Planet Rugby

"Concussion is not trivial"

03rd January 2014 19:14

Share:

alistair hargreaves concussion saracens

No joke: concussion

In a Planet Rugby interview, researchers shed light on their work developing a test to prevent players cheating concussion.

Professional rugby players are cheating concussion. That has been the claim from ex-Scotland international Rory Lamont, who states many of his former contemporaries deliberately under-perform in pre-season Cogsport baseline tests.

Players undergo these assessments at the start of the season, setting a neurological benchmark which they must match after a concussion to return to play. A lower score in these checks can therefore negotiate a swifter return to the action.

When Lamont's comments first came to air in July, they sparked major concern around player welfare, with repeated head trauma strongly linked to a series of debilitating neurological conditions.

Now, however, research is being done into what is hoped will prove a more effective method to gauge when an individual is fit to resume playing.

At Birmingham University, Dr Michael Grey - a reader in Motor Neuroscience - and neurosurgeon Mr Tony Belli are attempting to put together a new, objective assessment, offering a more definitive aid to what can be a tricky return to play decision.

Belli's study, building on previous research started in Italy by Professor Vagnozzi's group, has shown an alteration in brain metabolism occurs after a concussion, detectable by an MRS brain scan.

However, these scans, says Grey, are not cheap, and certainly priced beyond the means of small clubs and academies.

Instead, the duo are trialling a method known as Transcranial Magnetic Stimulation (TMS), a non-invasive technique that measures brain function after injury, which they hope could provide a cheaper, quicker and more practical alternative.

"We're trying to get an objective measure of concussion," confirmed Belli to Planet Rugby's Jamie Lyall.

"At the moment, that relies on subjective psychological tests or self-reporting of symptoms, which have been shown to be unreliable in certain situations. What we're worried about is people who report the symptoms of concussion and go back to play before they're ready - they could suffer a second knock at a bad time."

The test would also nullify player manipulation - or "cheating" - or any equivocal interpretation of results.

"If you have an objective marker, you can't argue," stated Belli.

"If the brain hasn't healed, then the brain hasn't healed. There would be no question of interpreting the results in an ambiguous way."

In addition, Belli says, the period at which one is vulnerable to further damage post-concussion, which could lead to a build-up of chronic brain damage, has not been well-documented. That, adds Grey, is why the use of an objective test carries such importance.

"When we have someone suffering multiple mild head injuries - is the timing important for accumulation of damage?" said Belli, in relation to the type of neurodegenerative diseases now seriously affecting many former athletes.

"That's something that's not been particularly well elucidated. If you go back and have another injury before you're ready, does that increase the risk of an accumulation of damage or not? We know from our own patients that if you have a second injury before the brain has healed, you may not die, but you could be feeling the effects for quite some time and in quite a profound way."

"The key is that we don't know the window of vulnerability - hence the need for these objective measures to determine when it's safe for a player to return to the field," added Grey.

"The idea is to test the physiology - it's not possible to manipulate one's physiology."

Key to the concussion furore surrounding rugby - and contact sport in general - are two issues that go hand-in-hand; two that the pair are keen to stress.

For many years, rugby has not taken concussion seriously. It was viewed as a "badge of honour" for players. Coaches have lauded those who play on through a bad head knock; they were labelled brave or heroic for shrugging off the injury, while those who did not were derided as "soft".

That very dangerous attitude, says Grey, where it still persists, needs to be rectified.

"We need to change the idea that head injury is trivial," stated Grey.

"We're combating years and years of people being told that a little knock on the head isn't a big deal. We're now starting to understand that multiple little knocks to head may in fact be a big deal. We need to change the culture, and I think that will happen.

"If we look to ice hockey in North America, for example, that cultural change is well into effect because the problem has been known for many, many years. What to look for, what to do when one suffers a concussion - these are things known at the very lowest levels of ice hockey. It took many years and quite a cultural change to affect that, and I think we can do the same with rugby."

A shift in rugby's culture and mindset must be married with a comprehensive programme of education for those involved with the sport, however.

The IRB often draws attention to its own guidelines - guidelines both Grey and Belli rate highly - but beyond the very basic RugbyReady course mandatory for coaches and referees, one must go looking for the specific concussion directives.

"The key word is education," confirmed Grey.

"That's what's lacking at the moment. There needs to be a better education programme for people involved with the sport.

"The IRB have a very good website, and they point to this frequently. That's fantastic, but there's no actual requirement that anybody go to this website and read this information. There's no requirement for coaches, parents, referees - any of those people - to know about the risks or the signs of concussion. That's one area where things could really be improved."

"At professional level," added Belli, "the club doctors should be aware of the guidelines. But it's a completely different story at community level.

"I think the most important thing is making sure people are aware concussion is not trivial. It may sound trivial, but it isn't.

"We really need to educate coaches and athletes on how to recognise a concussion, how to deal with it, how long to rest, what to look out for, when can you be sure you have recovered.

"Our research will take several years, if successful; to come to fruition, but what rugby can do tomorrow is set up a programme of education across the country. That's within everybody's grasp to implement.

"We need to stress that no test, including our own, will work unless there is an educational element to this. People need to come forward if they've had a concussion and they need to be taught how to recognise it. Coaches need to be able to spot it more easily. I don't think there will be any sort of magic device that will tell you who's been concussed on the pitch. Every technological battle will have to go hand in glove with education."

By Jamie Lyall
@JLyall93


Concussion; not just in rugby, but across all sports carrying a risk of head injury, is a very serious issue, and one that we at Planet Rugby have given extensive coverage over the past six months. Below are links to several articles chronicling the path the game has taken:

Concussion expert slams rugby bosses

NFL concussion precedent an omen

PSCA set to stay

Forthcoming Fixtures
FixtureDetails
All times are local
Aviva Premiership
Sunday , September 21
Newcastle vs NorthamptonNewcastle vs Northampton Preview
Friday , September 26
London Welsh vs Gloucester19:45
Saturday , September 27
Saracens vs Sale15:00
Leicester vs London Irish15:00
Northampton vs Bath15:15
More Aviva Premiership fixtures
Rugby Championship
Saturday , September 27
South Africa vs Australia16:05
Argentina vs New Zealand23:10
More Rugby Championship fixtures
Guinness PRO12
Sunday , September 21
Ospreys vs EdinburghOspreys vs Edinburgh Preview
Friday , September 26
Edinburgh vs Scarlets19:35
Leinster vs Cardiff Blues19:35
Glasgow vs Connacht19:35
Saturday , September 27
Zebre vs Ulster15:00
Munster vs Ospreys18:30
More Guinness PRO12 fixtures
Top 14
Saturday , September 27
Toulon vs Montpellier18:00
Stade Francais vs La Rochelle18:00
Oyonnax vs Clermont Auvergne18:00
Grenoble vs Racing Metro Paris18:00
Bayonne vs Toulouse18:00
Brive vs Bordeaux-Begles18:00
Lyon vs Castres18:00
More Top 14 fixtures
Currie Cup
Friday , September 26
Cheetahs vs Blue Bulls19:10
Saturday , September 27
Sharks vs Eastern Province Kings14:00
Pumas vs Western Province15:00
Griquas vs Lions15:00
More Currie Cup fixtures
ITM Cup
Sunday , September 21
Otago vs WaikatoOtago vs Waikato Preview
More ITM Cup fixtures
Recent Results
FixtureDetails
All times are local
Aviva Premiership
Saturday , September 20
Sale 46 - 8 London WelshSale vs London Welsh Report
Harlequins 26 - 23 WaspsHarlequins vs Wasps Report
London Irish 32 - 36 SaracensLondon Irish vs Saracens Report
Bath 45 - 0 LeicesterBath vs Leicester Report
More Aviva Premiership results
Guinness PRO12
Newport Gwent D'gons 13 - 33 GlasgowNewport Gwent D
Scarlets 43 - 0 Benetton TrevisoScarlets vs Benetton Treviso Report
More Guinness PRO12 results
Top 14
Racing Metro Paris 27 - 16 ToulouseRacing Metro Paris vs Toulouse Report
Grenoble 24 - 15 Bayonne
Clermont Auvergne 43 - 12 LyonClermont Auvergne vs Lyon Report
Montpellier 23 - 3 Stade FrancaisMontpellier vs Stade Francais Report
La Rochelle 26 - 29 Bordeaux-Begles
Castres 27 - 18 Oyonnax
More Top 14 results
Currie Cup
Western Province 36 - 12 GriquasWestern Province vs Griquas Report
Blue Bulls 15 - 26 SharksBlue Bulls vs Sharks Report
Eastern Province Kings 22 - 37 CheetahsEastern Province Kings vs Cheetahs Report
More Currie Cup results
ITM Cup
Hawkes Bay 36 - 17 Bay Of Plenty
Auckland 32 - 7 North HarbourAuckland vs North Harbour Report
Manawatu 36 - 17 Southland
More ITM Cup results
Aviva Premiership
Friday , September 19
Gloucester 22 - 25 ExeterGloucester vs Exeter Report
More Aviva Premiership results
Guinness PRO12
Munster 31 - 5 ZebreMunster vs Zebre Report
Connacht 10 - 9 LeinsterConnacht vs Leinster Report
Cardiff Blues 9 - 26 UlsterCardiff Blues vs Ulster Report
More Guinness PRO12 results
Top 14
Brive 13 - 53 ToulonBrive vs Toulon Report
More Top 14 results
Currie Cup
Lions 29 - 15 Pumas
More Currie Cup results
ITM Cup
Counties Manukau 20 - 28 CanterburyCounties Manukau vs Canterbury Report
More ITM Cup results
Aviva Premiership Table
PosTeamPPts
1Bath314
2Saracens313
3Exeter310
4Leicester Tigers39
5Harlequins38