The Growing Headache of Rugby

When growing up playing rugby, injuries were part and parcel of your weekend.

A black eye was a rite of passage, a dislocated shoulder was expected and a broken nose was proof you could rough it with the forwards.

However, there was one injury that every player experienced yet it didn’t quite get the same air time: Concussion.

During my teenage years, I experienced banging headaches after games, played matches with impaired vision and once tumbled off a school field which ended with spending a night in hospital under observation. Yet I just saw this as part of the game and would always try my hardest to just walk it off; an attitude so deeply ingrained in the macho fabric of the sport.

In simple terms, concussion is where the brain is shaken and knocks against the inside of the skull. It has become common place on every pitch in the country, meaning the real damage caused by such injuries has been, to an extent, ignored. However, in the last few years, with the discovery of chronic traumatic encephalopathy (CTE) within NFL players, concussion has found itself taking centre stage in a debate around the long-term effects of contact sport.

In recent studies, CTE was discovered in 99% of deceased American Football players, who donated their brain to science. The disease is directly linked to repeated head trauma with build-up of abnormal amounts of tau protein in the brain that disables neuropathways and this has led to memory loss, aggression and depression. Those studies have subsequently led to a greater focus on the injury on our side of the pond, with an increased discussion around the effects of head trauma at all levels of the game.

Specifically, there have been strong calls from various academics to address the issue within the school/junior game where children are vulnerable to these types of injuries. In a recent study, the highest concussion rates in children was through rugby with 4.18 concussions per 1,000 athlete exposures, compared to just 1.2 for ice hockey and 0.53 for American football.

Professor Allyson Pollock from Newcastle University has led this particular research and has called for schools to no longer enforce tackling amongst younger age groups, with these types of head injuries having links to increased risk of dementia and Alzheimer’s in later life.

Having played rugby from the age of 10, and having experienced concussion on a regular basis during my teenage years, does this mean I should be worried? Am I now at a greater risk in later life? Are these questions we are all asking ourselves, but too scared to say out loud, in case it jeopardises the game we love?

Well, the evidence is still not 100% there yet with various studies also being inconclusive, and so the debate rages on. However, what is clear is that injuries such as this are getting the sport a bad reputation and with people now paying more attention to the issue, in a world where opinions can change overnight, governing bodies need to get a hold of the situation and show they are listening.

To ensure sports such as Rugby Union and Rugby League are able preserve their current formats, issues will need to be addressed.

We have to accept the game of rugby has changed, and the governance of the game has not kept up. The era of professionalism has resulted in bigger, faster players, and at professional level the force of collisions ranges from 20-40Gs on the body, that’s similar to being in a car crash. Every year players get bigger and the tackles more intense, with longer seasons resulting in players spending large periods of their careers on the side line. Even at junior level more and more players are hitting the gym earlier, idolising the size of their heroes, believing that to be the next international super star they need to be a giant. Size and power seem to be more important than skill and this is resulting in a conveyor belt of rugby machines…that are starting to break down.

The issue of concussion and safety is a touchy subject in rugby, however three key issues need to be addressed. Prevention through coaching at grassroots level needs to be relooked at. The correct tackling technique needs to become essential if you want to play. During those early stages of rugby development, there needs to be better coaching in training sessions, but also implementation of that coaching during the games. Could refs penalise poor tackling technique in Junior or Schools rugby? Furthermore, skill sets should be prioritised over size. Far too often Junior rugby is dominated by one kid who grew five years too early, that gets given the ball and told to run straight. There have been some suggestions a way of dealing with this is to look at the New Zealand approach of reclassifying junior teams by size as opposed to age.

Then there needs to be leadership from the professional game, to start setting an example to all the levels below. It shouldn’t be common place to get injured every few weeks. An attitude change is needed. Could clubs even turn their focus back to smaller skilful players, rather than picking out the 18 stone 18-year-old winger straight from the Academy? In recent years injuries among professional players have sky rocketed, and players are now starting to speak out. If there are changes to deal with the injury situation at the senior level, this will eventually trickle down to the grasssroots.

Although, I accept however good the coaching is and however teams and governing bodies try to shape the game, injury will still happen. Therefore, finally the sport needs to look at treatment and response to injuries within the game. The professional game has now been forced to introduce checks for concussion, with side line tests to assess if they can play on. Yet how many clubs on a Saturday, or school games on Wednesday will play with only a part-time physio on the side line who only knows basic first aid? The RFU have created a concussion identification programme at the pro level to spot these injuries, but how much is being done at the lower levels to enforce this? Should teams be forced to contribute each game towards a neutral medic/physio who is able to check, assess, and pull inured players off the field, without the influence of coaches swaying decisions?

The fundamental rules of the game do not need to change, but the coaching, and management of the sport need to be reassessed. They need to look for ways to reduce and manage injuries such as concussion, to ensure future players get to enjoy the full benefits of this great sport in years to come. If we bury our heads in the sand, the headache will grow.