Concussions in Rugby

phog

Saracens’ protective patches are a game-changer not a gimmick

CatFromHue

It sounds good to me and is in a good spot too.

There was an Irish guy who was short listed for a a Dyson award for his product that was a gum shield with instruments in it so you could measure head impacts, don't know what ever happened to it and I see from LinkedIn he's working for Dyson now.

thomond2006

To follow on from the other thread, what exactly is delayed concussion? This sounds the most scary to me if symptoms that could have a player (rightly) pulled from a match and therefore kept safe from further risk don't manifest themselves for hours.

theres an nfl documentary called "league of denial" thats well worth a look it shows how badly playing through all these concussions/other injures can affect you and how hard people had to fight to get the nfl to properly implement a concussion policy it could be tougher again in rugby because your relying on team doctors for a lot of it

total former

thomond2006 wrote: »

To follow on from the other thread, what exactly is delayed concussion? This sounds the most scary to me if symptoms that could have a player (rightly) pulled from a match and therefore kept safe from further risk don't manifest themselves for hours.

As I understand it, "delayed concussion" just means that some of the symptoms aren't apparent right away, so the pitch side assessment isn't going to detect them. It's still the same injury, the same concussion.

But really, the problem is that we're relying on a very limited test to judge it. If a guy can tell the doctor where he is, who he's playing for, what the score is etc, he'll pass. The player is never going to tell the doctor about non-cognitive symptoms likes headache or nausea and he'll be let back out.

So we can either say right, if a guy looks to have been knocked out, he has to go off and stay off, or we all continue as per the status quo and we just accept incidents like North, Murray, Fritz, Smith as part of the game and the players are just collateral damage.

wittycynic

total former wrote: »

As I understand it, "delayed concussion" just means that some of the symptoms aren't apparent right away, so the pitch side assessment isn't going to detect them. It's still the same injury, the same concussion.

But really, the problem is that we're relying on a very limited test to judge it. If a guy can tell the doctor where he is, who he's playing for, what the score is etc, he'll pass. The player is never going to tell the doctor about non-cognitive symptoms likes headache or nausea and he'll be let back out.

So we can either say right, if a guy looks to have been knocked out, he has to go off and stay off, or we all continue as per the status quo and we just accept incidents like North, Murray, Fritz, Smith as part of the game and the players are just collateral damage.

I agree.

The ten minute assessment is not going to catch a lot of concussions, in fact there is very little that you can catch so quickly. Chiefly the doctor will be looking for neurological signs of an acute haemorrhage like incorrect pupil dilation, loss of balance, loss of strength on one side, etc. The problem is, many of these symptoms might not present immediately, in fact a lot of the time they don't.

I fear it is only a matter of time before this lack of care gets someone killed on the pitch. And that's before we deal with the much more widespread problem of repeated concussions and CTE.

Shelflife

Delayed concussion.

Not sure if I've mentioned this story on this website, but it warrants repeating if I have.

Player at my club gets a blow to the head, ref checks him out and says no mate your game is done, player protests and insists hes fine but to no avail hes off.

later that evening his partner has gone out and hes alone in the house, he begins to feel unwell and ring his partner, she comes home and finds him unconscious on the floor, ambulance is called and he spends a few days in hospital.

Sounds like the perfect anecdote for the trumpet bearers of concussion, but its 100% true.

Simply put, if in doubt sit them out, lights out you're out !

Clearlier

wittycynic wrote: »

I fear it is only a matter of time before this lack of care gets someone killed on the pitch. And that's before we deal with the much more widespread problem of repeated concussions and CTE.

It's not a matter of time. It has happened already. It probably happens every year but most of the time it happens at low levels of the game and gets very little publicity. One plus about the high profile that concussion has at the moment is the greater awareness of it at lower levels of the game. I got a bang on the head playing at a low level about 20 years ago. I don't really know what happened but I do remember my captain (who was also the coach/organiser etc) telling me to go to the sideline for a few minutes. I knew that we were already short of players so a few minutes later I just wandered back on to the pitch and played wing for the rest of the game. Of course it was stupid but I didn't know any better and neither did anyone else. When I got the blinding headaches and photophobia a couple of hours later I copped what had happened and took 3 weeks off which was the protocol then. I'd like to think that if the same situation happened today that there is enough awareness out there for me to be told to stay out of the game. There's not an awful lot that we can do about the serious injuries caused by a single blow to the head but there is a lot that can be done to avoid 2nd impact syndrome.

Shelflife wrote: »

Delayed concussion.

Not sure if I've mentioned this story on this website, but it warrants repeating if I have.

Player at my club gets a blow to the head, ref checks him out and says no mate your game is done, player protests and insists hes fine but to no avail hes off.

later that evening his partner has gone out and hes alone in the house, he begins to feel unwell and ring his partner, she comes home and finds him unconscious on the floor, ambulance is called and he spends a few days in hospital.

Sounds like the perfect anecdote for the trumpet bearers of concussion, but its 100% true.

Simply put, if in doubt sit them out, lights out you're out !

That's not delayed concussion that's delayed symptoms. In my very limited experience you don't get the symptoms other than being a bit out of it immediately after the bang to the head. Good on that ref though. It's really encouraging to hear of that.

A couple of comments from the other thread that I wanted to respond to:

total former wrote: »

I'm not implying anything. Just pointing out that when you look at all the facts, facts that are not in dispute, it doesn't look great.

Edit: I'll spell out those facts and then I'm done.
1. Team is defending narrow lead in closing stages.
2. Star player takes heavy knock to back of head.
3. Player is removed.
4. Player returns FOUR MINUTES later. That's four minutes absence in total so maybe 2-3 minutes of assessment?
5. Team wins match.
6. Player is subsequently diagnosed with "delayed" concussion, misses no matches of consequence.

I think if the above was describing any other country or foreign club, we'd be scratching our heads about it.

Yes he was assessed by a doctor but so was Florian Fritz, so was George Smith against the Lions, so were many others.

Barry O'Driscoll resigned from IRB because he felt five minutes wasn't enough to check for concussion. Murray didn't get near that.

Judge yourself, I would have doubts.

I remember the bang on the head and I was surprised that he returned. I hadn't heard that Murray had been subsequently diagnosed with concussion. I would describe that as a clear diagnostic failure. I do remember BOD being taken off against NZ the previous autumn at a critical point in the game where if he had been able to continue I think that we would have won which leads me to think that player welfare is paramount for the medical team (I don't know if there were any changes or discussion after that incident though which might have influenced later behaviour). The diagnosis might have been helped by the knowledge that BOD appeared to be picking up concussions from increasingly innocuous incidents towards the end of his career.

phog wrote: »

Yes it is, very much so.

I'd be fairly sure a doctor could be struck off for knowingly putting a patient at risk.

It's rarely if every quite as clear cut as that. We are highly reliant on the integrity of doctors and it would be straightforward in most instances for them to explain away a scenario where they should have taken a player out of the game.

total former

http://www.worldrugby.org/news/55545

Following a full post-incident review, World Rugby believes that Wales player George North should not have remained on the field of play following a head impact in the 61st minute of the Wales versus England RBS 6 Nations match at the Millennium Stadium on Friday night.

The World Rugby head injury protocol clearly states that a player should be immediately and permanently removed from the field of play where there are any visible symptoms or suspicion of a potential concussion.

However, following thorough discussions and input from the independent expert Concussion Advisory Group, World Rugby accepts the WRU’s explanation that neither the team medical staff nor the independent doctor had sight of the incident and understands that the medics acted within the framework of information they had at the time and would have taken a different course of action had they had direct pitch-side visibility or access to the same broadcast footage seen by those watching on television.

Well, I'm afraid that's simply not good enough.

dub_skav

Deleted User wrote: »

Well, I'm afraid that's simply not good enough.

Agreed, absolutely not good enough. The fact he had already taken a blow to the head in the same match just makes it worse.
What are those laptops in front of the coaches for if they can't see broadcast footage? (Genuine question).

Also, North was involved in a tackle on the ball carrier when it happened, what were the coaches and medical staff looking at. He fell down with his arms by his sides, he even fell towards the sideline, i.e. between the sideline view and the ball.
One of the England players (I think it was Mike Brown) knew how serious it was as he pointed to North, drawing attention to it.

.ak

After the 2nd knock out, was he treated? I mean did medical team attend to him on the pitch? Surely they should've realized he took a knock at that stage, with or without footage?

.ak

dub_skav wrote: »

Agreed, absolutely not good enough. The fact he had already taken a blow to the head in the same match just makes it worse.
What are those laptops in front of the coaches for if they can't see broadcast footage? (Genuine question).

You're right, they often review the live feed, but they're more interested all the technical data the GPS is tracking.

However, the medical team do not have laptops sitting infront of them.

total former

.ak wrote: »

After the 2nd knock out, was he treated? I mean did medical team attend to him on the pitch? Surely they should've realized he took a knock at that stage, with or without footage?

Yes, he was treated; the Welsh doctor has said that he seemed perfectly lucid, but if he had seen how North had got the injury, he'd have taken him off straight away.

Webbs

This from the WRU doctor

“In the second incident on 60 minutes regrettably I was unsighted at that moment and another pitch-side medic was also unsighted,” he added.

"All I saw was George North getting up off his knees.

"When I arrived at the scene, as it were, he was completely lucid and was conversing spontaneously with me.

"I undertook some on-pitch evaluations, and that point I deemed him fit to continue.

“Regrettably we did not get a chance to see the incident.

“Had I had that chance there is no doubt he would have been removed from the field of play.

“When George was injured the analysis team were reviewing another incident because they look at the performance rather than the medical side.

“So there was no communication at the time with George’s incident.

“There are no pitch-side replays currently available and the independent match day doctor was also unavailable to aid us in that process.

“We did not see it but having seen it since he looks like he had a momentary loss of consciousness. In that case he would have been removed from the field of play.


If thats the case and there is no reason to doubt his version then it appears it was one of those that fell through the net, and as a result hopefully there will be a change to protocols to reflect it

awec

Should the onus be put on players to inform coaches / medical staff that they have taken a heavy blow? Not everything can be seen, but North will have known he took a smack on the bake.

.ak

awec wrote: »

Should the onus be put on players to inform coaches / medical staff that they have taken a heavy blow? Not everything can be seen, but North will have known he took a smack on the bake.

Players don't want to leave the field.

awec

.ak wrote: »

Players don't want to leave the field.

Right, but that shouldn't matter.

Should players be retrospectively punished for failing to report serious blows to the head to medical staff though?

Players don't want to come off so they don't report serious issues. The only way to make them report it is to make the punishment for not reporting it worse than missing the rest of the current game. Perhaps a ban from subsequent matches.

Players can be absolved from any onus simply by the reason that if a concussion occurs, the player can be deemed not to be compos mentis, i.e is not of sound mind and can't really be held accountable for his actions. POC, BOD etc have all been 'guilty' of playing on and under-egging injuries. It's part of what makes a player a player, going beyond the pain barrier etc.

For this reason alone, the decision must rest with an independent doctor. If WRU's medical staff are allowed 'miss' events in a game, then World Rugby have to demand that there is oversight. The independent doctor in the case of North might well be considered negligent if we're 'ok' with the WRU medical team 'missing' the event that BBC replayed a few times shortly after.

The ratio of False Positives : Missed Negatives might go up, but that's the cost that must be incurred. (Players who 'might be okay and then subsequently are' will be leaving the field more often, in order to stop players who 'might be okay and subsequently are not' playing on)

dub_skav

I don't believe players should have to be involved in the process, too much subjectivity.

Surely we should make use of the TMO to intercede? I'm not sure if he is currently allowed to or not, he may need to be invited by the referee.
But, the technology is there for him to see TV replays etc and he would just need to have a word in ref's ear - or indeed direct to the sideline medics and tell them to review.

It also seems wrong that teams have GPS, analytics, analysis teams etc, coaching teams all using serious technology, but medical issues need to be seen in real-time by a guy on the sideline.

Not blaming anyone in particular, but something seems very wrong about all this

dastardly00

In the case of Sexton, it is stated that he has suffered four concussions in 2014. The fourth concussion was against Australia on November 22nd. When were the others?

aimee1

dastardly00 wrote: »

In the case of Sexton, it is stated that he has suffered four concussions in 2014. The fourth concussion was against Australia on November 22nd. When were the others?

France away, SA at home were two I think

total former

Gerry Thornley's take on it.
http://www.irishtimes.com/sport/rugby/international/time-for-irb-to-act-as-concussion-becomes-commonplace-1.2106180

Some good points, even if very green-tinged in their sentiments.

chupacabra

dub_skav wrote: »

Surely we should make use of the TMO to intercede? I'm not sure if he is currently allowed to or not, he may need to be invited by the referee.
But, the technology is there for him to see TV replays etc and he would just need to have a word in ref's ear - or indeed direct to the sideline medics and tell them to review.

How can a TMO tell a rugby player is concussed just be watching a slow motion replay?

Neil3030

chupacabra wrote: »

How can a TMO tell a rugby player is concussed just be watching a slow motion replay?

I'd imagine they could help determine if the player was knocked out by looking at super slow motion replays of the hit, looking for signs that the player was unconscious - legs or arms crumbling, absence of reflexive behaviours such as the arms being put out to break a fall, unusual body posture as they fall, stuff like that.

TMO couldn't tell if a player was concussed, but he could suggest that a player requires inspection from the independent doctor.

Edit: Doesn't even need to be the TMO. The independent matchday doctor should just have screens available to him to replay anything he wants to see.

dub_skav

chupacabra wrote: »

How can a TMO tell a rugby player is concussed just be watching a slow motion replay?

As the others have said, he can't.

But, in the case of the George North incident or something equally obvious, that technology could be used to alert medical professionals to have a look.

ec18

Deleted User wrote: »

TMO couldn't tell if a player was concussed, but he could suggest that a player requires inspection from the independent doctor.

Edit: Doesn't even need to be the TMO. The independent matchday doctor should just have screens available to him to replay anything he wants to see.

Don't they have them? I think I saw a video recently where the IRFU doctor was going through the concussion procedure from pitchside to assessment etc and he said that he has a live feed that he can watch and rewind.

Neil3030

Does anybody know what the protocols are btw? Is it just a GCS and pupil light reflex test?

total former

dub_skav wrote: »

As the others have said, he can't.

But, in the case of the George North incident or something equally obvious, that technology could be used to alert medical professionals to have a look.

There is nothing stopping medical professionals from using such technology?

total former

Neil3030 wrote: »

Does anybody know what the protocols are btw? Is it just a GCS and pupil light reflex test?

Not entirely sure tbh.

Shane Jennings was on Second Captains (last week I think); told a story about getting a heavy knock to the head, physio/doctor runs on, asks him what the score of the match is, because Jennings could tell him that it was still scoreless, he got a pat on the arse and was told to carry on. I'm paraphrasing there, obviously, but it didn't sound great.

The difficulty is twofold;
- Concussion is a spectrum; anything that causes impact to the brain is technically concussion, what you're diagnosing is the severity of the symptoms so a guy could be concussed but look and act absolutely fine - how do you diagnose that? Going from the media discussion, you'd think it was as easy as judging whether the guy's leg is broken or not.
- Any such diagnosis is completely subjective and open to interpretation and interference. So if a guy gets a knock to the head and is nauseous, dizzy and is seeing stars, it's up to him whether he actually tells his doctor that. In the middle of a Six Nations game or Heineken Cup semi-final, maybe he'll fess up and maybe he won't. Likewise, one doctor might see a slightly slower response time and insist the player be removed, another might regard it as being of no consequence and allow him to continue.

No-one has come up with any way of overcoming these problems as yet.

davegrohl48

“The 2013-14 season report, which follows results from previous years, does not support the theory that there is a rising injury trend in the professional game,” said Simon Kemp, the Rugby Football Union’s chief medical officer. “
2013 - 14 there were 86 reported concussions.

I believe the 2015 figures will change that viewpoint completely. RFU will have way more than 86 reported concussion cases in the professional game this year.

Neil3030

total former wrote: »

Not entirely sure tbh.

Shane Jennings was on Second Captains (last week I think); told a story about getting a heavy knock to the head, physio/doctor runs on, asks him what the score of the match is, because Jennings could tell him that it was still scoreless, he got a pat on the arse and was told to carry on. I'm paraphrasing there, obviously, but it didn't sound great.

The difficulty is twofold;
- Concussion is a spectrum; anything that causes impact to the brain is technically concussion, what you're diagnosing is the severity of the symptoms so a guy could be concussed but look and act absolutely fine - how do you diagnose that? Going from the media discussion, you'd think it was as easy as judging whether the guy's leg is broken or not.
- Any such diagnosis is completely subjective and open to interpretation and interference. So if a guy gets a knock to the head and is nauseous, dizzy and is seeing stars, it's up to him whether he actually tells his doctor that. In the middle of a Six Nations game or Heineken Cup semi-final, maybe he'll fess up and maybe he won't. Likewise, one doctor might see a slightly slower response time and insist the player be removed, another might regard it as being of no consequence and allow him to continue.

No-one has come up with any way of overcoming these problems as yet.

Well in theory it's quite simple to overcome these issues by 1. moving towards a prognostic cut-off, and 2. by moving away from self-report in assessing symptoms.

By 'prognostic cut-off' what I mean is they might use prognostic models to calculate the risk of an unfavourable clinical outcome in the acute phase of the injury (six months post impact). This can be computed using relatively simple tests like the GCS and a pupil reflex.

Say, for example, the IRB accept that anything over 10%, a player must be taken off. This method would completely remove self-report from the equation and also consider that concussion is a spectrum.

total former

davegrohl48 wrote: »

“The 2013-14 season report, which follows results from previous years, does not support the theory that there is a rising injury trend in the professional game,” said Simon Kemp, the Rugby Football Union’s chief medical officer. “
2013 - 14 there were 86 reported concussions.

I believe the 2015 figures will change that viewpoint completely. RFU will have way more than 86 reported concussion cases in the professional game this year.

They might. But increased reporting does not mean increased incidence. Why not?

In previous years, a reported concussion meant a mandatory period on the sideline. So what happened? People didn't report concussions.

Now, a guy can be concussed and as long as he meets his return to play protocols (which take about a week to do), he can play the next game unhindered, so there is no real downside to admitting that a player is concussed, hence an apparent increase in concussion.

davegrohl48

The first proper data comparison for concussion will be 2016 versus 2015.

MadYaker

This is something that would really bother me if I had a loved one involved in Rugby at a professional level. I wouldn't have liked to see the look on Sexton's mother's face after he got slammed by bastereaud the last day.... It's only going to get worse as players continue to get bigger, stronger and faster.

sydthebeat

MadYaker wrote: »

This is something that would really bother me if I had a loved one involved in Rugby at a professional level. I wouldn't have liked to see the look on Sexton's mother's face after he got slammed by bastereaud the last day.... It's only going to get worse as players continue to get bigger, stronger and faster.

they clashed heads... did you not see the incident??

Wang King

Cardiff flanker Rory Watts Jones has been forced to retire at 26 due to concussion injury he got in November.

Morf

Neil3030 wrote: »

I'd imagine they could help determine if the player was knocked out by looking at super slow motion replays of the hit, looking for signs that the player was unconscious - legs or arms crumbling, absence of reflexive behaviours such as the arms being put out to break a fall, unusual body posture as they fall, stuff like that.

Fencing response.

GRAPHIC VIDEO OF CONCUSSION INJURIES

Clicking discretion is advised.

https://www.youtube.com/watch?v=ZlXjwAlOflA

Concussion Blog is a great resource.

rrpc

Jonathan Thomas has just retired from rugby due to epilepsy believed to have been brought on by multiple head traumas.

http://www.the42.ie/jonathan-thomas-retire-2331343-Sep2015/

Luckily for him so far it's a mild case but frightening to see.

irishbucsfan

Ah wow big shame. Wonder if they brought in DOC as a precursor to that.

rrpc

irishbucsfan wrote: »

Ah wow big shame. Wonder if they brought in DOC as a precursor to that.

Quite likely since Thomas was apparently suffering symptoms as long ago as last year.

The Lost Sheep

The parents of Benjamin Robinson, the Carrickfergus Grammar School rugby player who died as a result of head injuries sustained in a rugby match in January 2011, have issued legal proceedings in Belfast High Court against a number of rugby institutions and two individuals.

The Irish Rugby Football Union (IRFU), Ulster Rugby, World Rugby, Carrickfergus Grammar School, the coach of the school team Neal Kennedy and the referee, David Brown, who officiated at the match have all been named in the writ. Proceedings in the matter are well advanced.

http://www.irishtimes.com/sport/rugby/parents-of-rugby-player-benjamin-robinson-issue-legal-proceedings-1.2847339

CatFromHue

Can you remember what were the rules at the time regarding head knocks Sheep?

This would have been the 10/11 season so the concussion details were really only starting to come out. From memory Jackman and Fogarty had only recently retired due to concussion problems not long before this lad died.

jacothelad

Women's Rugby has shown a huge rise in the incidence of concussions. The rise is almost 250%.

Squidgy Black

jacothelad wrote: »

Women's Rugby has shown a huge rise in the incidence of concussions. The rise is almost 250%.

I wonder does this align with the fact they've gone professional at club level in a lot of places?

sydthebeat

jacothelad wrote: »

Women's Rugby has shown a huge rise in the incidence of concussions. The rise is almost 250%.

are you referring to the report "A Temporal Comparative Study of Women’s Rugby Injuries Presenting to an Emergency Department" ?

The Lost Sheep

jacothelad wrote: »

Women's Rugby has shown a huge rise in the incidence of concussions. The rise is almost 250%.

that the Irish times story Jaco?

Squidgy Black wrote: »

I wonder does this align with the fact they've gone professional at club level in a lot of places?

its not professional here though and I wonder does it take into account the significant rise in playing numbers and account for that in number of injuries

sydthebeat

Squidgy Black wrote: »

I wonder does this align with the fact they've gone professional at club level in a lot of places?

i think its much more influenced by the simple increase in participation by women in sports in ireland, especially the rise in participation in rugby, which would be seen as a more accessible sport for someone taking up a sport for the first time.

Squidgy Black

Ah thought it was a World Rugby study not an Irish one.

Playing numbers would make more sense.