Concussions in Rugby

.ak

irishbucsfan wrote: »

I read this article and it caught me completely by surprise. Don't know if the guy is talking nonsense or not, because I have no clue about the field. Interesting to hear his view on it though.

Yeah, strange how animated he is about it though, really strongly worded. Almost seems like he has an agenda, or rather thinks his peers on the other side of the fence have an agenda.

pickarooney

Fractured cheekbone and eye-socket plus a concussion and Burgess plays on 'like a hero'

http://www.smh.com.au/rugby-league/league-news/sam-burgess-injury-why-is-playing-on-allowed-20141009-113ebk.html

.ak

Rules are different in RL I take it?

http://www.science20.com/the_conversation/brain_injury_in_sport_is_an_unfolding_tragedy_were_only_now_starting_to_count_the_cost-145993

Article about American Football, but gives a few feelers for how damaging this is...

Teferi

Concussion produces a certain type of protein in the blood stream it has been discovered. Possibility of sideline blood draws in the future as this develops?

http://www.irishtimes.com/sport/rugby/dr-%C3%A9anna-falvey-set-great-example-with-call-on-conor-murray-in-australia-match-1.2014741

We have to send out the message that player health is the most important thing.

Falvey did the right thing, and deserves plaudits. However, we really, really really need to rush towards the day where it's not surprising or praise-worthy.

digzy

Is the general opinion, that wearing headgear does nothing for concussion prevention?

Teferi

digzy wrote: »

Is the general opinion, that wearing headgear does nothing for concussion prevention?

I don't think it is just opinion, I think it is scientific fact that they don't prevent concussion.

Pudsy33

The headgear prevents cuts and cauliflower ears. That's about it.

thomond2006

digzy wrote: »

Is the general opinion, that wearing headgear does nothing for concussion prevention?

Yes. I believe the research in the US concluded as much.

phog

Saracens’ protective patches are a game-changer not a gimmick

CatFromHue

It sounds good to me and is in a good spot too.

There was an Irish guy who was short listed for a a Dyson award for his product that was a gum shield with instruments in it so you could measure head impacts, don't know what ever happened to it and I see from LinkedIn he's working for Dyson now.

thomond2006

To follow on from the other thread, what exactly is delayed concussion? This sounds the most scary to me if symptoms that could have a player (rightly) pulled from a match and therefore kept safe from further risk don't manifest themselves for hours.

nerd69

theres an nfl documentary called "league of denial" thats well worth a look it shows how badly playing through all these concussions/other injures can affect you and how hard people had to fight to get the nfl to properly implement a concussion policy it could be tougher again in rugby because your relying on team doctors for a lot of it

total former

thomond2006 wrote: »

To follow on from the other thread, what exactly is delayed concussion? This sounds the most scary to me if symptoms that could have a player (rightly) pulled from a match and therefore kept safe from further risk don't manifest themselves for hours.

As I understand it, "delayed concussion" just means that some of the symptoms aren't apparent right away, so the pitch side assessment isn't going to detect them. It's still the same injury, the same concussion.

But really, the problem is that we're relying on a very limited test to judge it. If a guy can tell the doctor where he is, who he's playing for, what the score is etc, he'll pass. The player is never going to tell the doctor about non-cognitive symptoms likes headache or nausea and he'll be let back out.

So we can either say right, if a guy looks to have been knocked out, he has to go off and stay off, or we all continue as per the status quo and we just accept incidents like North, Murray, Fritz, Smith as part of the game and the players are just collateral damage.

wittycynic

total former wrote: »

As I understand it, "delayed concussion" just means that some of the symptoms aren't apparent right away, so the pitch side assessment isn't going to detect them. It's still the same injury, the same concussion.

But really, the problem is that we're relying on a very limited test to judge it. If a guy can tell the doctor where he is, who he's playing for, what the score is etc, he'll pass. The player is never going to tell the doctor about non-cognitive symptoms likes headache or nausea and he'll be let back out.

So we can either say right, if a guy looks to have been knocked out, he has to go off and stay off, or we all continue as per the status quo and we just accept incidents like North, Murray, Fritz, Smith as part of the game and the players are just collateral damage.

I agree.

The ten minute assessment is not going to catch a lot of concussions, in fact there is very little that you can catch so quickly. Chiefly the doctor will be looking for neurological signs of an acute haemorrhage like incorrect pupil dilation, loss of balance, loss of strength on one side, etc. The problem is, many of these symptoms might not present immediately, in fact a lot of the time they don't.

I fear it is only a matter of time before this lack of care gets someone killed on the pitch. And that's before we deal with the much more widespread problem of repeated concussions and CTE.

Shelflife

Delayed concussion.

Not sure if I've mentioned this story on this website, but it warrants repeating if I have.

Player at my club gets a blow to the head, ref checks him out and says no mate your game is done, player protests and insists hes fine but to no avail hes off.

later that evening his partner has gone out and hes alone in the house, he begins to feel unwell and ring his partner, she comes home and finds him unconscious on the floor, ambulance is called and he spends a few days in hospital.

Sounds like the perfect anecdote for the trumpet bearers of concussion, but its 100% true.

Simply put, if in doubt sit them out, lights out you're out !

Clearlier

wittycynic wrote: »

I fear it is only a matter of time before this lack of care gets someone killed on the pitch. And that's before we deal with the much more widespread problem of repeated concussions and CTE.

It's not a matter of time. It has happened already. It probably happens every year but most of the time it happens at low levels of the game and gets very little publicity. One plus about the high profile that concussion has at the moment is the greater awareness of it at lower levels of the game. I got a bang on the head playing at a low level about 20 years ago. I don't really know what happened but I do remember my captain (who was also the coach/organiser etc) telling me to go to the sideline for a few minutes. I knew that we were already short of players so a few minutes later I just wandered back on to the pitch and played wing for the rest of the game. Of course it was stupid but I didn't know any better and neither did anyone else. When I got the blinding headaches and photophobia a couple of hours later I copped what had happened and took 3 weeks off which was the protocol then. I'd like to think that if the same situation happened today that there is enough awareness out there for me to be told to stay out of the game. There's not an awful lot that we can do about the serious injuries caused by a single blow to the head but there is a lot that can be done to avoid 2nd impact syndrome.

Shelflife wrote: »

Delayed concussion.

Not sure if I've mentioned this story on this website, but it warrants repeating if I have.

Player at my club gets a blow to the head, ref checks him out and says no mate your game is done, player protests and insists hes fine but to no avail hes off.

later that evening his partner has gone out and hes alone in the house, he begins to feel unwell and ring his partner, she comes home and finds him unconscious on the floor, ambulance is called and he spends a few days in hospital.

Sounds like the perfect anecdote for the trumpet bearers of concussion, but its 100% true.

Simply put, if in doubt sit them out, lights out you're out !

That's not delayed concussion that's delayed symptoms. In my very limited experience you don't get the symptoms other than being a bit out of it immediately after the bang to the head. Good on that ref though. It's really encouraging to hear of that.

A couple of comments from the other thread that I wanted to respond to:

total former wrote: »

I'm not implying anything. Just pointing out that when you look at all the facts, facts that are not in dispute, it doesn't look great.

Edit: I'll spell out those facts and then I'm done.
1. Team is defending narrow lead in closing stages.
2. Star player takes heavy knock to back of head.
3. Player is removed.
4. Player returns FOUR MINUTES later. That's four minutes absence in total so maybe 2-3 minutes of assessment?
5. Team wins match.
6. Player is subsequently diagnosed with "delayed" concussion, misses no matches of consequence.

I think if the above was describing any other country or foreign club, we'd be scratching our heads about it.

Yes he was assessed by a doctor but so was Florian Fritz, so was George Smith against the Lions, so were many others.

Barry O'Driscoll resigned from IRB because he felt five minutes wasn't enough to check for concussion. Murray didn't get near that.

Judge yourself, I would have doubts.

I remember the bang on the head and I was surprised that he returned. I hadn't heard that Murray had been subsequently diagnosed with concussion. I would describe that as a clear diagnostic failure. I do remember BOD being taken off against NZ the previous autumn at a critical point in the game where if he had been able to continue I think that we would have won which leads me to think that player welfare is paramount for the medical team (I don't know if there were any changes or discussion after that incident though which might have influenced later behaviour). The diagnosis might have been helped by the knowledge that BOD appeared to be picking up concussions from increasingly innocuous incidents towards the end of his career.

phog wrote: »

Yes it is, very much so.

I'd be fairly sure a doctor could be struck off for knowingly putting a patient at risk.

It's rarely if every quite as clear cut as that. We are highly reliant on the integrity of doctors and it would be straightforward in most instances for them to explain away a scenario where they should have taken a player out of the game.

total former

http://www.worldrugby.org/news/55545

Following a full post-incident review, World Rugby believes that Wales player George North should not have remained on the field of play following a head impact in the 61st minute of the Wales versus England RBS 6 Nations match at the Millennium Stadium on Friday night.

The World Rugby head injury protocol clearly states that a player should be immediately and permanently removed from the field of play where there are any visible symptoms or suspicion of a potential concussion.

However, following thorough discussions and input from the independent expert Concussion Advisory Group, World Rugby accepts the WRU’s explanation that neither the team medical staff nor the independent doctor had sight of the incident and understands that the medics acted within the framework of information they had at the time and would have taken a different course of action had they had direct pitch-side visibility or access to the same broadcast footage seen by those watching on television.

Well, I'm afraid that's simply not good enough.

dub_skav

Deleted User wrote: »

Well, I'm afraid that's simply not good enough.

Agreed, absolutely not good enough. The fact he had already taken a blow to the head in the same match just makes it worse.
What are those laptops in front of the coaches for if they can't see broadcast footage? (Genuine question).

Also, North was involved in a tackle on the ball carrier when it happened, what were the coaches and medical staff looking at. He fell down with his arms by his sides, he even fell towards the sideline, i.e. between the sideline view and the ball.
One of the England players (I think it was Mike Brown) knew how serious it was as he pointed to North, drawing attention to it.

.ak

After the 2nd knock out, was he treated? I mean did medical team attend to him on the pitch? Surely they should've realized he took a knock at that stage, with or without footage?

.ak

dub_skav wrote: »

Agreed, absolutely not good enough. The fact he had already taken a blow to the head in the same match just makes it worse.
What are those laptops in front of the coaches for if they can't see broadcast footage? (Genuine question).

You're right, they often review the live feed, but they're more interested all the technical data the GPS is tracking.

However, the medical team do not have laptops sitting infront of them.

total former

.ak wrote: »

After the 2nd knock out, was he treated? I mean did medical team attend to him on the pitch? Surely they should've realized he took a knock at that stage, with or without footage?

Yes, he was treated; the Welsh doctor has said that he seemed perfectly lucid, but if he had seen how North had got the injury, he'd have taken him off straight away.

Webbs

This from the WRU doctor

“In the second incident on 60 minutes regrettably I was unsighted at that moment and another pitch-side medic was also unsighted,” he added.

"All I saw was George North getting up off his knees.

"When I arrived at the scene, as it were, he was completely lucid and was conversing spontaneously with me.

"I undertook some on-pitch evaluations, and that point I deemed him fit to continue.

“Regrettably we did not get a chance to see the incident.

“Had I had that chance there is no doubt he would have been removed from the field of play.

“When George was injured the analysis team were reviewing another incident because they look at the performance rather than the medical side.

“So there was no communication at the time with George’s incident.

“There are no pitch-side replays currently available and the independent match day doctor was also unavailable to aid us in that process.

“We did not see it but having seen it since he looks like he had a momentary loss of consciousness. In that case he would have been removed from the field of play.


If thats the case and there is no reason to doubt his version then it appears it was one of those that fell through the net, and as a result hopefully there will be a change to protocols to reflect it

awec

Should the onus be put on players to inform coaches / medical staff that they have taken a heavy blow? Not everything can be seen, but North will have known he took a smack on the bake.

.ak

awec wrote: »

Should the onus be put on players to inform coaches / medical staff that they have taken a heavy blow? Not everything can be seen, but North will have known he took a smack on the bake.

Players don't want to leave the field.

awec

.ak wrote: »

Players don't want to leave the field.

Right, but that shouldn't matter.

Should players be retrospectively punished for failing to report serious blows to the head to medical staff though?

Players don't want to come off so they don't report serious issues. The only way to make them report it is to make the punishment for not reporting it worse than missing the rest of the current game. Perhaps a ban from subsequent matches.

Players can be absolved from any onus simply by the reason that if a concussion occurs, the player can be deemed not to be compos mentis, i.e is not of sound mind and can't really be held accountable for his actions. POC, BOD etc have all been 'guilty' of playing on and under-egging injuries. It's part of what makes a player a player, going beyond the pain barrier etc.

For this reason alone, the decision must rest with an independent doctor. If WRU's medical staff are allowed 'miss' events in a game, then World Rugby have to demand that there is oversight. The independent doctor in the case of North might well be considered negligent if we're 'ok' with the WRU medical team 'missing' the event that BBC replayed a few times shortly after.

The ratio of False Positives : Missed Negatives might go up, but that's the cost that must be incurred. (Players who 'might be okay and then subsequently are' will be leaving the field more often, in order to stop players who 'might be okay and subsequently are not' playing on)

dub_skav

I don't believe players should have to be involved in the process, too much subjectivity.

Surely we should make use of the TMO to intercede? I'm not sure if he is currently allowed to or not, he may need to be invited by the referee.
But, the technology is there for him to see TV replays etc and he would just need to have a word in ref's ear - or indeed direct to the sideline medics and tell them to review.

It also seems wrong that teams have GPS, analytics, analysis teams etc, coaching teams all using serious technology, but medical issues need to be seen in real-time by a guy on the sideline.

Not blaming anyone in particular, but something seems very wrong about all this