IRB must tackle concussion head-on

Date published: August 13 2014

In a sport with a traditionally macho ethos, concussion is a subject that has generated much heated debate across the rugby world.

In a sport with a traditionally macho ethos, and a highly physical nature, concussion and its possible complications is a subject that has generated much heated debate across the rugby world.

With the introduction of new trial regulations massively shortening a potentially concussed player's recovery time, heavy criticism of the IRB's stance from players, coaches and officials alike, and several prominent occurrences at the highest level – new light has been shone on the problem. The events of the past season and beyond have confirmed that concussion is an issue the governing body can ill afford to take lightly.

Research beginning in 2008 by US scientists at the Centre for Study of Traumatic Encephalopathy at Boston University – otherwise known as the Boston Brain Bank – into neurological disease, depression and suicide among NFL players has yielded some worrying results. In particular, the emergence of a condition known as Chronic Traumatic Encephalopathy (CTE) – generally associated with memory loss, aggression, confusion, impaired judgement, depression, and even progressive dementia – has ignited widespread concern and anger among the sport's community.

CTE has been frequently diagnosed in athletes who take part in collision sports, such as American Football or boxing, and have suffered repeated blows or trauma to the head. The symptoms may take years after the end of the athlete's career to appear, but with such serious consequences for the individual and their family, it's easy to see why such a condition has caused great commotion among the American sporting fraternity. To date, around four-thousand former players and two-thousand family members have filed a class action against the NFL, claiming that the body were aware of the research and the subsequent risks, but failed to take action.

With these events making waves in the US, it is clear the IRB must act now to protect player welfare, and avoid future health complications in a sport where the level of physicality at the top tier has been upped almost immeasurably since the turn of the millennium. With the size, strength and weight of the individual combatants increasing dramatically, and the advent of professionalism in the mid-nineties bringing about greater fitness, conditioning and training regimes, the collisions occurring between players are now very definitely filed in the “ferocious” category.

The laws surrounding concussion have also been altered drastically in the past decade, but the manner in which they have been changed flies in the face of the game's rising physical intensity. Ten years ago, concussion brought about a compulsory three week recovery period – but this was opposed strongly, and was at times avoided by coaches tempted to claim that no concussion had occurred rather than risk losing a star player for three weeks. In response to the protests, this phase was subsequently cut to a single week, provided the individual passes a series of daily tests.

Currently, it is stated in the IRB Code (Regulation 10) that a player suspected of concussion must leave the field of play and is not permitted to return. There is now a supplementary ruling, being trialled by the sport's governing body, allowing the same player to return to the fray if he can pass a series of tests lasting five minutes. This trial ruling is widely expected to be made permanent in the near future, but has met with strong opposition and caused much controversy among some of rugby's most highly-respected individuals.

Most notably, the long-standing IRB official, doctor and former Ireland full-back Dr Barry O'Driscoll resigned from the Board last March in protest at the game's attitude to concussion. O'Driscoll, clearly frustrated and disillusioned by the introduction of the “five minute rule” or Pitch Side Concussion Assessment (PSCA), claimed that “rugby is trivialising concussion” in a Scotland on Sunday interview.

“The same player who eighteen months ago was given a minimum of seven days recovery time is now given five minutes. There is no test that you can do in five minutes that will show a player is not concussed. It is accepted the world over. We have all seen players who have appeared fine five minutes after a concussive injury then vomiting later in the night. To have this as acceptable in rugby, what message are we sending out?”

O'Driscoll argues that the questions and tests undertaken during the PSCA should serve as a benchmark for later examination to ensure the player's condition has not worsened, and that there is no bleeding on the brain or further complications.

Former Scotland full-back Rory Lamont, who was forced to retire in April this year after a career heavily affected by injury, has also brought forth a series of revelations in the media over the past week with regards to player welfare, injuries and concussion. Many of his scathing comments are well-documented elsewhere, but the Scot claims that players are deliberately “cheating concussion”, by posting intentionally low results in start-of-season baseline tests. These baseline tests provide a benchmark level which the player must return to in order to be passed fit to play. A low baseline result thus means that concussed players are likely to be able to play again before they are fully recovered.

Two high-profile incidents involving George Smith (in the Lions third test in Sydney) and Brian O'Driscoll (in Ireland's Six Nations clash with France) that took place last season brought the issue to the fore once again. In both cases, the players suffered heavy head knocks, and were clearly “out of it” for several seconds, before being helped from the field – both sporting a pair of decidedly unsteady legs.

Commentators remarked at the time how sad it was to see, in particular, Smith's game ending so prematurely (his collision with hooker Richard Hibbard coming just minutes into the series-deciding fixture), and speculated on his likely replacement. However, several minutes later, the great man returned to the action, supposedly fit to continue. O'Driscoll too, was allowed back onto the pitch to continue playing (despite the PSCA not being in place in the Six Nations at the time).

These occurrences only served to further underline the need for change. With strong opposition from the likes of Dr O'Driscoll and Dr James Robson (Scotland's highly-respected team doctor and chief medical officer for the Lions on six tours), former players such as Lamont, and the research undertaken at the Boston Brain Bank, the IRB must act decisively now.

The NFL suffered greatly from taking a blinkered approach to player welfare, but is now lending heavy financial backing to the cause. While no-one is suggesting CTE's prevalence in American Football will be mirrored by rugby union, recent on-field events and off-field revelations set a troubling tone.

The governing body has been forced to sit