Rugby says it looks after its own. Concussion crisis tells us something very different
Authorities talk the talk when it comes to welfare but players are suffering multiple head traumas
David Walsh, Chief Sports Writer
Saturday January 29 2022, 6.00pm, The Sunday Times
The final act of last year’s Six Nations Championship was the rescheduled game between France and Scotland at the Stade de France. Trailing 23-20 with less than ten minutes remaining, Scotland lost Finn Russell, their talismanic fly half, to a red card. Their hopes should have perished. Instead, the Scots became more defiant and turned the game round with a last-second try.
The 2021 edition of the old championship was compelling. Scotland’s victory at Twickenham, England’s fine win against an impressive France, Ireland’s dominating performance against Eddie Jones’s team in Dublin. All of those games were played in empty stadiums and though the atmosphere was soulless, the rugby was memorable.
There won’t be an empty seat when this year’s Championship begins in Edinburgh and Dublin on Saturday. And if competitive rugby, played in throbbing stadiums, is to your liking, this tournament is one to savour. After last season, why should the Scots fear England? After autumn victories over New Zealand, Ireland and France will be stronger than a year ago. England, too, came through their autumn tests enhanced by change and emboldened by youth.
And Wales? They’re just the defending champions. The country that has won more grand slams than any other in the 22 years of the Six Nations. Almost routinely, Wales rise to this occasion.
What though if we invited to the carnival all the recently retired players who have suffered brain damage playing the game that we love? Steve Thompson, Carl Hayman, Alix Popham, Michael Lipman, Dan Scarborough, Kieran Low and many who are not ready to speak publicly about their predicament. Early onset dementia, probable CTE: the words sound not like a diagnosis but a sentence.
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One hundred and sixty rugby union players and 75 rugby league players have joined a lawsuit taken against the games’ respective governing bodies, claiming the authorities could have done more to protect them from brain damage. The big majority of these players are in their thirties and forties.
Tim Cowley, 43, is among the 160 former union players. On Thursday he had a conversation with the neurologist who’d examined his brain two months before. A Kiwi, Cowley spent four years with Cornish Pirates in the English Championship and a further three seasons with Bourgoin in the French Top 14. Over the course of his career he suffered multiple concussions.
He retired in 2011. In recent years, headaches, memory lapses and mood swings became too frequent and too intense to ignore. “I wasn’t looking forward to the conversation with the neurologist,” says Cowley, “but I needed to know. He said my short term memory wasn’t good and that it would get worse. He also said that my brain had shrunk which happens when you’ve had blows to the head.
“The more encouraging news is that there is now a ground-breaking treatment about to become available that will give people in my situation the chance to slow down the rate of brain shrinkage and the speed of memory loss. So I’m taking a lot of positives from the consultation.”
Has he, like Hayman, Thompson, Lipman, Popham and so many others been diagnosed with early onset dementia? “The neurologist said my case was like theirs but I wasn’t ready to ask him if I had dementia. Another consultation is scheduled and that will be discussed. Today’s players need to know there’s a shitload of players like me who if they had a chance to go back in time, would do things very differently.”
Sam Underhill, 25, is one of today’s players. He was also one of the stars of the England team that reached the 2019 World Cup final and he played his part in the recent victories, against Australia and South Africa. Underhill though is not in the England squad for next weekend’s game at Murrayfield and may not figure in this season’s Championship. His problem is concussion.
In his first match for Bath, a Premiership game against Northampton, he made an impressive 23 tackles before getting a knock to the head that caused him to lose consciousness. That was September 2017. Two months later, playing for England against Australia, he suffered another concussion and on his return in early 2018, he spoke of the need to improve his tackle technique and make better decisions in the collision area.
Over the past three years, there have been stretches where he’s been symptom free and able to play his best. The propensity to getting concussions remained. He suffered another while training with England last summer and then, in the autumn, had to pass a head injury assessment (HIA) to return to the fray against Australia at Twickenham.
“Carried hard and often in the trenches for modest returns. Went off for a HIA but returned for a second bite of the cherry,” said an analyst on the website RugbyPass of Underhill’s performance. Underhill is a warrior and a week later he was helping the team beat world champions South Africa.
Then, the concussions returned. Eleven minutes into a Boxing Day fixture for Bath, Underhill got his head in a bad position tackling Gloucester’s Jordy Reid and that was it, game over. After a four-week break, he returned against Leinster in the Champions Cup last weekend. This time, he lasted 15 minutes. Another concussion.
“A lot these injuries come from the second or third tackler coming in and it’s Underhill, he gets his head in the wrong place,” said Lawrence Dallaglio in his co-commentator’s role with BT Sport. His colleague Brian O’Driscoll observed that it had been Robbie Henshaw’s hip that came into contact with Underhill’s head while the match commentator Alastair Eykyn put the injury into context.
“That is nasty in itself but he has only just come back from concussion problems and it was one of the reasons for his absence from the England Six Nations squad, so this will be a grave concern to club and country.”
What of the concerns for Underhill himself? How many concussions is too many concussions?
Anyone aware of his history watched his return last weekend hoping he hadn’t come back too soon. Research shows that those who have suffered previous concussions are more at risk of further damage. In its Concussion Guidance, World Rugby says: “Players with a history of two or more concussions within the past year are at greater risk of further brain injury and slower recovery and should seek medical attention from practitioners experienced in concussion management before return to play.”
Underhill had two or more concussions in the 12 months before the Leinster game. He would have undergone the return-to-play protocols, been symptom free and may have felt one hundred per cent fit and ready to play. But knowing if a player has fully recovered from brain injury is difficult if not downright impossible.
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“We have all the return-to-play guidelines,” Professor Michael Farrell, a brain pathologist at Beaumont Hospital in Dublin, said in the RugbyPass documentary, The Price of Concussion in Rugby, “but we do not have really good biomarkers either in the blood, radiological or otherwise that would allow us to say one’s brain has completely returned to normal and one is free to return.”
Adam Hughes was a centre for Dragons and Exeter Chiefs before retiring in 2018 at 28. “What I found with concussions is the more you had, the easier the next one comes. After each one I took longer to recover, to a point I was just never recovering at all. That’s when I knew I had to retire,” he said.
In his book Open Side, Sam Warburton tells about a scene in the changing room after a match against the All Blacks in 2014. George North came and sat by Warburton and Dan Lydiate. “I’ve had another concussion,” North said. “I got hit on the head, and for half a second I didn’t know where I was, or which way I was supposed to be playing.”
The two back-rowers thought this hilarious, not the concussion but North’s reaction. “Mate,” said Lydiate, “that happens to us literally every game.”
Warburton then explained the reality of the game he played. “I’ve lost count of the number of times I’ve taken a knock to the head, got up and not been sure which way I’m playing. Never go off unless you’re injured and a blow to the head, unless you’re actually unconscious, doesn’t count.”
The former Welsh skipper says that in considering a title for his book, he was tempted to go with Too Big, Too Fast, Too Strong. Warburton proposes a number of changes to improve player welfare.
Central contracts, a maximum of 25 games per season, full-contact training limited to ten minutes per week, a minimum of 12 weeks between the last game of the season and first contact session of the following season, a reduction in the number of replacements from eight to six and enforcement of all the laws governing the breakdown. Many of these changes would reduce revenue and therefore are not likely to happen. In May 2011, World Rugby chose to change the return-to-play protocols for concussion.
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At the time it was mandatory for concussed players to take a three-week break from the game. That was dropped in favour of a six-stage Graduated Return to Play protocol which could allow a player to return to action one week after his injury.
“We are yet to see any evidence which justifies the introduction of a return-to-play protocol that allows a player to return to the field of play in time for the following weekend,” said Professor Bill Ribbans, a sports doctor who has worked with Northampton. “We believe the current system is open to abuse and means players and medics can find themselves under huge pressure to return in time for the ‘next crucial game.’”
Last June Luke Cowan-Dickie was knocked out playing for Exeter in the Premiership final. The following weekend he played for the British & Irish Lions in South Africa.
On it goes and more recently retired players emerge from what Dylan Hartley calls “the shadowlands” to tell of the damage done to their brains. We wonder about the players of Warburton’s generation? What of today’s players? Is the game still inflicting injuries that will diminish future lives. Hartley has but a vague recollection of England’s grand-slam victory at the Stade de France in 2016.
“I have a sketchy memory of feeling the coldness of the turf,” he wrote in his book, The Hurt, “and hearing the buzz of the crowd. I can’t recall doing the cognitive test for concussion in the doctor’s room beneath the main stand which probably proves the point that I failed it.
“Lifting the Six Nations trophy remains a blur, a bit of fuzz. No face is symmetrical and each of us has our own self-image. Looking back at the photographs and the video of the ceremony I can see better than anyone that I am not right. There is a distant look in my eyes and a distinctive tilt to my head. I’m smiling but there’s no one at home.”
Hartley lost 246 days of his career to concussion.
All the while World Rugby, the Rugby Football Union and all of the other authorities talk the talk on welfare without bringing about significant change. Every game you watch is another reminder of the frequency of brain injuries.
Even rugby’s own people don’t believe in the current return-to-play protocols. “If it was up to me,” Dr Ken Quarrie, chief scientist with New Zealand Rugby, said last year, “players who have been concussed would not be able to return to play for at least a couple of weeks ]preferably longer]. Because there is evidence that symptom recovery precedes physiological recovery, I would endorse a longer no-play period than currently permitted.”
In February 2011, Ben Robinson, 14, died after concussions received in a schools rugby game in Northern Ireland. Over the last 11 years, Ben’s father Peter has campaigned for greater awareness of the dangers posed by concussion and better treatment for those who suffer head traumas.
“Ben’s story isn’t a positive story but it could be,” Peter Robinson has said. “I would hate to think he died in vain. Rugby, they don’t like Ben’s story but he’s one of their own.”
What rugby can learn from NFL’s concussion protocol
• After scientific research concluded a strong correlation between concussions and future neurological problems, the NFL established a concussion protocol in 2009.
• The ever-evolving protocol was designed by the NFL’s Head, Neck and Spine committee to better identify and treat concussions, before allowing athletes to return to the field.
• Designated spotters start the process by looking out for collisions which may incite a concussion, ready to call for a precautionary timeout if necessary.
• Each NFL team is also equipped with a neuro-trauma expert tasked with monitoring the athletes for key signs of concussion, such as loss of consciousness, head-clutching and disorientation. 6Once the experts diagnose a concussion, the player must follow a four-step process before returning to action. The athlete starts with rest and recuperation, followed by light aerobic exercises and later physical activities, such as strength training. To pass the final stage, athletes must be given clearance by both the neuro-trauma expert and team doctor.
• The Head, Neck and Spine committee can issue hefty fines and dock draft picks if a team violates the protocol; in 2016, the Seattle Seahawks were fined $100,000 for failing to manage Russell Wilson’s concussion appropriately. By comparison, World Rugby’s protocol for concussed players is a mandatory six-day rest before returning to play.
Topic: S Times article regarding concussion (Read 645 times)
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