Concussions in Rugby

emmet02 · 11-07-2013 8:49am #1

Luke Marshall, Berrick Barnes, Lealiifano, Smith

All players we've seen getting knocked out of their socks playing in the last 6 months.
Plenty of others too. Smith coming back onto the pitch is terrible for the game imo. Absolutely negligent.

IRB have brought in the Concussion Bin etc, but it's clearly not being administered correctly. The cognitive tests are clearly bull**** and players are going to get really badly hurt.

Marshall really shouldn't be playing rugby for a serious length of time after the amount of concussions suffered this season.

Interesting Article here
http://www.rte.ie/sport/rugby/2013/0710/461694-odriscoll-calls-for-concussion-re-think/

O’Driscoll, a former Ireland international player and uncle of current Ireland international Brian, held various positions related to medicine, anti-doping and discipline with the International Rugby Board over a period of 15 years.
But he cut all ties with the body a year ago, in part because of his opposition to the introduction of the "five-minute rule". The rule means players can return to the field of play after a serious head injury if they pass a short assessment on the sideline.

And a heated and educated discussion on RTÉ here with Bernard Jackman & Dr. Barry O'Driscoll - http://www.rte.ie/sport/player/816/461538/

Anyone ever been knocked out on a field and be able to say that they should have been allowed to continue?

razorblunt · 11-07-2013 9:04am

What worries me about the concussion bin is that we won't truly see the effects until later in the player's lives. Smith's one was a joke though, the guy was all at see you could have told me he was Conrad Smith playing in Wellington and he'd have believed it.

I also think it's a worry on our own doorstep, Cian Healy is very prone to appearing "out of it" and carrying on and the season before last SOB was the same.

What makes it more frustrating is the poor tackling technique leading to some (if not) most of these injuries, though fair enough Smith's was just a huge clash of heads.

Worrying times.

irishbucsfan · 11-07-2013 9:30am

We had a top class doctor who worked with us (voluntarily). I was knocked out very briefly on the field of play once (stamped on accidentally) and he inspected me and sent me back on and I had no issues.

Another time I just clipped my head off someone's knee on the way into a ruck and he pulled me off straight away.

Concussions are bizarre things and I wouldn't want to be the one to have to diagnose them on the sideline, it seems very difficult.

Dravokivich · 11-07-2013 10:25am

A mate of mine has talked to me about various concussions he's been in. Not due to rugby, but accidents, or on the receiving end of a bashing. He finds it quite odd to even try to describe it. To him, it was as if he was in various stages of drunkeness at once and that's how it was perceived by a doctor before. Rather reckless as well because the concussion went unattended to for a few days.

I don't get why they've let players back on after showing even minor signs of being concussed as it's very hard to determine the full scale of it with all the excitement that is bound to be around a match.

jamiedav2011 · 11-07-2013 11:05am

Anyone who's interested in this topic should seek out the doc 'Head Games'.
A fairly sobering insight into what repeated concussion can do to you, a condition called CTE eventually evolves which can only be diagnosed after death.

Some great journalism on this subject in recent times in the US.

pickarooney · 11-07-2013 11:51am

I was kind of worried for Richard Hibbard after he was involved in two big head clashes and collapsed after appearing to choke out in the scrum in the last test but nothing was made of it

Foyler · 11-07-2013 1:19pm

I've written about it on here before and agree that its a ticking timebomb, the fact that the IRB have seen whats happened in the NFL, the pending lawsuits and fallout with CTE etc and continue with this sticking plaster approach is shocking and hard to figure out, the only explanation I can come up with is that it seems to be a throwback to the amateur era but given the excellent job they've done in other areas it just doesn't sit right.

I had 4 pretty serious concussions when I was out for up a minute, 3 in rugby and 1 playing GAA, obviously I was off the pitch straight away and in one instance woke up in the ambulance on the way to the hospital.
The first time I took 2 weeks off but not the then mandatory 3 weeks.
The last one was in my final season and we were involved in a relegation battle, the lads reckoned I swallowed my tongue and a few told me after they were near tears thinking I was definitely a gonner this time:(.
With that in mind I insisted on a Brain scan before I'd play again.
It came up clear but as highlighted above the real concern is not how you get on for the rest of the match/day/week but what the repercussions can be later in life.
I'm only 36 but its definitely had an effect on my short term memory, I can be quite moody as well but my old man never played ball and is a cranky baxtard to can't really blame the concussion for that:D.

It shows up the cog tests and concussion bin as the joke they are, emmet highlighted some prominent examples above but from watching and playing over the years it is becoming an all too regular occurance, I'd guesstimate that you would see at least one case in every 2 games played at a decent level.
The decision has to be taken away from the players and sadly from what I've seen the physio/medical teams cannot be trusted to make the right call either so going back to the old school, 3 weeks off would be a start and I think if the ref has any doubt a player should be sent to the line.

In relation to Marshall, I'm reminded of a chat I had with a US doctor around the time I retired, he was telling me of his Nephew, a promising collegiate Football player who had 1 bad concussion and was put through rigorous neurological tests and given 3 months off before being allowed play again.
He went on to have 2 more concussions and was forced to retire, no questions asked.

The IRFU, IRB and medical professionals involved in handling this issue over the last 5 years should hang their heads in shame, I'm pretty sure Karma and the lawsuits will catch up with them eventually.

Edit, clicked that smilie at the top by mistake, ignore that, couldn't be further from what I feel on the issue!

LeeroyJones · 11-07-2013 2:30pm

I feel like I'm being 100% naive here for suggesting something so simple, but here it goes.

Can the IRB, 6 Nations, Rugby Championship, ERC, Super Rugby etc. just appoint an independent doctor to each fixture who has nothing whatsoever to do with any team/player involved in the fixture?

I feel as though the medical staff at these teams are being put under too much pressure, medically & morally, by their coaching colleagues to get players fit and on the field. This is not to say that the coach's are being immoral, they're no doctors, but what they are demanding just might not be feasible which puts the Doctors in the awkward position.
If there was an independent Doctor he/she could just call an injury as it is; pretty much as though as if it was any other patient coming into an A&E. The coaches don't like it, tough sh*t - Independent Doctor has the final call.

This would not undermine the team's medical staff either. By all means allow them be the first to treat a player; at the end of the day they know the player's medical/injury history etc. But if it were to come down to big decisions regarding injuries, or indeed Bloodgate-esque matters, the Independent Doctor has the official call.

This is an issue in urgent need to be addressed clearly.

dregin · 11-07-2013 3:23pm

LeeroyJones wrote: »

I feel like I'm being 100% naive here for suggesting something so simple, but here it goes.

Can the IRB, 6 Nations, Rugby Championship, ERC, Super Rugby etc. just appoint an independent doctor to each fixture who has nothing whatsoever to do with any team/player involved in the fixture?

I feel as though the medical staff at these teams are being put under too much pressure, medically & morally, by their coaching colleagues to get players fit and on the field. This is not to say that the coach's are being immoral, they're no doctors, but what they are demanding just might not be feasible which puts the Doctors in the awkward position.
If there was an independent Doctor he/she could just call an injury as it is; pretty much as though as if it was any other patient coming into an A&E. The coaches don't like it, tough sh*t - Independent Doctor has the final call.

This would not undermine the team's medical staff either. By all means allow them be the first to treat a player; at the end of the day they know the player's medical/injury history etc. But if it were to come down to big decisions regarding injuries, or indeed Bloodgate-esque matters, the Independent Doctor has the official call.

This is an issue in urgent need to be addressed clearly.

I think the concussion test is carried out by an independent party. Not sure whether or not they're a medical professional, though.

Teferi · 11-07-2013 3:30pm

dregin wrote: »

I think the concussion test is carried out by an independent party. Not sure whether or not they're a medical professional, though.

Are they entirely independent though? I'm fairy certain I've read that it tends to be a medical professional hired by the hosts so there could still be some pressure from them. Perhaps they should be hired through/by the IRB.

emmet02 · 11-07-2013 3:38pm

'Independent' in rugby doesn't really exist.

Independent citing commissioners are a nice example.

JRant · 11-07-2013 4:45pm

emmet02 wrote: »

'Independent' in rugby doesn't really exist.

Independent citing commissioners are a nice example.

To be honest it shouldn't be about an independent doctor. The clubs have a responsibilty to each of their employees (players) to make sure they are safe. Leaving a player on the pitch who has clearly been knock-out is gross negligence in my book.

I've been concussed a few times on the pitch and stupidly played on. On 2 occassions I had no idea I even played a match on does days.

It's time clubs/countries wised up and put an end to it before it's too late.

Swiwi. · 11-07-2013 6:28pm

I'm much more in favour of an individualised system than the old method of a blanket 3 week stand-down for every concussion, which seemed arbitrary and without a foundation in medical science. However, whether the current assessment system has been adequately validated is another matter - it did seem surprising to see Smith back out on the field, on the other hand CL was "right as" for Test Match 2, with 20/20 vision when it came to goalkicking.

wittycynic · 11-07-2013 8:11pm

The looming threat of a Chronic Traumatic Encephalopathy epidemic being visited on a large cohort of former rugby players should be forcing the RIB to sit up and take notice.

While there's no evidence that a small number of well managed concussions can lead to CTE, the succession of head injuries that someone like Luke Marshall has sustained should be giving him, his family, and Ulster Rugby serious cause for concern. The lad is clearly susceptible to concussions and a facility should be introduced to permanent exclude particularly vulnerable individuals from the game in the interests of preserving their neurological well-being.

.ak · 12-07-2013 9:10am

You can be knocked out without being concussed, right?

andrewdcs · 12-07-2013 9:22am

.ak wrote: »

You can be knocked out without being concussed, right?

<I'm not a doctor, but I play one on the tinternet>

If you are talking about a head bang, no.

You can be concussed without being knocked out though, any bad head bang that makes you confused / ginger walking / disoriented etc. is a concussion.

Being knocked out through a head bang is always considered a concussion (as it is the act of the brain bopping the inside of your skull that caused the loss of consciousness)

Obviously you can be knocked out for a variety of reasons without it being a head bang, generally related to blood flow.

Buer · 30-07-2013 9:34am

Rory Lamont's comments recently have put a renewed focus on this area. I'm glad a former international came out and confirmed what we already knew. Players are under massive pressure to get themselves on the field and, if they don't they feel that they will damage their careers and the relationship with their coaches. They end up cheating the concussion tests. We've heard this before though so we probably won't see any movement on it.

He cites a couple of examples where his injuries were downplayed including where he played for Scotland with a hamstring injury but felt he couldn't rule himself out despite not being fit as it would have an impact on his future selection. He had to be taken off at half time.

More condemning is the claim that Toulon refused him a scan and he ended up going through the entire season there with a broken bone. If true, that's negligence bordering on malpractice.

Swiwi. · 30-07-2013 9:37am

Buer wrote: »

Rory Lamont's comments recently have put a renewed focus on this area. I'm glad a former international came out and confirmed what we already knew. Players are under massive pressure to get themselves on the field and, if they don't they feel that they will damage their careers and the relationship with their coaches. They end up cheating the concussion tests. We've heard this before though so we probably won't see any movement on it.

He cites a couple of examples where his injuries were downplayed including where he played for Scotland with a hamstring injury but felt he couldn't rule himself out despite not being fit as it would have an impact on his future selection. He had to be taken off at half time.

More condemning is the claim that Toulon refused him a scan and he ended up going through the entire season there with a broken bone. If true, that's negligence bordering on malpractice.

Yeah, the whole macho thing is a real issue in NZ too. At school, you always risked being labelled a pansy/wuss if you pulled out of a game, even if a genuine enough injury. Then you just accumulate niggles over time. And that was just school level stuff, let alone professional rugger.

pickarooney · 30-07-2013 11:02am

Buer wrote: »

Rory Lamont's comments recently have put a renewed focus on this area. I'm glad a former international came out and confirmed what we already knew. Players are under massive pressure to get themselves on the field and, if they don't they feel that they will damage their careers and the relationship with their coaches. They end up cheating the concussion tests. We've heard this before though so we probably won't see any movement on it.

He cites a couple of examples where his injuries were downplayed including where he played for Scotland with a hamstring injury but felt he couldn't rule himself out despite not being fit as it would have an impact on his future selection. He had to be taken off at half time.

More condemning is the claim that Toulon refused him a scan and he ended up going through the entire season there with a broken bone. If true, that's negligence bordering on malpractice.

At the same time why did he not just get an xray himself rather than suffer for a year?

jacothelad · 30-07-2013 10:06pm

The latest studies on concussion show that it resembles Alzheimer's.

"Researchers from the Division of Neuroradiology at the University of Pittsburgh School of Medicine have published a study looking at the relationship between white matter and injury patterns and severity of postconcussion symptoms in patients with mild traumatic brain injury (MTBI) with normal findings on conventional MRI exams. The researchers studied data from imaging exams performed on 64 patients with MTBI and 15 control patients using diffusion tensor imaging to measure fractional anisotropy. Of the patients with MTBI, 42 were men, and their mean age was 17 years. Sports injury was the reason for concussion in two thirds of the patients. All patients underwent neurocognitive evaluation with ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). The researchers analyzed correlations between fractional anisotropy values, the ImPACT total symptom score, and findings of sleep-wake disturbance. The results showed a significant correlation between high ImPACT total symptom score and reduced fractional anisotropy at the gray-white junction, most prominent in the auditory cortex. Significantly reduced fractional anisotropy scores were found in patients with sleep-wake disturbances in the parahippocampal gyri relative to patients without sleep-wake disturbances. The researchers concluded that the initial traumatic event that caused the concussion acts as a trigger for a sequence of degenerative changes in the brain that result in patient symptoms that could be treatable or preventable,"

Bassfish · 31-07-2013 12:58am

Last February I took a running TH prop's knee to the side of the head while tackling him. I was dazed and didn't feel right but there was only five minutes left so I played on. After the match, I showered and changed, felt pretty ok. I then headed off in my car to meet my wife for dinner in town as has been my plan all week. About half way there I was stopped at lights and I suddenly realised that I could not remember where I was going, why i was going there or who I was meeting. I pulled over and panicked for nearly a minute until it came to me. Bloody frightening experience. The doctor ordered me to take a month out.

emmet02 · 03-08-2013 10:01am

http://www.bbc.co.uk/news/uk-scotland-23545796

irishbucsfan · 03-08-2013 11:09am

I hope they are monitoring guys who've retired from pro rugby. Obviously this case was not a professional player, but I can only imagine the dangers are increased in pro rugby to that of that was happening in amateur rugby.

Stev_o · 03-08-2013 1:20pm

Honestly, I think we will see the worst of it in years to come. I think we will be lucky to see BOD look fit and well at age 50. Lewis Moody will be a shell of a man aswell come his later life. The amount of careless times were players haven't been properly treated from concussions is pretty scary (And it's becoming one of the most common injuries now in high level games)

Chucky the tree · 04-08-2013 11:36pm

It will take awhile for professional rugby players to see the full effect due to rugby only becoming professional recently enough. All you have to do is look at NFL and see what happens to players later in life when they have been subject to repeated concussions and head traumas. Hopefully the IRB won't be stupid enough to let it last for 10+ years until a well known rugby player shows signs of early brain trauma before they actually do something that will be of use.

toomevara · 17-10-2013 9:28am

Interesting discussion on BBC radio5 about this issue this morning. it's really difficult to listen to this guy and not become deeply concerned about the issue, the way its dealt with in the game, and the long term impact on players...It's particularly worth listening to the audio clip on the page below.

http://www.bbc.co.uk/news/uk-wales-24554550

TheGoldenAges · 17-10-2013 11:27am

Funny this came up. I'm actually reading League of Denial and only watched Frontline's documentary on concussions in the NFL recently (Brilliant even if you're not a fan of the sport).
It's only now that the NFL has decided to connect the dots and believe that concussions can have effects after a player retires.
Unfortunately it seems the IRB has almost ignored this issue completely in my eyes and the 5 minute concussion bin is a joke. How supposed "experts" in their field can see this as enough time to deduce if a player has concussion is laughable.

Hippo · 17-10-2013 12:58pm

Absolutely, the five minute assessment is nonsense. The NFL settlement has ice hockey looking over its shoulder now and rugby can't be far behind. Long-term evaluation of retired players should be a priority for the IRB, their duty of care must extend beyond a player's active career with such potentially serious latent injuries.

CatFromHue · 17-10-2013 7:34pm

TheGoldenAges wrote: »

Unfortunately it seems the IRB has almost ignored this issue completely in my eyes and the 5 minute concussion bin is a joke. How supposed "experts" in their field can see this as enough time to deduce if a player has concussion is laughable.

To play Devil's Advocate for a bit have the IRB ignored the issue.

It wasn't that long ago when substitutions weren't allowed in the game and in the 90's early 00's the game wasn't half as physical as it was now. It was an out of the ordinary occurance for a player to get concussed in a game. It did happen all right but not to the same level as it is now. Now you see the medical staff on the touchlines ready to run onto the pitch but 5 years ago this wasn't the case.

I don't the concussion bin is a great idea either and don't think it works.

TheGoldenAges · 17-10-2013 8:17pm

CatFromHue wrote: »

To play Devil's Advocate for a bit have the IRB ignored the issue.

It wasn't that long ago when substitutions weren't allowed in the game and in the 90's early 00's the game wasn't half as physical as it was now. It was an out of the ordinary occurance for a player to get concussed in a game. It did happen all right but not to the same level as it is now. Now you see the medical staff on the touchlines ready to run onto the pitch but 5 years ago this wasn't the case.

I don't the concussion bin is a great idea either and don't think it works.

From my understanding of concussion from reading that book a lot of the time concussions go unnoticed until days afterwards with players complaining of dizzyness, sensitivity to bright lights and migraines. Also once you've had one concussion, you're twice as likely to get another one and twice as likely again to get another one and so forth.

And yes I agree the logic behind the concussion bin is flawed and doesn't work. The IRB has made steps but they don't go far enough in my opinion.

Morf · 17-10-2013 11:35pm

Dr. Barry O'Driscoll was the strong advocate for action on the issue in the IRB and he resigned as they didn't seem to be taking it at all seriously.

Google his name, "IRB" and "concussion".

Can't find a suitable article at the moment but you'll get the idea if you have more time than myself this minute.

Concussions in Rugby

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