Tackling Concussion in Rugby: The Invisible Injury

As we look ahead to the start of the new season of European rugby, this week we’re looking at the impact of concussion and its prevalence in recent rugby history. Concussion, or the invisible injury, as it’s also known, seems to be very high on the agenda of World Rugby – and rightly so, but are changes really being made to reduce the number of concussion related injuries on the field?

Let’s face it, rugby is a hard-hitting, all out contact sport. Knocks and injuries occurring here and there are inevitable right? Fitness and muscular development is forever increasing and therefore increasing the number of collisions on the field. But the number of concussion related injuries seems to have sky-rocketed over recent years. In particular, it is the most common injury amongst English professional rugby players. Typically, the tell tale signs of concussion include loss of consciousness, dizziness / drowsiness, blurred vision as well as nausea and vomiting. A recent 2014 report highlighted 70 cases in the Premiership, 23 cases in two of Europe’s domestic competitions accounting for 17% of reported injuries – a figure World Rugby will be striving to reduce!

Players are educated and coached to tackle and take contact in a safe as possible manner. But a coach could highlight the correct tackle technique, as well as other skills, till the cows come home, but you can’t replicate the exact game environment. Players improvise; they play what’s in front of them and if that means a last ditch tackle by throwing their body in to save a try being scored, then so be it. Bodies are on the line. That perfect technique the coach was portraying in training goes out the window. And there have been a number of victims to concussion in the not so distant past.

George North suffered from concussion on 3 occasions in 2015. You may recall the Northampton Saints game against Wasps when North collided with Wasps’ Nathan Hughes as North scored. Hughes’s foot inadvertently made contact with the head of North resulting in Hughes’s dismissal. North was left lying in a motionless and unconscious state in the in-goal area before receiving medical attention. Previous to this, North had 2 head knocks in the Six Nations game against England. At one stage he appeared to be momentarily knocked out. The medical staff seemed to have missed it and unbelievably North was not taken off the field and continued to play the rest of the game. Systematic errors and not human error was blamed, as the medical staff didn’t have access to video replays of the incidents. Fortunately, Warren Gatland decided not to go ahead with North’s inclusion for the proceeding clash with Scotland. The whole incident looked farcical and sent the World Rugby top-bods into disarray. North’s recovery lasted months prior to his inclusion in the Wales squad for RWC 2015. Many believed this specific incident was the tipping point for World Rugby’s stance on concussion and their ability to handle it more effectively.

Another Welshman, Justin Tipuric – more recently however, suffered a nasty concussion in this year’s Six Nations against Italy. The flanker fell from a lineout and subsequently received a hefty blow to the head. This being one week after Sam Warburton suffered a minor concussion injury against England. This time though, the Welsh medical team were quick to diminish any speculation on Tipuric’s return to action. And with that, he missed the rest of the Ospreys’ Pro 12 season as well as the Wales tour to New Zealand. The Welsh coaching team were understandably concerned for Tipuric’s health and justified such a lengthy recovery process. Following the injury, it was made apparent that Tipuric suffered a moment of sight loss whilst being treated at the hospital. Neither side wanted to ascertain any blame, but lineout jumpers rely heavily on the trust of their lifters as well as the opposing jumpers having a duty of care and competing safely. Again, it’s an incident that can’t be coached on the training field. Players learn correct technique at the lineout, but if you’re under pressure , you want to compete at every opportunity. Such incidents occur – non intentional of course, but they do occur.

Super rugby has also had its fair share of incidents. Waratahs and Australia International Full Back Israel Folau was tackled head on and the resulting clash of heads looked momentarily like folau had lost consciousness. The medical team carried out the necessary head injury assessment but Folau was able to return to the field of play after just 10 minutes. Looking at replays, Folau should have probably been side-lined for precaution, but it’s a decision that the medical team backed wholeheartedly. The side-line medical staff should have reviewed it more thoroughly  – full speed replays makes watching the incident cringeworthy. Either way the debate rumbles on and continues to be at the forefront of World Rugby’s regulatory agenda.

So just how serious is rugby’s concussion problem? I think it’s safe to say that it is a pretty serious one and lessons do need to be learned to ensure player safety and welfare remains the number one priority.

It’s serious enough that players are now seen to be wearing GPS technology patches for data collection. Saracens players are now wearing these to accumulate data on collisions, behind their ears, to understand further the impact the collisions have.

It’s serious enough that studies are showing the significance of concussion in later life. Brain injuries, depression and cognitive impairment are significantly higher in retired rugby players. It’s certainly a scary thought to think that the continued accumulation of knocks, collisions and injuries alike can have such a profound effect on later life.

The ever changing laws in rugby doesn’t help. A consistency in these laws at the lineout, scrum and even the breakdown needs to be in place so that a systematic improvement in player welfare and handling concussion injuries can be made and be allowed to progress.

New Zealand rugby is trialling 2 on-field referees in games in the National Provincial Championship with the aim of making the game tidier and essentially easier to referee in circumstances surrounding concussion and returning to playing afterwards. Introducing concussion awareness coaches should somewhat help to pick up the common signs. Either way, it certainly seems to be having an impact on managing unions.

However you see yourself in the whole concussion debate, there’s undoubtedly more that needs to be done to combat it, but in-roads have been made. Perhaps the players themselves should take more responsibility on protecting the safety of their opponents. Looking ahead to the new Aviva Premiership season, it is hoped that we will be able to see the issue controlled more effectively. As a result, hopefully we’ll see a significant reduction in the amount of concussion related injuries.

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