Planet Rugby

"Concussion is not trivial"

03rd January 2014 19:14

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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

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