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Rugby, Concussion & Dementia: What Do We Do Next?

PARIS, FRANCE - FEBRUARY 13: Jonathan Sexton of Ireland leaves the pitch due to injury during the RBS Six Nations match between France and Ireland at the Stade de France on February 13, 2016 in Paris, France. (Photo by Dan Mullan/Getty Images)

Concussion and head trauma is not a case of scare mongering, witch hunting or trying to turn fans and players away from a game; it’s a real threat with genuine consequences.

The University of Michigan’s Institute for Social Research revealed in 2009 that former NFL players were 19 times more likely to suffer from early onset of Alzheimer’s than the general public, and that there are now close to 40 known cases of Chronic Traumatic Encephalothapy (CTE) in deceased NFL players.

That’s just the guy’s who have died, nevermind the former players that are currently suffering from the degenerative brain disease or those that will be diagnosed with it in the future.

Like American Football, Rugby is just as physical, just as demanding, and places just as much emphasis on collisions, so why should we expect drastically different results in Rugby than what we’ve seen in American Football? We shouldn’t and we don’t.

It’s a reality that most rugby fans accept. It’s a contact sport and naturally it comes with inherent risks, but that doesn’t mean that we shouldn’t do our absolute utmost to protect our players, for their present and future health.

Currently, under World Rugby’s laws, any player that shows clear signs or symptoms of concussion, or suspected concussion, at all levels of the game, must immediately be removed from the field of play or the training environment in which they are in.

It’s a simple concept and a law that the governing bodies are taking very seriously. You only need to look at Ireland’s Mike McCarthy or Munster’s Mark Chisolm to see just how seriously rugby is taking concussion and head trauma. Both players have been stood down for the rest of the season after picking up respective concussions against France and the Newport Gwent Dragons.

The decision to stand both players down has largely been unprecedented in rugby as what was commonly viewed as an injury that would rule you out for a week or two, is now being treated as season ending.

It’s a remarkable turnaround in injury diagnosis as with most injuries we tend to see quicker recoveries and shorter lay-offs, but with concussions we’re seeing the opposite with players now being shut down for months on end.

And there’s a reason for this, and it’s all too real and it will become all too familiar over the next few decades.

The rationale behind the removal of McCarthy and Chisolm from rugby this season is so that both players don’t turn into the next Neil Wolfe and Ross Brown.

Both Wolfe and Brown were respected All Blacks, both players enjoyed great rugby careers, but both men were part of the 1964 Ranfurly Shield winning Taranaki side that had five players diagnosed with dementia.

In a chilling and insightful series by the New Zealand Herald, journalist Dylan Cleaver explores the link between dementia and rugby, and the effects the disease has had on former All Blacks and New Zealand rugby players.

Cleaver notes that the fact that there are five players in the one team with dementia, signifies that there is an undeniably strong link between head trauma, concussion and dementia.

In one of his piece’s, he cites  a study from Massey University that shows the direct and indirect consequences of traumatic injury – not only to the head but also to other body areas, if significant – could constitute a plausible risk factor for the earlier development or faster progression of dementia.

Furthermore, biostatistician Thomas Lumley noted that for five players in one team to have succumbed to dementia, there is a possibility that it could be a statistical blip, but that the odds of that being the case would be less than a 1 in 10,000 chance.

So if there are studies that show links between head trauma and the early onset of degenerative brain diseases, what should we do next?

Does rugby follow the NFL’s suit and try to bury the problem under the rug, and pin it down to a bunch of quacks trying to make some noise? Or as a sport does it stand up and try to minimise the possibilities of later life brain diseases such as CTE, dementia and alzheimer’s?

World Rugby seems to be taking the latter approach, and while the professional game is largely doing everything within its powers to ensure player wellbeing, the same sentiment has not always trickled down to the amateur and junior ranks.

Take for instance this Leinster Senior Schools Cup quarter-final between Roscrea and Gonzaga. Referee Gary Glennon suspects a Gonzaga player to have sustained a head injury but the team’s medic is adamant he has suffered no such injury and is baffled as to how Glennon forced the player to be removed from the field of play.

Under current World Rugby rules, there is no head injury assessments (HIA) allowed at underage rugby and the referee decided here to err on the side of caution in ordering the player off the field.

Of course, in the professional game these HIA’s have to be done by independent doctors, not those that are associated with the team for the exact reason as seen above.

The danger of head trauma not only lies  within the professional ranks, but also within the junior and amateur levels where players will either try to play through a head injury, or where they will be given injury advice by either a team medic, or someone who is playing the role of a team medic but may not have the necessary qualifications to make on the spot assessments.

Either way, increased education and further study into head related trauma in rugby is the only way forward for the sport. Naturally, limiting the amount of live contact sessions during training sessions would decrease the likelihood of brain related injuries, but realistically that’s not always going to be a possiblity.

Some have also suggested that tackling be banned at the grassroots levels, and while of course that would reduce the number of head injures, the sport would also invariably start to suffer as a result.

As previously stated, rugby is a physical sport and there’s no real way of completely avoiding head injuries, it’s an inevitable part of the sport and all who play it realise that there is a certain level of risk when you step on the field.

However, what we can do as a community is to have a duty of care for all players on the field. The onus lies on coaches, medics, referees, touch judges, managers and the players themselves, if there’s a suspected concussion or a player is showing concussion like symptoms, we owe it to them as players, friends and people to remove them from the field.

Yes some of these diseases are hereditary and will occur in some players regardless of their career lengths, but if we can minimise the chances of rugby related brain diseases, then we must do everything possible to ensure that we don’t let the next Ross Brown and the next Neil Wolfe become the next Ross Brown and the next Neil Wolfe.

Jack O’Toole, Pundit Arena


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Author: The PA Team

This article was written by a member of The PA Team.