Concussions in Rugby

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!

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.

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.

Personally, I think the concussion bin is no more than optics - "look, we recognise concussion is an issue, honest".

If I were in charge of the laws, if you are knocked out, i.e. if the lights go out and you ragdoll, you're on a three week holiday effective immediately. We have the video ref for foul play, so why not use it to see if a player visibly went out.

Players and clubs can't be trusted to do this voluntarily (just look at Munster's reluctance to acknowledge POM's KO), so it should be taken out of their hands, like the medical suspensions in the UFC, which often even prohibit a return to contact for a certain period after a KO.

That doesn't deal with the issue of concussions without a loss of consciousness, but would help hugely in reducing the risks of secondary concussions, which are where the really serious side effects can come into play.

If a player is concussed but continues on, what is the extra damage that could be done during play?

It should be abundantly simple to deal with a lot of this. Have an independent doctor at games, who can request a player be checked and can order a player out of the game. Require a mandatory independent post-game test for any player checked in the course of a game, and have his release for play decided by an independent medical panel. It won't reduce problems to zero, but it should do a lot.

irishbucsfan wrote: »

Unqualified rugby referees should not be making medical decisions. Especially based on video evidence.

Also, being knocked out does not guarrantee a severe concussion. You can be much more severely concussed without going out.

I agree that the real challenge is identifying those concussions where the obvious KO is not there, and that such concussions can be really bad news. But the least that should be done is that if a player is knocked out, that player is off, not to return that day.

Being knocked out means that you have suffered a concussion - by definition, a loss of brain function due to an impact - whether its 'serious' or not is irrelevant, you should no longer be on a rugby pitch, ideally not until proper scans have been done or a not insignificant amount of time has passed, or both.

Identifying those concussions where a loss of consciousness doesn't happen involves educating everyone in the game that if you are woozy/suffering a lack of function, you are risking your life as you know it by continuing, and that anyone who becomes aware of such symptoms in a player should have them removed. That takes time. We could eliminate cases where KO'd players continue tomorrow.

Personally, I think its better that a player who takes a 'big knock' and is removed by a referee erroneously is a price worth paying if that same power is used to prevent long term damage to another player. Referees aren't to be asked to make a full diagnosis, but if you hide behind "they're not a doctor" for cases where a player obviously lost consciousness, how can we ever hope to address this. Referees in boxing and mma make these calls regularly, why not in rugby?

Just read this paper in this morning's latest edition. Here is a section of it.

"
Further evidence that head trauma could be associated with Alzheimer's disease later in life has been reported in a new study.
The study, published online in Neurology on December 26, was conducted by a team led by Michelle M. Mielke, PhD, Mayo Clinic, Rochester, Minnesota.
"In our study we found that among older adults with mild cognitive impairment, those who reported having had a head trauma earlier in life were more likely to show brain changes suggestive of Alzheimer's disease. But we didn't find any such association in cognitively normal individuals," Dr. Mielke commented to Medscape Medical News.
"Our results add merit to the idea that concussion and Alzheimer's disease brain pathology may be related. However, the fact that we did not find a relationship in cognitively normal individuals suggests that any association between head trauma and amyloid is complex," she added."

I've just been reading an article in the latest "JAMA Neurology". Here is the gist.

"There are thought to be epidemiologic and pathophysiologic links between traumatic brain injury (TBI) and Alzheimer disease. Amyloid plaques have been found in the brains of up to 30% of patients who died at any age in the acute phase of a TBI. Now, researchers from the University of Cambridge, England, have published a study in JAMA Neurology [1] in which they performed PET using Pittsburgh Compound B (PiB), a marker of brain amyloid deposition in 15 patients with TBI and 11 healthy control individuals. The patients with TBI were recruited after a maximum of 1 year after injury. They validated their findings using autopsy-acquired brain tissue from 16 TBI victims and 17 patients with nonneurologic causes of death. The results showed that compared with the controls, the patients with TBI showed significantly increased PiB binding throughout the cortical gray matter and the striatum. In the autopsy tissue samples, they found PiB binding in the neocortical gray matter in the same regions where amyloid deposition was demonstrated by immunohistochemistry, thus validating the specificity of the PiB signal to amyloid. The investigators concluded that the use of PiB PET for amyloid imaging following TBI provides the potential for understanding the pathophysiology of TBI, for characterizing the mechanistic drivers of disease progression or suboptimal recovery in the subacute phase of TBI, and for identifying patients at high risk for accelerated Alzheimer disease and for evaluating the potential of antiamyloid therapy."