Hidden Impact: Rugby & Concussion

Moflojo · 06-10-2015 11:07am #1

Last night RTE aired its documentary about concussion in rugby. The documentary featured former internationals, current internationals, youth players, neurologists, bereaved parents, and also a representative from the IRFU. It was an in-depth and balanced documentary and could be described as essential viewing for anyone with an interest in rugby, or even sport in general.

You can watch the documentary on the RTE Player here: http://www.rte.ie/player/ie/show/hidden-impact-rugby-and-concussion-30003555/10475911/

One of the most worrying features of the documentary was a survey of Ulster Schoolboy rugby players which found that 1 in 5 players had suffered a concussion.

The main questions that arise from the documentary are:

Is enough being done about concussion at an organisational level?

Are the professional set-ups setting a bad example on head injuries?

What potential side-effects are coming down the line for current & former professional players (and even amateurs)?

What tangible moves can be made to make rugby safer and reduce the risk of head trauma?

colster · 06-10-2015 11:18am

Moflojo wrote: »

Last night RTE aired its documentary about concussion in rugby. The documentary featured former internationals, current internationals, youth players, neurologists, bereaved parents, and also a representative from the IRFU. It was an in-depth and balanced documentary and could be described as essential viewing for anyone with an interest in rugby, or even sport in general.

You can watch the documentary on the RTE Player here: http://www.rte.ie/player/ie/show/hidden-impact-rugby-and-concussion-30003555/10475911/

One of the most worrying features of the documentary was a survey of Ulster Schoolboy rugby players which found that 1 in 5 players had suffered a concussion.

The main questions that arise from the documentary are:

Is enough being done about concussion at an organisational level?

Are the professional set-ups setting a bad example on head injuries?

What potential side-effects are coming down the line for current & former professional players (and even amateurs)?

What tangible moves can be made to make rugby safer and reduce the risk of head trauma?

I think it's time to penalise the tackling player if the tackle is dangerous to either tackled or tackling player so if a player tackles with his head on the wrong side then that should be a penalty/yellow card.
Similar could be enforced for the tackled player.

Moflojo · 06-10-2015 11:29am

colster wrote: »

I think it's time to penalise the tackling player if the tackle is dangerous to either tackled or tackling player so if a player tackles with his head on the wrong side then that should be a penalty/yellow card.
Similar could be enforced for the tackled player.

I agree with you 100%. Coaches tend to only care about results, not the welfare of individual players, so penalising players for using their heads in the contact area is the way forward.

I'd like to see the introduction of penalties for the following:
- Use of the head in the tackle (head on the wrong side).
- Barging with the head while in possession. So many players dip their heads going into contact and very often it's the perfectly legal tackler that comes off worst.
- Intentionally causing contact with a defender's head or neck. E.g. No handoffs to the head/face. No forearm smashes to the tackler's head or neck.

BoardsMember · 06-10-2015 11:40am

First things first though, you achieve the above by lowering the height of the tackle. Lower it to below the arm pits level. This lowers the likelihood of heads hitting hard things.

Some potentially lovely side effects: more offloads, less emphasis on bigger stronger players, more emphasis on skills, more running rugby, more line breaks.

Also need to stop fending with the forearm.

I'm not sure anyone voluntarily/willingly puts their head on the wrong side.

I'm also not sure how you stop players barging/ducking into tackles, although I agree it results in tackler being in a position where they have no soft bits to hit, and are often hit hard themselves.

rrpc · 06-10-2015 11:43am

My son was playing a division 1A game a few weeks ago and in the act of turning over ball was 'cleared out' by the opposition hooker. The impact was head to neck/head and he was concussed and had a very sore neck for a week or so afterwards.

He played on for a few minutes more, but was taken off by the team physio as he was clearly out of it. His club put him through the return to play protocols and that was done correctly but it's worrying when something like that happens at a fairly high level and the concussed player is allowed remain on the pitch at all and the offending player isn't sanctioned. There wasn't even a penalty given.

Moflojo · 06-10-2015 11:46am

BoardsMember wrote: »

I'm not sure anyone voluntarily/willingly puts their head on the wrong side.

I'm also not sure how you stop players barging/ducking into tackles, although I agree it results in tackler being in a position where they have no soft bits to hit, and are often hit hard themselves.

I'm sure no one intentionally puts their head on the wrong side, but you can be sure that if it starts to be penalised then coaches will begin to put more emphasis on teaching correct tackle technique.

Regarding barging, you're right about the defender being the qualitative aspect: No problem with an attacker dipping into space to get through a gap between defenders, but dipping into a defender using one's head should be outlawed.

colster · 06-10-2015 11:48am

BoardsMember wrote: »

First things first though, you achieve the above by lowering the height of the tackle. Lower it to below the arm pits level. This lowers the likelihood of heads hitting hard things.

Some potentially lovely side effects: more offloads, less emphasis on bigger stronger players, more emphasis on skills, more running rugby, more line breaks.

Also need to stop fending with the forearm.

I'm not sure anyone voluntarily/willingly puts their head on the wrong side.

I'm also not sure how you stop players barging/ducking into tackles, although I agree it results in tackler being in a position where they have no soft bits to hit, and are often hit hard themselves.

I think knee on head is a very common source of concussion. Lowering the tackle will not stop that. I think players do willingly put their head on the wrong side. They need to be protected from themselves.

Tim Robbins · 06-10-2015 12:16pm

colster wrote: »

I think it's time to penalise the tackling player if the tackle is dangerous to either tackled or tackling player so if a player tackles with his head on the wrong side then that should be a penalty/yellow card.
Similar could be enforced for the tackled player.

You are on to something here.

But the devil is in the detail. It can be hard to get your head on right side depending on the angles and skill levels. But dangerous contact in the tackle and ruck could probably be pinged more.

My suggestions.
1. No-one is allowed to coach rugby unless you have been trained and assessed. That's the way it is for Ref's. Some coaches out there are nut jubs (a very small minority) and put players in situations they rarely should be. If you have to Garda vetted, you need to be IRFU vetted. I spoke to an English coach on holidays who told me one coach in his school didn't pass his exam so couldn't coach.

2. When you get your coaching badge, you are reviewed at least once a year. Again it's the same for refs.

3. In Ireland contact starts at U8. In England it's U10.
I think World Rugby need to make a decision here based on best evidence and all countries have to stick to that.

In Ireland because we follow the calendar year it is possible to be only 6 and be playing U8 and hence contact Rugby. For a lot of kids that is way too young.

leakyboots · 06-10-2015 12:20pm

Yeah when I played I was born a few weeks after the cut off - and I was quite small and light back then so I was just turned a very 'young' u-14, u-16 etc year on and year off so I used rotate with playing soccer that year. Always annoyed me that I'd be completely out of my depth for a season and had to opt out.

Don't they do it by weight in NZ?

Moflojo · 06-10-2015 12:26pm

leakyboots wrote: »

Don't they do it by weight in NZ?

They give players the option to play in their age category or weight category. Separate competitions for both categories. They offer the same options at adult level too.

Mycroft H · 06-10-2015 12:29pm

Watched it last night. Speaking with my EMT hat on I'm not shocked. I've had arguments with pitchside physios and coaches in the past at amatuer level on whether a player should return to play. It's extremely dangerous to play on and I've watched in frustration as players walk back out to the pitch when they shouldn't have. Especially with the poorly understood Second Impact Syndrome is a possibility.

The concussion protocalls were awful in Rugby until quite recently. Rember ROG against France? A doctor let him play on. Shame. And it's not as if concussion is a new phenomenon in sport. It's round for ages. The IRB had it's head in the sand for a long long time.

Here's a quote from the Journal of Neurosurgery. Relating to the treatment of concussion in american football. From 1933!

http://journals.lww.com/neurosurgery/Fulltext/2014/10001/The_History_of_Neurosurgical_Treatment_of_Sports.2.aspx

It may be said that a player who receives repeated concussions should consider very seriously withdrawing from football. The danger…with a concussion is that of a coincident intracranial or intracerebral hemorrhage which may be delayed in its appearance. The neurological examination which follows a concussion, therefore, should be made not only immediately after the player’s removal from the game but he should be watched for at least twenty-four or 48 hours for any evidence of increased intracranial pressure, signifying bleeding.

It's only with high profile cases nowdays that everyone is now aware. Better late then never I suppose....

irishbucsfan · 06-10-2015 12:32pm

Moflojo wrote: »

They give players the option to play in their age category or weight category. Separate competitions for both categories. They offer the same options at adult level too.

It completely depends on where in New Zealand it is you're talking about.

It's not a blanket NZRU policy. Some people seem to think it is but it's actually just a policy applied to some of their competitions (unless they've recently adopted it across the board and I missed it). Generally it works as a weight cut-off over age guidelines. I haven't seen anywhere where it's a choice though.

Here's one of the cutoff charts: http://www.aucklandrugby.co.nz/Weights-and-Ages-Chart.aspx

TICKLE_ME_ELMO · 06-10-2015 12:33pm

Watched this last night and thought the incident in the recent Leinster Schools match was pretty shocking. You could see from the video that kid should have been taken off straight away and yet he was allowed to play on. Clongowes refused to speak to the doccumentary makers too.

The guy from the IRFU that appeared and kept talking about how great they are at educating people got on my nerves. Seemed like a PR job with very little to add to the conversation. It's obvious from some of the stories told that people are still ignoring head injuries at all levels. Perhaps some sort of fine for teams that let players play on with head injuries? Obviously it's not always easy to prove but the George North one (two) against England this year was the height of stupidity. He never should have been allowed back on the first time. That young lad who died in Northern Ireland died from second impact syndrome. If he'd been taken off after the first knock he may well have been fine. Same thing could have happened to North, or that kid from Clongowes, or the other young lad they were talking to on the documentary.

Moflojo · 06-10-2015 12:45pm

irishbucsfan wrote: »

It completely depends on where in New Zealand it is you're talking about.

Thanks, I knew it was a New Zealand initiative but didn't realise it was only in specific regions, I assumed it was across the board.

aimee1 · 06-10-2015 12:46pm

TICKLE_ME_ELMO wrote: »

Watched this last night and thought the incident in the recent Leinster Schools match was pretty shocking. You could see from the video that kid should have been taken off straight away and yet he was allowed to play on. Clongowes refused to speak to the doccumentary makers too.

The guy from the IRFU that appeared and kept talking about how great they are at educating people got on my nerves. Seemed like a PR job with very little to add to the conversation. It's obvious from some of the stories told that people are still ignoring head injuries at all levels. Perhaps some sort of fine for teams that let players play on with head injuries? Obviously it's not always easy to prove but the George North one (two) against England this year was the height of stupidity. He never should have been allowed back on the first time. That young lad who died in Northern Ireland died from second impact syndrome. If he'd been taken off after the first knock he may well have been fine. Same thing could have happened to North, or that kid from Clongowes, or the other young lad they were talking to on the documentary.

The mother of the kid who died also said something which was pretty stark. Its was something like "its going to take a death live on tv for things to change"

TICKLE_ME_ELMO · 06-10-2015 12:51pm

aimee1 wrote: »

The mother of the kid who died also said something which was pretty stark. Its was something like "its going to take a death live on tv for things to change"

She's probably right too. Look at Fabrice Muamba. There were a number of cardiac related deaths in GAA and other sports that got little or no attention, Muamba very nearly dies on live TV and it's an international issue and players all get heart screening now.

I think also, as pointed out, the NFL case will probably make them do more if only to protect their own finances.

WarZ · 06-10-2015 1:11pm

I've suffered 3 concussions, one from rugby, one from muay thai and one from a silly BMX accent when I was a nipper.

I wonder if I should get checked up, it's a scary subject to be honest.

irishbucsfan · 06-10-2015 2:11pm

WarZ wrote: »

I've suffered 3 concussions, one from rugby, one from muay thai and one from a silly BMX accent when I was a nipper.

I wonder if I should get checked up, it's a scary subject to be honest.

I had an issue with recurring concussions the last season I was playing before I left Ireland. I got repeated knocks on the head. I actually returned to the field in those games (this was in early 2011). We had a club physio and also a club doctor however the doctor only attended home games, it happened 3 games in a row and the third was at home, the doctor (who was very experienced with head trauma etc due to previous army work) literally dragged me off and told me to sit out the rest of the season (which was 4 or 5 games). I was pretty upset with that at the time but I haven't had any issues with head injuries ever since.

There needs to be better education of players, that's the main issue that's led to current problems. People feel weak when they go off with a concussion, they feel like they're being soft. I've started coaching recently and I try to drill it into players that a concussion is not like other injuries, it's not worth pushing through it. I grew up listening to stories of Willie John McBride playing games with broken collarbones, and other legendary tales of Irish legends putting their bodies on the line. I felt (albeit subconsciously) that going off with an injury was me failing my team. We need to make sure the next generation aren't as dumb/unedcuated as I was back then. I get the impression that people feel there is a cover up or something malicious going on, I've been involved in clubs/schools rugby a long time and I've never seen anything remotely like that. This is definitely a case for Hanlon's Razor:

Never attribute to malice that which is adequately explained by stupidity.

Looking back I remember playing a game at u20s level against Lansdowne and getting repeated knocks to the head. I was actually bleeding out of both nostrills, I looked like a dope with tissue shoved up both of my norstils and a headband on! I played one of the best games of my life that day, but I actually don't remember what happened that much, my first memory was after the final whistle our full back ran up to me and shaking my hand. I never really told anyone else (I think I thought it would weaken my personal accomplishment if they thought I wasn't fully compos mentis during the game) but I absolutely should have been taken off about 20 minutes in. Looking back I'm very lucky that things went as they did for me, and I think the same is true for an unsettlingly large number of my team mates.

thomond2006 · 06-10-2015 2:19pm

http://www.theguardian.com/sport/2015/oct/06/jonathan-thomas-wales-worcester-head-trauma-epilepsy-rugby?CMP=share_btn_tw

unce09f · 06-10-2015 2:22pm

I'd say the GAA was loving that documentary last night.

thomond2006 · 06-10-2015 2:23pm

unce09f wrote: »

I'd say the GAA was loving that documentary last night.

The GAA has had concussion issues as well. Aidan O'Shea vs Kerry last year comes to mind. I don't think anyone would enjoy that documentary in any case.

TICKLE_ME_ELMO · 06-10-2015 2:29pm

Second Captains did a piece on concussion on the last TV series and they had a guy, can't remember now was he hurling or football, but he was talking about getting a concussion and how he was fine for the whole rest of the match and even afterwards but a few hours after he went home he started crying and couldn't stop. They were discussing the 10 minutes assessments and if they were actually any use. His story was obviously saying they're not.

TICKLE_ME_ELMO · 06-10-2015 2:59pm

Here's a link to more info on the research Leinster are doing with TCD into concussion assessment tests. The talk of a finger prick test on the documentary didn't make a lot of sense to me but it's much clearer after reading that. Would be an amazing medical breakthrough if they can get it to work.

http://www.leinsterrugby.ie/branch/13762.php?preferdesk=1#.VhLvitm9LCQ

https://www.youtube.com/watch?v=RwqiWO7Ly6k

Moflojo · 06-10-2015 2:59pm

TICKLE_ME_ELMO wrote: »

Second Captains did a piece on concussion on the last TV series and they had a guy, can't remember now was he hurling or football, but he was talking about getting a concussion and how he was fine for the whole rest of the match and even afterwards but a few hours after he went home he started crying and couldn't stop. They were discussing the 10 minutes assessments and if they were actually any use. His story was obviously saying they're not.

The neurologists on the Hidden Impact documentary were fairly scathing of the 10 minute 'Head Injury Assessment' provision that IRB introduced. Dr. Barry O'Driscoll resigned from his position as IRB medical advisor because of the introduction of the HIA. He suggested the IRB pulled the 10 minute assessment period out of their arse - that there's no medical evidence to support it.

TICKLE_ME_ELMO · 06-10-2015 3:10pm

Moflojo wrote: »

The neurologists on the Hidden Impact documentary were fairly scathing of the 10 minute 'Head Injury Assessment' provision that IRB introduced. Dr. Barry O'Driscoll resigned from his position as IRB medical advisor because of the introduction of the HIA. He suggested the IRB pulled the 10 minute assessment period out of their arse - that there's no medical evidence to support it.

Yeah, the more people talk about their own experiences with concussion the more it becomes clear that the 10 minute thing is a load of rubbish. They just wanted to be seen to be doing something.
It's a difficult one to do anything about because, as pointed out last night, you don't have to get an actual blow to the head to get a concussion. I think that's where the Kinetics of Concussion research Leinster and TCD are doing comes in.

aimee1 · 06-10-2015 3:22pm

thomond2006 wrote: »

The GAA has had concussion issues as well. Aidan O'Shea vs Kerry last year comes to mind. I don't think anyone would enjoy that documentary in any case.

Johnny Cooper in all ireland football final a few years ago. Dublin were already down to 14 when he was hit badly and was just left wandering rhe pitch IIRC

tigerboon · 06-10-2015 5:26pm

unce09f wrote: »

I'd say the GAA was loving that documentary last night.

My son plays both and I have to say I've seen more head collisions in GAA. It's one of the risks in both games but it's how the coaches deal with it that's important. If a child gets any knock on the head he/she should be taken off the pitch.

Tim Robbins · 06-10-2015 9:16pm

What really concerns me is that kids are way more likely to get concussion because the membrane around their head is thinner. You have to be super safe in both GAA and Rugby with what drills you are doing as young kids tend to cluster and hence are more likely to bang heads.

GAA / Rugby / Soccer were invented for adults. But now kids start playing organised sport at age 5. We just all got to be responsible as parents, coaches and refs.

The Lost Sheep · 06-10-2015 9:36pm

Moflojo wrote: »

I agree with you 100%. Coaches tend to only care about results, not the welfare of individual players, so penalising players for using their heads in the contact area is the way forward.

I'd like to see the introduction of penalties for the following:
- Use of the head in the tackle (head on the wrong side).
- Barging with the head while in possession. So many players dip their heads going into contact and very often it's the perfectly legal tackler that comes off worst.
- Intentionally causing contact with a defender's head or neck. E.g. No handoffs to the head/face. No forearm smashes to the tackler's head or neck.

I don't think penalising head on the wrong side is needed but proper coaching especially at younger/more social levels here there is plenty of beginners.
Barging with the head while in possession can be penalised under law 10.4 foul play and striking an opponent with the head. Same as intentional contact with the head or neck

Tim Robbins wrote: »

You are on to something here.

But the devil is in the detail. It can be hard to get your head on right side depending on the angles and skill levels. But dangerous contact in the tackle and ruck could probably be pinged more.

My suggestions.
1. No-one is allowed to coach rugby unless you have been trained and assessed. That's the way it is for Ref's. Some coaches out there are nut jubs (a very small minority) and put players in situations they rarely should be. If you have to Garda vetted, you need to be IRFU vetted. I spoke to an English coach on holidays who told me one coach in his school didn't pass his exam so couldn't coach.

2. When you get your coaching badge, you are reviewed at least once a year. Again it's the same for refs.

3. In Ireland contact starts at U8. In England it's U10.
I think World Rugby need to make a decision here based on best evidence and all countries have to stick to that.

In Ireland because we follow the calendar year it is possible to be only 6 and be playing U8 and hence contact Rugby. For a lot of kids that is way too young.

Problem with stopping people who haven't done coaching courses from getting involved is you are stopping volunteers from getting involved as coachin courses are only on on certain weekends though if clubs have sufficient numbers they can get their own course in their club.
In most cases club coaches are reviewed fairly often. I did the mini course 5 years ago and did foundation about 4 seasons ago and have been reviewed by branch development staff twice in that time frame.....

zymar · 06-10-2015 9:58pm

there is definetly more being done which is great but there is always going to be accidental collisions, head on head/neck, knee on head/neck and the clearing out in the ruck is always a big hit.
why are there not more players wearing scrum caps ? even for protection from ending up with the dreaded cauliflower ears !! ?

TICKLE_ME_ELMO · 06-10-2015 10:01pm

zymar wrote: »

there is definetly more being done which is great but there is always going to be accidental collisions, head on head/neck, knee on head/neck and the clearing out in the ruck is always a big hit.
why are there not more players wearing scrum caps ? even for protection from ending up with the dreaded cauliflower ears !! ?

Scrum caps don't prevent concussions. It's the movement of the brain inside your head that causes them so even helmets don't do anything, really. The experts on the documentary pointed out that you don't even have to bang your head to get a concussion, the impact of a collision can travel up your spine and cause it.

Hidden Impact: Rugby & Concussion

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