Concussion - 'Something is broken in the game of rugby'
Other than being elite-level rugby players, what do Ben Smith, Conor Murray, Bernard Foley, Alexis Palisson, Sekope Kepu, Stuart Hogg, Nic Stirzaker, George North, Charlie Ngatai, Tommy Seymour, Colin Slade, James Parsons, and Ryan Wilson have in common?
They have all suffered recent concussions – and, to be honest, this is hardly a comprehensive list, just ones gathered on a quick trawl of Google.
https://youtu.be/XL7BUsCLC_I
Former All Black Slade was this week stood down by his Top 14 club Pau for the remaining five games of the regular season, after suffering three concussions since the start of the season last August, with the club saying it adopts a ‘zero-risk policy’ on this type of injury.
But this ‘phenomenal brain injury rate’ is ‘unsustainable’, according to one of the world’s leading authorities on head injuries in sport.
Read more: Foley had career doubts amid ‘scary’ concussion
Consultant neuropathologist Dr Willie Stewart, a member of World Rugby’s four-strong Independent Concussion Advisory Group, warned: “The reality is we’ve got a badly damaged game, which is badly damaging players’ brains – and if something isn’t done, World Rugby may as well give up and call the game boxing.
“We went into the last weekend of the Six Nations with six teams decimated by injury. We did not have a Super Saturday spectacle with three matches of two teams performing at the highest level; we had three matches of whatever those teams had left in the bag.
He questioned the effectiveness of tightened tackle laws. “World Rugby toughened up high tackle laws to say any contact at shoulder-level or above is immediately given a sanction.
“During the Six Nations game against England, Stuart Hogg was grabbed around the neck and got an elbow in the side of the head. He went off a couple of minutes later.
“There was no sanction against the players involved. The game just carried on. In fact, there was all sorts of mischief in that game, neck rolls etc, none of which was penalised. All of which, technically, could have been carded.
“It’s all very well World Rugby saying it is a world leader in removing players with concussion, but it’s also now a world leader in inflicting brain injuries on players.
“It’s time rugby dealt with the problem at heart, which is the phenomenal brain injury rate in the game.
“If you look at the latest Premiership injury review, it suggested there was a brain injury every couple of matches. At the England-Scotland game, there were five.
“Even a brain injury every couple of matches is unsustainable. I think even boxing would challenge that in terms of numbers. Certainly football would. Something is broken in the game of rugby. It needs fixing, quickly.”
Read more: Jamie Cudmore – Suspecting a concussion means it’s probably a concussion
For all the protocols and procedures, law changes and initiatives to deal with concussion, such as the new blue card system being trialled in Australia, Dr Stewart believes not enough is being done to ensure the protocols are properly applied.
An ‘Untoward Incident Review’ (UIR) into scrum-half Conor Murray’s concussion during Munster’s European Champions Cup game against Glasgow in January found that the Irish side had no case to answer over their implementation of the protocols.
Conor Murray in action for Munster during the European Champions Cup match against Glasgow in which he suffered a head injury
Midway through the second half of that game, Murray went down after attempting to tackle Glasgow’s Tim Swinson. Immediately, team-mate Andrew Conway realised something was wrong and waved frantically for attention. Meanwhile, Murray’s Glasgow opposite number Ali Price patted the player’s face and looked to referee Luke Pearce as if indicating something serious had occurred. Pearce blew his whistle several times, reflecting the urgency of the situation, and immediately signalled for the medics.
Murray was treated on the pitch for three minutes and then allowed to play on. It was another two-and-a-half minutes before he was removed from the game for a formal head injury assessment (HIA).
Yet the review team sought no evidence from these players or the referee. To describe Dr Stewart as unimpressed is to miss the perfect opportunity to use the word seething. “What we had [for the review] was ‘three wise men’, who were judge and jury. All they did was ask those who may be accused of mishandling the situation to explain themselves.
“The review board didn’t bother to gather any other evidence. Where’s the referee’s viewpoint? Where are the players from both teams who were calling the referee’s attention? Where are the other medics? That’s all part of the information-gathering, surely.”
In their evidence, Munster said: ‘After assessing his [Murray’s] cervical spine and clearing him of any significant cervical spine injury he was further assessed for any possible head injury. He answered all his Maddocks questions correctly’.
That last sentence was an instant red flag for Dr Stewart: “You only ask Maddocks questions if you’re worried that the brain might be injured and the player may be disoriented. By definition, they have then crossed the boundary from concerns about his neck, which they initially treated, to concerns about his brain.
“On that basis he should have gone off to be assessed, not assessed on the park.”
Dr Stewart said: “That alone should have been the cue for the review group to say, ‘Sorry, you got that wrong. He had to go off. If you’re asking those questions, you’re asking if he might have a concussion. He should have gone off’.
“But the UIR said, ‘that’s fine – he passed the questions, so it’s fine’.
Murray’s UIR was the third in rapid succession, following a review into the well-publicised George North incident, and another involving Sale flanker TJ Ioane. In each case no action was taken against any of the clubs.
Dr Stewart said: “These reviews should look at how the system let players down and address them. Each one has suggested that neither the protocols were at fault, nor the personnel applying those protocols were at fault. That just doesn’t add up.
“An incident happened that had people saying, ‘hang on, that doesn’t look right,’ the whole thing has to be something that has gone wrong, otherwise why is it an untoward incident?”
He pointed to another case – that of Toulouse winger Alexis Palisson, who was clearly concussed in a Top 14 game at Stade Ernest Wallon against La Rochelle, yet allowed to play on following an HIA. “That kind of incident beggars belief in 2017, given that we can go back to George North incidents. There, the deficiencies in the application of HIA were revealed in that, on that occasion, it was said that the problem was there was no video available; that the medics on the touchline didn’t have a clear sight of what happened; that nobody informed them of what happened out of their sight.
“There are clear indications that there was something wrong with the system that would allow players with worrying symptoms to slip through the net. We should have closed these holes up – these loopholes should not still exist.
“What really disappoints me is that one of the things World Rugby has said is that everybody is responsible for player welfare, not just the team doctor. That player we saw get up, stagger and fall into a match official. Why did the official not act?”
Read more: Toulouse ‘to adopt two-doctor approach to HIAs’ after Palisson incident
The Palisson incident has yet to go through the notoriously slow French review process. In 2014, it took the Ligue Nationale de Rugby (LNR) nearly four months to rule on a shocking case involving Florian Fritz.
“In each of the incidents [Murray, North, Ioane], the officials have been arguably a bit weak in their handling of it. In the case of Conor Murray, the match official looked like he was playing the macarena on the whistle, he was so concerned about what happened to the player and yet he allowed him to play on,” Dr Stewart said.
“Why didn’t he say, ‘I’m sorry, you’re going off … now’ – if he feels it’s so important he got to blow the whistle seven or eight times, in his mind there’s something not right. He should have said, ‘I’m in charge here. This is my match You’re going off for an HIA’.
“We’ve seen it done – Wayne Barnes has done it, and there have been other instances – I don’t understand why match officials aren’t stepping up.”
Rugby laws state that referees have ultimate authority during a match. The blue card system being trialled merely adds official gloss to that authority. It is perhaps unfortunate this initiative is necessary – but it would appear that it is.
Player in Blue scrum cap goes down.
Ref goes to check
Informs medics "there's no HIA." and then…. pic.twitter.com/9z1jlHtqEL— The Champ Champs (@GifsRugbyNStuff) February 11, 2016
In the incident above, at a schools rugby match in Ireland – where no HIAs are permitted, and players are removed if they suffer a head injury – the medic argued with the referees’ decision.
The school later apologised.
Dr Stewart admitted HIAs are an imperfect tool for assessing concussion – but insists they are ‘the best of a bad bunch’. “No test for concussion ‘works’ in the sense that it will detect every single person who is concussed – that is part of the problem. Concussion-testing is very much a subjective assessment. There are no objective validated tests for concussion.
“The problem is I don’t see it being applied properly and I do have questions that when it is applied whether it is being used appropriately.
“An HIA is an assessment of brain function. The first part is to ask the Maddocks’ questions. They are about orientation – where are you? What half is it? What’s the score? – that sort of thing.
“There is a reason this assessment takes place off the park. Previously it was a pitchside assessment. There is well-known case evidence of Brian O’Driscoll being put through the questions at the Aviva, and he looked over the medic’s shoulder at the scoreboard and was able to work out where he was, what the score was and which half it was.
“The questions are pretty lame – but the fact you’re asking them means you’re worried about a player’s welfare. Then the HIA goes on to other things: memory tests and number crunching.
“None of these are truly objective ways of detecting concussion. They’re always subjective – for instance, if you ask a professional athlete if they have blurred vision, they’re going to say ‘no’, because they know if they say ‘yes’, they’re coming off.
“What the HIA is really for is to remove the player from the game, because once you’ve got them off the park, it’s far easier to keep them off. The reason for taking them off is to give medical staff time to reassess the player and also to look again at any video of the incident.”
But there’s one over-riding issue that worries Dr Stewart. “Rugby needs to figure out whether it wants to be a heavyweight slugging match where it’s down to who has the most fit players left on the pitch at the end of the 80 minutes, as opposed to who has the most skillful rugby players.
“I think, unfortunately, it’s evolving into a heavyweight slugging match, where the skills of rugby are regarded as the violence on the pitch, not how you can move the ball and the players around.”
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Comments on RugbyPass
Brayden Iose and Peter Lakai are very exciting Super Rugby players but are too short and too light to ever be a Test 8 vs South Africa, France, Ireland, and England, Lakai could potentially be a Test player at 7 if he is allowed to focus on 7 for Hurricanes.
5 Go to commentsPencils “Thomas du Toit” into possible 2027 Bok squad.
1 Go to commentsDon’t see why Harrison makes the bench. Jones can play at 10 if needed, and there is a good case for starting her there to begin with if testing combinations. That would leave room for Sing on the bench
1 Go to commentsWhat a load of old bull!
1 Go to commentsOf the rugby I’ve born witness to in my lifetime - 1990 to date - I recognize great players throughout those years. But I have no doubt the game and the players are on average better today. So I doubt going back further is going to prove me wrong. The technical components of the game, set pieces, scrums, kicks, kicks at goal. And in general tactics employed are far more efficient, accurate and polished. Professional athletes that have invested countless hours on being accurate. There is one nation though that may be fairly competitive in any era - and that for me is the all blacks. And New Zealand players in general. NZ produces startling athletes who have fantastic ball skills. And then the odd phenomenon like Brooke. Lomu. Mcaw. Carter. Better than comparing players and teams across eras - I’ve often had this thought - that it would be very interesting to have a version of the game that is closer to its original form. What would the game look like today if the rules were rolled back. Not rules that promote safety obviously - but rules like: - a try being worth 1 point and conversion 2 points. Hence the term “try”. Earning a try at goals. Would we see more attacking play? - no lifting in the lineouts. - rucks and break down laws in general. They looked like wrestling matches in bygone eras. I wonder what a game applying 1995 rules would look like with modern players. It may be a daft exercise, but it would make for an interesting spectacle celebrating “purer” forms of the game that roll back the rules dramatically by a few versions. Would we come to learn that some of the rules/combinations of the rules we see today have actually made the game less attractive? I’d love to see an exhibition match like that.
29 Go to commentsIrish Rugby CEO be texting Andy Farrell “Andy, i found our next Kiwi Irishman”
5 Go to commentsI certainly don’t miss drinking beers at 8am in the morning watching rugby games being played in NZ.
1 Go to commentsThis looks like a damage limitation exercise for Wales, keeping back some of their more effective players for the last 20/25 minutes to try and counter England’s fresh legs so the Red Roses don’t rack up a big score.
1 Go to commentsVery unlikely the Bulls will beat Leinster in Dublin. It would be different in Pretoria.
1 Go to commentsI think it is a dangerous path to go down to ban a player for the same period that a player they injured takes to recover. Players would be afraid to tackle anyone. I once tackled my best friend at school in a practice match and sprained his ankle. I paid for it by having to play fly-half instead of full-back for the rest of that season’s fixtures.
5 Go to commentsJust such a genuine good bloke…and probably the best all round player in his generation. Good guys do come first sometimes and he handled the W.Cup loss with great attitude.
2 Go to commentsWord in France is that he’s on the radar of a few Top14 clubs.
5 Go to commentsGet blocking Travis, this guy has styles and he’s gonna make a swift impact…!
1 Go to commentsWhat remorse? She claimed that her dangerous tackle wasn’t worthy of a red! She should be compensating the injured player for loss of earnings at the minimum. Her ban should include the recovery time of the injured player as well as the paltry 3 match ban.
5 Go to commentsArdie is a legend. Finished and klaar. Two things: “Yeah, yeah, I have had a few conversations with Razor just around feedback on my game and what I am doing well, what I need to improve on or work-ons. It’s kind of been minimal, mate, but it’s all that I need over here in terms of how to be better, how to get better and what I am doing well.” I hope he’s downplaying it - and that it’s not that “minimal”. The amount of communication and behind the scenes preparation the Bok coaches put into players - Rassie and co would be all over Ardie and being clear on what is expected of him. This stands out for me as something teams should really be looking at in terms of the boks success from a coaching point of view. And was surprised by the comment - “minimal”. In terms of the “debate” around Ireland and South Africa. Nice one Ardie. Indeed. There’s no debate.
2 Go to commentsThere’s a bit of depth there but realistically Australian players have a long way to go to now catch up. The game is moving on fast and Australia are falling behind. Australian sides still don’t priories the breakdown like they should, it’s a non-negotiable if you want to compete on the international stage. That goes for forwards and backs. The Australian team could have a back row that could make a difference but the problem is they don’t have a tight five that can do the business. Tupou is limited in defence, overweight and unfit and the locks are a long way from international standard. Frost is soft and Salakai-Loto is too small so that means they need a Valentini at 8 who has to do the hard graft so limits the effectiveness of the backrow. Schmidt really needs to get a hard working, tough tight 5 if he wants to get this team firing.
3 Go to commentsSorry Morgan you must have been the “go to for a quote” ex player this week. Its rnd 6 and there is plenty of time to cement a starting 15 and finishing 8 so I have no such concerns.
2 Go to commentsGreat read. I wish you had done this article on the ROAR.
2 Go to commentsThe current AB coaching team is basically the Crusaders so it smacks of wanting their familiar leaders around. This is not a good look for the future of the ABs or the younger players in Super working their way up the player ladder. Razor is touted as innovative, forward looking but his early moves look like insecurity and insular, provincial thinking. He is the AB's coach not the Golden Oldies.
10 Go to commentsSimple reason for wanting him back. Robertson wants him as captain. Otherwise he wouldn’t be bothering chasing him. Not enough reason to come back just to mentor.
10 Go to comments