Planet Rugby

Concussion expert slams rugby bosses

01st November 2013 20:57

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Dr Robert Cantu of Boston University

Brain expert: Dr Robert Cantu

In an interview with Planet Rugby's Jamie Lyall, a leading neurosurgeon and sports concussion expert has heavily criticised the International Rugby Board (IRB)'s stance on a debilitating neurological condition now believed to be affecting rugby players.

Dr Robert Cantu is Co-Director of Boston University's Centre for the Study of Traumatic Encephalopathy, conducting research on the donated brains of ex-athletes with primary focus on Chronic Traumatic Encephalopathy (CTE).

CTE, as defined by the University website, is "a progressive and degenerative disease of the brain found in athletes with a history of repetitive brain trauma." Symptoms can include memory loss, confusion, impaired judgement, depression, and eventually, dementia.

That Dr Cantu and his team believe they have strong evidence to suggest rugby players are being affected by this disease should be more than enough to set the metaphorical alarm bells ringing - particularly among a sport that prides itself on player welfare.

And yet, the IRB remain resolute in their assertion that there is "no scientific link" between concussion and CTE. While keen to stress the multifactorial nature of the condition, that assertion is one vehemently refuted by Dr Cantu.

"I don't believe that's true at all. That's head-in-the-sand time if you believe that," he said.

"It is not untrue to say that head trauma is the cause of the disease exclusively, because CTE is unquestionably a multifactorial situation. There are almost certainly genetic predisposing factors as well as other environmental factors that contribute to CTE.

"But in our "Brain Bank", there are now over 170 brains that we have examined. The overwhelming majority had CTE, and the only consistent common factor is head trauma. In virtually every case, it's repetitive head trauma. The situation is overwhelming. It's just unthinkable to believe that it isn't the overriding factor. Is it the only factor? No, I don't believe that. But it is the primary factor."

Surely then, the IRB must face up to that compelling evidence? They need cast but a brief glance across the Atlantic toward their NFL counterparts for a blueprint on how to deny the head injury facts, and suffer a heavy moral and financial penalty .

"I think they do (need to face those facts)," said Dr Cantu.

"I think there will be cases of CTE in rugby, and I think in a very short number of years the evidence will be overwhelming that it is repetitive head trauma that's causing it. Fortunately, with rugby, there isn't a lot of head trauma - but when it does occur, it can be quite significant and must be managed properly."

At the highest level, Dr Cantu is a supporter of the much-maligned Pitch Side Suspected Concussion Assessment (PSCA), allowing five minutes of dedicated off-field examination time for individuals who have suffered a head knock. And while the removal of the burden of snap, high-pressure, on-field decisions from the shoulders of team doctors is to be applauded, the neurosurgeon believes that there should be no time constraints on the assessment.

"The international concussion statement from Zurich (in which Cantu was involved) clearly indicated that it often takes 15 or even 30 minutes to assess an individual and determine whether or not they have a concussion," he said.

"As you go through those evaluations - the eye test, the balance test, the cognitive test - if you're not immediately sure, it may take you fifteen to twenty minutes to complete your test. The point is; you shouldn't put a time limit on it. It should be whatever it takes to be absolutely sure that individual doesn't have a concussion.

"As someone who has been on the sidelines and tried to make those diagnoses - they often can't be made in five minutes. So, having five minutes is a whole lot better than having one minute, but it's still not adequate."

Away from the elite game, the rugby world was saddened by the tragic death of 14-year-old Ben Robinson in January 2011 while playing for his school team in Northern Ireland. Ben was momentarily knocked unconscious during the game, but crucially, was not removed from the field of play. After being involved in a subsequent barrage of heavy tackles, and concussion-tested three times, he collapsed on the pitch and later died in hospital.

His parents are now battling to raise awareness of the dangers of concussion in rugby, and the need for comprehensive and mandatory education initiatives to be put in place. For Dr Cantu, cases involving youngsters like Ben ring emphatically true.

"I couldn't feel that education is any more important in this area," he said.

"It's more important in this area than any other I can think of with regards to head traumas because the consequences are so grave. I believe it's essential that all participants in collision sports, not only the parents and coaches but the kids themselves, have concussion education."

But the neurosurgeon takes the idea of both raising awareness and safeguarding sport's youngest and most at-risk partakers one step further than many.

"I don't think very young individuals should be playing collision sports, because the brain of the very young - especially under the age of twelve - is much more vulnerable than the adult brain," he said.

"There is emerging literature to support that, some of which is coming from our own work at Boston University."

It seems, then, that that most favoured mantra of politicians - education, education, education - is the key theme in the campaign to combat concussion.

The research of Dr Cantu and his colleagues at Boston University offers sound scientific rationale against the IRB's policy, and further rejection of what is rapidly becoming irrefutable evidence could open the door to a whole world of welfare and legal strife.

And while continuing to make inroads into protecting those who make a living from the game, the body must work with its unions to implement adequate and compulsory concussion training for everyone involved with rugby. The risks are simply too great to leave our heads in the sand any longer.

By Jamie Lyall

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