Q | What is this new report into concussion in rugby?
A |The England Professional Rugby Injury Surveillance Project has analysed every single match and training injury from England’s Premiership season since 2002, and the key findings from last season are that concussion remains the most commonly reported injury in the game, and instances of it have risen for the third year in a row.
Q | Why is it relevant now?
A | Because Wales have decided to rest winger George North for the match against Scotland at the weekend after he received two heavy blows to the head against England last Friday. The second one left him in a heap on the floor, but went unnoticed by the Wales medical team, prompting widespread alarm from both the rugby community and the public at large.
Q | Should we be concerned?
A | This report, compiled by Dr Simon Kemp, the head of sports medicine at the Rugby Football Union reaches some worrying conclusions. While the number of injuries has remained within a stable range for the last decade, reported concussions rose to 86 in the last year covered from 54 in the previous one, and all experts on the subject agree that the actual number will be far higher.
Q | So why is concussion on the rise?
A | According to the report: “Improving concussion awareness amongst players, coaches, referees and medical staff and the standardisation of concussion management has been the major medical focus of the English professional game since 2012 and is likely to have contributed significantly to this rise in concussion reporting.”
Q | Does everyone agree?
A | Not everyone. World Rugby’s former chief medical officer, Dr Barry O’Driscoll, who resigned over concussion and what he felt was indifference to it within the game, said earlier this week: “These people are playing a new game, a different game and they are being experimented on. When I played rugby everyone was 2st lighter and, crucially, players looked for the gaps so the tackles were made by outstretched arms. Now, heavier players look for the contact and run straight at opponents and keep going until a gap eventually comes. We know very little about the brain for certain and we have a huge amount to learn, but at the moment these players are being experimented on.”
Q | What is being done about it?
A | Dr Kemp has announced plans for a study to begin in March, which will take its sample from the pool of 800 or so retired England international rugby players still alive. “They range in age from 22 to 85,” he said. The study will look at the long-term effects on the brain and brain function from having played international rugby.
There will be scientific inexactitudes to overcome. The popular opinion is that the game has changed, but concussion awareness has also changed. Dr John Brooks, a former Harlequins player who now has a PhD in the epidemiology of rugby injuries, and who set up the audit into England rugby injuries, said it is hard to know, even as recently as “15 or 20 years” ago, how many players were getting concussed.
Q | How does rugby union compare with other sports?
A | Concussion in the English Premiership last season was at a rate of 10.5 per 1,000 hours. which is less than the 17 in professional boxing and 25 in horse racing. But those sports impose a mandatory 30-day lay-off for anyone found to have concussion.
In rugby union, players can return to matches after two weeks. And this survey recorded that a third of those reporting with concussion were back training after six days.
Q | Is it difficult to diagnose concussion?
A | Dr Kemp said there was “no gold standard” in diagnosing concussion, which remains difficult to manage effectively. “Almost every other injury, if you have a scan or an X-ray, it will reveal it. If, with concussion, all that happens is impaired thinking for a couple of days, it can be very hard to detect.
“There are very few published studies on the return to the field of play after concussion. What you’ve got to do is look to whether existing practices in your sport are safe or not.”
In the Premiership, return to play is independently scrutinised and is also in line with the Zurich Consensus, which are concussion guidelines for all sport.
Q | So how can incidents of concussion be reduced?
A | According to Dr Kemp: “We have to change the culture across the sport generally.” The problem is that, although players are now routinely put through a “concussion education module”, the anecdotal evidence is often to the contrary.
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