Sunday, January 31, 2016

Rugby’s concussion discussion


logo post greenOnce again I must thank Sony Pictures for inviting me to their special screening during the week of the film “Concussion” starring Will Smith.   But perhaps the best way for me to show my appreciation would be for me to harp on it here on the site for a bit so here goes!

In this story based on actual events, Smith plays the part of Dr Bennet Omalu, a Nigerian-American forensic pathologist who discovered a condition called chronic traumatic encephalopathy (or “CTE”) in retired American footballers while working for the coroner’s office in Pittsburgh, Pennsylvania.  Basically the actor’s challenge was to show Dr Omalu to be every bit the hero that some of his other characters in films like Independence Day and I Am Legend were meant to be, and you’ll have to excuse the mixed US sporting metaphor when I say he totally “knocks it out of the park”.

Ultimately what helped Dr Omalu make the discovery was the fact that he had absolutely no interest whatsoever in the sport of American football.  Not that he hated it, mind you, rather he wasn’t brought up to appreciate its traditions and such.  Instead, his mind was only focused on what he could see through his microscope, and this evidence told him that many retired players were suffering from the effects of repeated blows to the head despite the wearing of a helmet.

His findings put him front and center against the fans (especially in a largely working class area like Pittsburgh where they almost literally worship their team the Steelers) and more importantly the organising body of the sport, the NFL, which is run by the owners of the 32 teams/franchises (who, as a character in the film points out, actually “own a whole day of the week”).

Obviously I have no wish to give you any “spoilers” - to find out how he got on against those people you’ll have to see the film for yourself (in Irish cinemas from Feb 12).  My focus here is to examine how the subject matter of the film can be understood and incorporated into the game of rugby.

A pathologist or indeed any kind of scientific “-ist” I most certainly am not.  But I am of a mind to appreciate the findings of scientists, especially when they have been widely supported and ratified by their peers.  In other words, from where I’m standing, the fact that CTE exists isn’t even up for debate - it’s merely a question of how we as lovers of sport react to it.

Where I can offer an reasonably informed opinion, however, is in the area of comparing the sports of American football and rugby, though in doing so I am going to have to choose my words very carefully.

Basically my overall point is that while I would not have any raw data to support it, my theory is that concussion-related incidents happen much less frequently in rugby than in the sport across the pond into which it evolved.  I really hope that theory is not misunderstood, however - because it is not my intention to convey that the matter is any less serious for us fact, in some ways, it makes it even more so.

The most fundamental difference between the two sports is what happens after the tackle.  In American football, once the player with the ball is deemed to be stopped, the “play” is over and they start all over again from that point on the field.  In rugby, however, the play does not necessarily end by any stretch. 


In the “league” code, there is a pause it’s true but only a brief one - the players on the field must stay in their positions and no substitutions can be made.  In union, once a tackle is made nobody stops and the play generally devolves into what is known as the “breakdown”.

Please accept my general definitions for the purpose of my argument - I am well aware that the sports have numerous exceptions. 

What I am trying to say here is that in American football, the player making the tackle has pretty much one thing on his mind - to halt the progress of the man with the ball.  And the man with the ball generally has one thing on his mind - to either evade or at least endure the hit enough to be able to sneak a few yards on the field after the contact.  So in any one game it can be assumed that multiple concussion-related incidents have taken place at different points and with so many breaks in the action, they’ll be easier to spot.

In rugby, particularly in the modern game at the highest level, a player cannot afford to merely think about stopping an opponent.  The play will generally carry on afterwards so you, the tackler, will have to be of a mind to getting up again and making the next tackle, or perhaps try to poach the ball, or at very least make yourself available to your team in their attempt to keep out the opposition.

While rugby does involve some direct head on head collisions, what we need to look out for more often than not is incidental contact after tackles.  And the term “incidental” should not trivialise the matter in any way.  Sometimes it’s a player heading to ground finding a stray knee of someone not involved in the tackle on the way down.  In Johnny Sexton’s case against Wasps recently, he was trying to assist his team mate in a tackle only to find Brendan Macken’s head colliding into his own.

Such permutations are almost limitless in rugby, yet because the play more often than not carries on, and also because such dangerous contact happens much less frequently, they can be missed.  Also into the equation we have the fact that sometimes the player will know he has been hit and won’t want to be taken from the field, while at others they won’t even realise it has happened. 

Then we have the question of what to do when concussion is suspected.  As well as Johnny Sexton there have been high-profile incident involving other test players like Luke Marshall and George North.  What the governing bodies have come up with is a set of procedures known as the “Head Injury Assessment Protocols”.  

Overall, I am in favour of this method, but despite having no medical experience I would wager that these protocols are ones that need to be constantly monitored and re-evaluated where necessary.  In fact those with just the right amount of medical experience like Dr Barry O’Driscoll have repeatedly make similar claims.

The details of the wording and such I will leave to the legal and medical boffins...but as far as I am concerned the principle philosophy driving the creation of the protocols must be that player welfare is paramount.  It doesn’t matter what the occasion is, it doesn’t matter how “legendary” the player is considered to be - if concussion is suspected, he or she must no longer take part until properly cleared to do so. 

There is one change, albeit a very small one, to the status quo I reckon can be made.  How about we stop calling it a “scrum cap” and instead re-brand it something like a “rugby cap”?  More and more backs are wearing them now and if they offer any kind of protection to players then maybe, just maybe, more can be persuaded to wear them if the name isn’t so position-specific.

But that is of course a minor point.  The major one is that everyone involved in the game, from those on the board of national rugby unions to those on the touchline at junior 4ths matches on muddy pitches at the weekend, makes themselves aware of what can happen and more importantly, what they can do about it once it does. 

Watching this film should go a long way towards demonstrating the folly of choosing to ignore the dangers of concussion.  Here’s hoping the generations to come will know those dangers every bit as much as they know the Laws of the Game.  Let’s be sure to keep the discussion going in the meantime.  JLP


For more on how the matter relates to the Irish game in particular I strongly recommend you read this article by VIncent Hogan in the Irish Independent just over a year ago.   Hard to believe it has been 5 years since the Ben Robinson tragedy.  RIP

Other related links of interest-


The Autopsy That Changed Football


The IRFU Guide to Concussion


Does OJ Simpson have degenerative brain disease CTE?


Taken by JLP from RDS press box on Nov 16, 2019