes.com/sites/dandiamond/2013/08/29/nfl-pays-765-million-to-settle-concussion-
case-still-wins/

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There is relatively little understanding about the long term effects of repeated concussion.
This leads to both amateur and professional athletes either not thinking an incident is worth
reporting or taking risks they might otherwise avoid.
In amateur sport, such as school sport, we would expect extra vigilance but there is a
possibility that concussion protocols are kept deliberately vague by the professional sports
because very often there is a lot of money at stake – for example, expensive players,
sponsorship deals, television coverage time scales, long term health care and Insurance
premiums.
Governing bodies do not want to become liable for future lawsuits. The fact that football is
so widely played, in over 200 countries, would leave FIFA/UEFA vulnerable to a lawsuit even
larger than that brought against the NFL if it was discovered that concussion was leading to
later life problems in ex-players.
Many players want to play on and not being subbed off because they want to play in as
many games as possible to either increase the likelihood of being scouted by professional
teams or getting a new contract signed. This is backed up by a quote from Shontayne Hape
in the New Zealand Herald article,
"When you come to a new club and you are an international player you are supposed to
impress... there was a load of pressure to deliver. You don't want to let anybody down.
You get paid to get out there and play and you want to play. You never think [anything
bad] is going to happen to you, so you do it."26
and again by Rory Lamont who brings to bear the argument on being seen to be putting up a
strong front
"in a job where every game is a chance to win your next contract and keep paying
the mortgage, it is easy to understand a player's desire to get back playing. The
bravado culture in rugby is another driving force. There is nothing more heroic and
sacrificial than to declare yourself available for selection in spite of injury and
coaches will often commend such behaviour. If the player is not informed of the
long-term health implications, he doesn't know what he is gambling."27
Coaches are also involved; they are in as much of a battle to keep their jobs as the players
are. This can lead to them putting pressure on players to play on through their injuries and
perhaps even to put pressure on medical staff to declare the players fit.

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There is pressure exerted on the players by the coaches and by themselves, there is
pressure on the coaches from the owners and from the desire to win and there is pressure
put on medics by players, coaches and the owners. This becomes an unhealthy environment
where the players are treated as tools, with little to no thought going in to their future
careers or lives outside the sport.
CONCLUSION
Over the years, the incidence of concussion and its effects on players of all three sports has
undoubtedly been neglected be this due to lack of research, lack of education, financial
greed or the willingness of a player to take risks for glory.
In this day and age of information sharing, of responsibility, of people living longer and
being better educated it can no longer be ignored and, positively, the situation appears to
be improving.
1) Protocols are improving.
In American Football, according to one study, concussion rates doubled in the NCAA
(College level American Football) in the year after new concussion management protocols
were put in place. The conclusion that this study came to was that the massive increase in
numbers of concussions was most likely down to having
"a more formalized concussion plan on the part of medical staff"28
And
"the increased recognition and reporting on the part of players and coaches after the
rule change"29.
The plight of ex-players with severe, debilitating, brain injuries is starting to move more in to
the public focus. For example an article in the Huffington Post by a young man who suffered
a subdural haematoma whilst playing American Football that stemmed from Post-
Concussion Syndrome. He made it clear the this injury has led to
"depression, suicidal thoughts, skull disfigurement, a higher risk of developing
dementia, and a severely plummeting scholastic GPA"30
28 10/10/14 Sports Health [Sports Health] 2014 Sep; Vol. 6 (5), pp. 402-5
29 10/10/14 ibid
30 11/10/14 http://www.huffingtonpost.com/journey-bailey/high-school-football-
concussions_b_6289572.html

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The director of the Centre for Brain Injury and Repair Pennsylvania University sums up
concussion as
"a mild brain injury, but there's nothing mild about it, they're just mild compared to
severe brain injuries that land players in the hospital with tubes in their head for
days or months."31
Rugby is also taking positive steps. Geoff Parling, England and Leicester lock, was concussed
multiple times over the space of a few weeks and so was rested by England and Leicester for
six weeks. Parling states that although he was frustrated by being removed from a game and
having the chance to represent England taken away, he realises that this was the correct
course of action.
Also
"New Zealand No8 Kieran Read who, after suffering repeated concussions during last
season’s Super 15 with the Crusaders, was rested for six weeks and missed the first
two Tests against England, during which time he was constantly assessed by head
injury specialists."32
Football is bringing in a minimum 3 minute period of concussion assessment.
2) Fines are being Introduced
The National Rugby League (NRL) in Australia/New Zealand now says that they will be
handing down fines of up to A$20,000 and possible points deductions to any team found to
be trying to get round the concussion protocols and Greenberg, the former Canterbury
[Bulldogs NRL team] chief executive, said he believed the new regulations and the use of
side-line concussion tests had worked to improve how teams dealt with affected players
and wants more of the same on Sunday. He stated
"People understand the rules. We've been through 192 games of the premiership
this year and we've had four breaches of the policy, I think, so by and large everyone
has done the right thing."33
3) Technology is being utilised and enhanced.
31 11/10/14 ibid
32 10/10/14 http://www.theguardian.com/sport/2014/sep/24/geoff-parling-leicester-england-concussion
33 10/10/14 http://www.stuff.co.nz/sport/league/10556494/Grand-finalists-warned-about-concussion-rules

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Saracens rugby club are pioneering impact sensors such as a device, called the xPatch,
produced by a US company, which measures the size and angle of hits to the head. It
provides a medical method of sitting out players who have suspected concussion – there is
no way to cheat a sensor.
Edward Griffiths said
"We don't want to meet our players in 20 years' time to find them suffering from
dementia and reflect we suspected something was going on but didn't really
know."34
And American Football is constantly looking at new helmet technology
4) So Which Sport puts the Players at Most Risk?
In my opinion Football players are at the least risk of concussion because, although the
most widely played, it is a limited contact sport.
Rugby players are the second least at risk because the Governing bodies put more focus on
player safety than they do in American Football – perhaps due to the propensity for law
suits. The NFL paid $756 million to ex-players, on the condition that they were able to state
that the conditions were not American Football related. This is likely to protect them from
future law suits based on players developing CTE (Chronic Traumatic Encephalopathy) from
Post-Concussion Syndrome.
Therefore American Football puts players at the most risk of concussion because of the
points above and:
1) The use of helmets encourages players to feel that they are at no risk of head injury
and therefore they tackle and break tackles using their heads.
2) The rules of the sport means that there are a greater number of blind-side tackles -
as players are not expecting to be tackled their heads often undergo massive
acceleration and deceleration.
3) There is a culture in American Football of playing on even through injury that is very
present. A player might legitimately sit out with damaged ligaments that would keep
him out for a week or two but might end his career if he played with them. However
for a concussion which has a similar propensity for career ending re-injury this is not
34 17/10/14 http://www.bbc.co.uk/sport/0/rugby-union/30671380

15
the case – the injury is not obvious and a player can often continue to take part in
the match.
There will always be a risk of concussion in contact sports; it is how the risk is managed that
is the key to improvement. In all three of these sports it is still a key that still needs
attention, we must never be complacent.
Appendix
1.1 – “since 2008, the NFL already has survived:
1. More than 30 front-page stories in the New York Times investigating the link
between football and concussions;
2. Prime-time investigations into concussions on CBS’s “60 Minutes” and CNN;
3. Congressional hearings;
4. The suicide of several ex-players who turned out to have CTE–including Junior Seau,
a marketable star; and
5. A major lawsuit that could’ve destroyed it.”

Callum EPQ edit feb 10

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