Concussion in Rugby: The IRB should learn from American Football

Michael Duffy

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Each weekend of the Six Nations championship brings the issue of concussion more and more to the forefront of the debate about the long term effects of head injuries sustained while playing contact sports. The world of rugby must move quickly to examine the flimsy concussion protocols adopted by some associations which apparently allowed Welsh Centre George North to re-enter the fray after being concussed twice during the opening match of their Six Nations encounter against England.

According to Dr. Barry O’Driscoll(former Ireland and Connaught player), who incidentally resigned from his position as chief medical advisor at the IRB over its attitude to concussion, claims the George North incident is yet another clear example of medical concerns being overridden.“I am afraid it is very difficult to come to any other conclusion that it is not the state of the players’ brain but the state of the game that is determining a lot of these cases. If George North had been in a boxing ring then the fight would have been stopped. He was out cold”.

Dr. Barry O’Driscoll  believes that team doctors are being put under undue pressure to obfuscate the concussion protocols as was clearly illustrated in the case of George North’s return to the field of play.”What has happened is that World Rugby have got themselves in an awful mess by creating two categories of concussion: a suspected concussion, where you must come off and stay off, and a potential concussion, where you can come back on. It is a nonsense. By very definition if you are doing a concussion assessment then you have to suspect the player is concussed. It opens a pathway for brain injured players to stay on the field.”

So what exactly are the IRB guidelines on concussion. Here is a condensed summary of their current concussion protocol.

  • Concussion must be taken extremely seriously to safeguard long term Player welfare.
  • Players suspected of having concussion must be removed from play and must not resume play in the match or training.
  • Players suspected of having concussion must be medically assessed.
  • Players suspected of having concussion or diagnosed with concussion must go through a graduated return to play protocol (GRTP).
  • Players must receive medical clearance before returning to play.

With regard to GRTP(graduated return to play protocol) ,the management of a GRTP following a concussion or suspected concussion of a Player should be undertaken on a case by case basis and with the full cooperation of the Player. If the GRTP is managed by a medical practitioner, then  a player completing each stage successfully (without the reoccurrence of any symptoms) would take
approximately one week to proceed through the full GRTP rehabilitation protocol.

The problem here is that not all RFU’s(Rugby Football Unions) are applying a strict adherence to these guidelines as the Welsh RFU’s handling of George North incident clearly shows, and also that there is a clear need for independent medical assessors to be appointed for these games in place of the medics who are appointed by and influenced by the unions themselves.

Will Rugby suffer a similar fate to American Football?

In August 2013 The NFL(The governing body of American Football) was successfully sued by former players over brain related injuries. The NFL agreed to pay a settlement of  $765 million to over 18,000 retired players, agreeing to compensate victims, pay for their medical exams and underwrite research due to concussion related injuries to these players.

More than 4,500 former athletes — some suffering from dementia, depression or Alzheimer’s that they blamed on blows to the head — had sued the NFL, accusing it of concealing the dangers of concussions and rushing injured players back onto the field while glorifying and profiting from the bone-crunching hits that make for spectacular viewing at the NFL games.

The NFL had long denied any wrongdoing and insisted that safety always has been a top priority.In recent years, a string of former NFL players and other concussed athletes have been diagnosed after their deaths with chronic traumatic encephalopathy, or CTE(a degenerative brain disease that can be identified only in an autopsy). Some neurological experts in the US predict that over a third of all former American Football players are likely to suffer from sort of cognitive brain disorder after retirement.

The message for the  IRB is clear given the precedent that has already taken place  in American Football: Act now before players suffer the long term consequences from concussion  related injuries or  else compromise the future health and wellbeing of the game.

 

 

 

 

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Michael Duffy