Time to play it safe

For most, the Principality of Monaco is synonymous with Formula One, royal families (now including a South African swimmer), luxury yachts and, as, I discovered this past week, average property prices of R400000 per square metre.

Monaco is also the host venue for the International Olympic Committee's World Conference on Prevention of Injury and Illness in Sport, an event that brings together researchers, doctors and directors of major sports from around the world to discuss issues related to health in sport.

Given that it happens only every three years, there is a great deal of ground to cover, ranging from eating disorders to injury. But if there was a primary concern addressed in the 2014 conference, it was traumatic brain injury in contact sports.

In South Africa, this type of injury is a real danger in rugby.

In the US, the media spotlight has fallen on American football, and the billion-dollar lawsuits that have resulted due to the risk of dementia, Alzheimer's and other debilitating conditions that can affect players later on in life as a result of frequent collisions and concussions.

These injuries have tarnished the reputation of the sport, with many parents (President Barack Obama among them) saying that they would have grave reservations about allowing their children to play the sport.

This is clearly a situation we want to avoid in rugby, and the need to reduce the risk has been taken up in a very sincere way by the IRB and national federations. New concussion guidelines, which include the sideline concussion test that you have no doubt seen many times during the Super 15 season, and policies on when a player can return to play, have been introduced globally. These have significantly reduced the number of repeat concussions and the serious possible consequences.

South Africans have played an influential role in these guidelines, with Dr John Patricios being an influential member of a team that developed a global concussion consensus statement in Zurich last year.

In South Africa, catastrophic injuries peaked in the mid-2000s, inspiring the necessary creation of the BokSmart programme, which aims to reduce the risk by educating coaches and referees on correct techniques, playing conditions and medical management, since their influence stands to have the broadest impact on the potentially vulnerable players.

Data that was presented at the International Olympic Committee conference revealed that, to date, just under 70000 people have passed through the Bok-Smart programme, with encouraging early results showing significant decreases in the number of catastrophic injuries since its inception.

Another area that has seen tremendous improvement is the safety of the scrum. Those watching the sport will no doubt be aware of the changes in the scrum sequence - you may recall the "Crouch, touch, pause, engage" verse, and the latest version, "Crouch, bind, set".

These changes have been introduced specifically because the scrum is recognised as the most dangerous phase of the sport - one in three catastrophic injuries occur because of collapsed scrums.

The first change - introducing the touch and pause sequence - was quickly recognised as ineffective. An IRB-commissioned study found that when the bind was introduced, the impact force dropped from about 20000 newtons to 10000. That 50% reduction inspired the sequence you hear and see today.

Ultimately, risk is part of sport, and realistically it can never be reduced to zero. But our objective as scientists and clinicians is to lower the risk to where it is acceptable, addressing every possible aspect to ensure maximum safety.

Monaco is by no means the end, but it did reveal significant steps towards the solutions on a global stage, and, encouragingly, many of them have been made by South Africans.