Rugby makes headway

22 May 2017 - 09:28 By Prof Ross Tucker
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LOOK WHO'S BACK: Patrick Lambie has recovered from his vertebra injury and will start on the bench for the Sharks in tomorrow's clash against the Force at Kings Park Stadium, Durban.
LOOK WHO'S BACK: Patrick Lambie has recovered from his vertebra injury and will start on the bench for the Sharks in tomorrow's clash against the Force at Kings Park Stadium, Durban.
Image: MARK NOLAN/GETTY IMAGES

Concussion in rugby is in the spotlight. It's a problem that receives more coverage in the UK and New Zealand than in South Africa but that is changing, which is a good thing.

When concussion forces Pat Lambie to miss months of rugby, only to suffer another when he returns, it shifts the conversation to the impact of head injuries on players, which is good because awareness brings with it an important mandate to change things.

There was a time when playing on after head injuries was a mark of courage and guts. Tough guys fought through it, rising up after being knocked unconscious and fighting on for their team.

That has changed, thankfully, and now, doing that is seen as reckless. The culture change is the result of awareness and policy change, as more people recognise the importance of properly managing what rugby correctly calls a mild traumatic brain injury.

This awareness is what makes us look at Lambie and wonder: "Should he consider retirement?"

I'd argue this is a much better place to be than obliviousness about the possibility of long-term problems, though I realise this is a difficult dilemma for the player himself.

In regard to concussion, the sport is in a better place than it was a decade ago. That may seem a paradoxical statement, given that concussion has never happened as frequently as it does in 2017. In professional rugby, there is a concussion more or less every two hours. That's one every one-and-a-half matches.

Six years ago, there was one every four-and-a-half matches. In other words, the incidence of concussion has tripled. So how can that be a good thing? Well, it used to be that concussion was diagnosed far less often. Players suffered head injuries but played on. Awareness and policy changes mean that more than ever, head injuries are detected, and that's important.

In the 2011 World Cup, for instance, 56% of players who would later be diagnosed as concussed actually stayed on the field and kept playing. By 2016, that figure was under 10%. Those 10% are still a problem, of course, because they are the ones who slip through the various tests, and play on after head injury when they should be removed.

However, it's a lot better than it was, at 56%, thanks to awareness, education and the HIA protocols followed when a player suffers a head injury.

What happens after concussion is the focus of much of the recent discussion. Lambie, for instance, is a player with a history of multiple concussions, and he's taken very long to recover from them in the past.

Nobody fully understands these persistent concussion symptoms. In most cases, concussed players will show no symptoms for up to two weeks. Some will take months. We don't know why they happen in some cases and not others and, perhaps most crucially of all, what they mean for a player's long-term health.

The link between concussion and later-life conditions like dementia and Alzheimer's is the most concerning of all, but that has yet to be conclusively proven.

There is a study showing that NFL players who suffer three or more concussions during their careers are three times more likely to experience depression later in their lives.

We also know that a player returning from concussion is 60% more likely to be injured in the same season as those who were not concussed.

These studies suggest that neurological changes may take a little longer to resolve than previously thought.

This realisation is part of the journey towards being able to manage concussion better.

We must also prevent them from happening, which is where recent law changes on high tackles were aimed.

In future, technique and coaching, as well as neck exercises to prevent concussion will be explored much more.

It's very much all hands on deck, with multiple studies going on around the world.

None of this helps the individual cases like Lambie, because we simply cannot say to a player: "Your neurology tests show X, therefore you should retire."

We can, however, say "better safe than sorry", and hope every player heeds this advice.

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