Rugby Being Put Through Wringer in Scotland

Scottish rugby has become somewhat of a surrogate for the problems in rugby when dealing with the current concussion issue.  Scotland certainly is not the only place this has become and issue (even though the IRB would like to tell you so); and this issue of concussions and sport seem similar in nature to what we have seen here in the States with American Football.

The uproar all began when a former player, Roy Lamont, made it known that he thinks/knows that players were both “sandbagging” and deliberately deceiving concussion test in order to remain playing;

Players regularly pass the tests. In many cases that is because they cheat,” revealed Lamont. “Players all talk about it. A test is done at the start of the season as a baseline test, and players who suffer from concussion have to return to that level to be passed fit to play.

“But some players will deliberately do stuff in the baseline test so that their results are low, making it easier to pass after concussion. And I’ve seen players carrying concussion into games. They’d come off a fairly straightforward tackle, but be sitting on the ground, starting into space for a few seconds.”

Interestingly Lamont’s comments were in response to an incident where a player was not sent off for concussion even though he exhibited overt signs;  Continue reading

Archaic Thinking/Management of Concussion Not Just a N. American Issue

I have cataloged this problem many times in many sports across the world.  It seems that perhaps the focus and glare is greatest here with North American sports (mainly football and hockey), but this problem extends further.  This issue perhaps came to a head in the UK over the past week with this article by Tom English;

Barry O’Driscoll played rugby for Ireland in the Five Nations championship of 1971.

As a respected doctor (whose son was team doctor for Ireland and the Lions in the recent past) with a background as an international full-back he became an important figure on the International Rugby Board where for 15 years he held positions on the medical, anti-doping and disciplinary committees. Until late last summer, when he resigned.

Dr. O’Driscoll left his post because of the way the International Rugby Board (IRB) was/is handling concussions on the field and in general.  As an aside, the IRB is a founding partner of the Zurich statement as well.

What would make a highly trained and well-respected doc – with rugby in the blood – step away?  Take a look, specifically at what happened to his nephew;

After one collision too many that day Brian O’Driscoll lost his bearings, was clearly unsteady on his feet and had to be helped from the field, like a boxer assisted from the ring. You did not need experience in pathology to know that the great man was out of it for a moment in time. Yet a few minutes later he was back on the pitch, supposedly as bright as a button and fully recovered.

He was back on the field because ?????;

There is an accompanying rule now – still on trial – and it states that if a player with suspected concussion can pass a series of tests lasting five minutes then he can be allowed back into the fray: the Pitch Side Concussion Assessment (PSCA) – or the five-minute rule.

Even worse the “new” rule was not even in place when his nephew sustained his concussion, leading the good doc to question what the sanctioning body and the medical board was doing;

“Rugby is trivialising concussion,” he says. “They are sending these guys back on to the field and into the most brutal arena. It’s ferocious out there. The same player who 18 months ago was given a minimum of seven days recovery time is now given five minutes. There is no test that you can do in five minutes that will show that a player is not concussed. It is accepted the world over. We have all seen players who have appeared fine five minutes after a concussive injury then vomiting later in the night. To have this as acceptable in rugby, what kind of message are we sending out?

“If a boxer cannot defend himself after ten seconds he has to have a brain scan before he comes back. And we’re not talking ten seconds for a rugby player, we’re talking maybe a minute that these guys are not sure what’s going on. They don’t have to have a brain scan, they have to have five minutes where they have to stand up straight without falling over four times, they have a basic memory test – ‘What’s the score? Who are you playing against? Which half did it happen in? And do you have any symptoms?’

“These questions should serve as a landmark for when you examine them six hours later to see if they’re getting worse or if they’re bleeding into their brain. That’s why you ask them, not to see if they can go back on. They are already concussed at that point. You don’t need to ask questions to find that out. If six hours later their responses are worse than they were earlier you say ‘Wait a minute, this shouldn’t be the case, is this guy going to bleed?’ That’s why you ask the questions and so it has always been. But we’re going in the other direction now. We’re going from being stood down for three weeks to one week to five minutes with players who are showing exactly the same symptoms. The five-minute rule came out of the blue. I couldn’t be a part of it so I resigned from the IRB. It saddened me, but I couldn’t have my name attached to that decision.”

As you can clearly see some places are not quite ready to accept the real issue of concussions – not the actual injury – the mismanagement of the injury once it occurs.  If the IRB places the new “five-minute pitch side rule” into place they are going in the absolute wrong direction.

If any player in any sport shows clear signs of concussion they should be removed and not allowed back in, period.  Even Zurich, which the IRB is part of states this.  Dr. O’Driscoll is merely saving his reputation by stepping aside, and in my opinion it is the exact correct move.

 

Rugby Union to Install New Concussion Rule

As part of the new rules in Premiership Rugby the installation of a “concussion bin” will begin September 1st.  Union and the sport of rugby took some criticism when recently played matches included some players that seemed to be dazed or even incapacitated after a hard knock.  Because of this the new rule was created;

If a team doctor or referee suspects that a player may have suffered concussion during an Aviva Premiership match, that player will be required to leave the field for five minutes to undergo cognitive tests.

If that initial suspicion is confirmed in a pitch-side assessment, the concussed player will not be allowed to return and the temporary substitution will be made a permanent one.

Not only does the team medical official have the ability to have the player removed the referee can be more aggressive in getting a player off the field.  The hope is that this will catch more players that have suffered a concussion and make sure they are removed, but if you remember the NHL tried this at the end of the 10-11 season and it was basically abandoned the following year.

Not only do I think this is a productive idea, but it is one that should be adopted by the sports that have limited substitutions, such as soccer and Aussie Rules.  Five minutes are sufficient to get the job done, but more time would be better.  Alas, this is a step in the right direction.

Good On ‘Ya Mate

We follow collision sports around the world as this issue is not localized to just North American sports.  With heading in soccer to the aerial displays of winter/action sports to the high-speed knocks in rugby, everyone can stand to learn and be prepared for concussions.  As we have kept saying it is just part of the game.  Yes, we would like to minimize every chance of concussion but realistically now is the time for awareness and proper management.

I keep an eye on Australia, especially now as the AFL is getting ready for play, and have criticized the apparent lack of understanding of concussion in Footy.  The other big sport this time of year Down Under is rugby, with the National Rugby League 21 days away from starting.  This sport to has drawn both good and bad from me and the visitors of the blog, but I read something today from the Herald Sun that makes me want to stand up and say “about time!”; Continue reading

Rugby Concussion Education: Tim O’Connor

The Concussion Blog is excited and privileged to have a guest author post about rugby.  Tim O’Connor is a barrister practicing in Ireland with a specialty in rugby and sports law.  He writes on the topic at www.rugbylaw.blogspot.com.  Tim will be posting from time-to-time from across the pond.  Here is is first entry about the IRB and concussion law (rules).

As a child, one of the very first things you learn playing rugby, is how to fall and protect your head.

And there’s a good reason. Rugby’s a fast-moving collision sport, and a relentless one; there are multiple phases, no rolling substitutions, and all sorts of areas where a misplaced boot, knee, elbow, shoulder or head can come sharply into contact with your head. No-one is taught to use their head in the tackle; but when a 160-pound 5’10” outhalf can find himself facing up to a 6’7” 260-pound lock who’s moving at 100m-in-11-seconds pace, accidents can and will happen when all the protection you have is a gumshield, maybe a scrum-cap, and determination.

So, rugby has known for a while that concussions happen. And the leading rugby nation on earth, New Zealand, have been leading the way on concussion management. Since their RugbySmart program was introduced in 2001, Continue reading

Examples Of Horrible and Great Decisions

Two weeks ago I highlighted the clear message from the International Rugby Board about concussions, however what I didn’t know is that this protocol was apparently not used for a French player in the World Championship match.  There were two comments, one that led me to the write up about this situation;

Parra took what appeared to be an accidental blow to the side of his head from the knee of All Blacks’ Captain Richie McCaw in a ruck, and appeared to be visibly concussed, looking shaky on getting up after receiving lengthy on-field medical attention. Continue reading

Rugby Makes CLEAR Statements

The International Rugby Board met last spring to make changes to the concussion protocol for their sport.  I had opined that rugby could have been in trouble with the incidence of concussion in their sport.  However I must say (after finally following up on it) the IRB has at least made it perfectly clear on how concussions will be handled for rugby;

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Continue reading

Rugby Making Changes For Concussions

The International Rugby Board (IRB) is set to make wholesale changes in the way injuries, in particular concussions, are handled at all levels of competition.  The results of the Rugby Football Union, Rugby Players’ Association and Premiership Rugby audit of injuries found that concussion/brain trauma was the fourth most common injury that removed a player from the match (3.9 per 1,000 game hours).

Now the IRB is ready to overhaul the system for inspecting a concussion and handling the injury itself;

“The IRB are at the final-draft stage on a new set of concussion guidelines that I expect would flag up the importance of players with symptoms of suspected concussion being removed from the field of play,” Kemp said. “Our management of players once they have come off is according to best practice.

“There are particular challenges around assessment in a game in which the potential for concussion is so high and players get dings the whole time. There are some challenges around making decisions in a short period of time on a pitch with a player who is often engaged in the next play. It will be the focus of a very robust initiative. I am very confident the position we will get to is entirely adequate.”

This will mark the first time the IRB and associated leagues/unions have specifically addressed this issue, highlighted by a scary incident where England wing Chris Ashton remained on the field after a big hit to the head, and an Irish Times article actually taking the rugby institution to task.

This is good for the sport, however changing how the sport currently deals with the injury, mandatory three-week lay off, will be a good start.  We will be looking forward to the specifics as new an unique views are always needed.