Game Still has Head in Sand Over the Risks of Brain Damage

The testimony has become uncomfortably familiar: the aversion to the light, the mood swings, the fatigue and the never-ending headaches. Any poll of rugby’s hardest players would place Jamie Cudmore,
12 Sep 2015 09:27
Game Still has Head  in Sand Over the Risks of Brain Damage
George Smith played on after his head injury against the Lions.

The testimony has become uncomfortably familiar: the aversion to the light, the mood swings, the fatigue and the never-ending headaches.

Any poll of rugby’s hardest players would place Jamie Cudmore, the Canada lock, pretty near the top of the list.

Having fulfilled the role of enforcer for Clermont Auvergne for the best part of a decade, Cudmore is accustomed to never taking a backwards step.

But for much of June, Cudmore was laid up on his sofa, incapacitated by a series of concussions that would rule him out of rugby for three months.

“I had all kinds of symptoms: headaches, being very irritable, tired when you shouldn’t be tired, then being really tired and not being able to sleep,” he said.

“That was really bizarre, just lying down and closing your eyes and not being able to sleep. It was very scary. The whole month of June, I was sitting on my couch. I couldn’t watch TV, couldn’t really do anything. I was stuck between the World Cup and retirement.”

Cudmore’s fears are understandable. Rugby players are used to pushing through physical pain but when the source is hidden and impossible to clearly diagnose then the equation changes.

There is no set recovery period for a broken brain as there is a broken leg.

Concussion became rugby’s biggest controversy the moment a dazed George Smith staggered back on to the field in Australia’s third Test against Lions two years ago.

Rugby’s authorities have introduced a raft of new measures for this World Cup designed to prevent another such occurrence, but have they gone far enough and are they truly acknowledging the long-term risks?

No one is immune from concussion’s grasp. This year alone, Johnny Sexton, George North, Mike Brown and Kieran Read have had to sit out extended periods. They were the lucky ones.

Ashley Smith, Rory Watts-Jones and Kat Merchant, a World Cup winner with England’s women just a year ago, were just three who had retire because of concussion last season.

Those lists will keep growing as the concussions will keep coming, not least when the World Cup kicks off in a week’s time.

After two months making their players faster, fitter and stronger, coaches will unleash their squads to collide like herds of rutting stags. The sight of players being knocked out is inevitable.

That much is unavoidable. It is what happens next that counts. With the eyes of the world on the sport, a repeat of the incidents that resulted in George Smith being returned to play, and North staying on the field after losing consciousness against England in the Six Nations match early this year, would be disastrous for rugby’s image.

After years of burying its head in the sand over the short and long-term risks of concussion, rugby’s authorities are attempting to be proactive.

At this World Cup, players suspected of concussion must be given the all-clear by an independent specialist as well as team medics, all of whom will have access to video replays.

Brett Gosper, the World Rugby chief executive, promised “sanctions” for teams who flout the concussion protocols.

Yet there are still concerns. The Head Injury Assessment tool is a series of cognitive, balance and memory tests that rugby medics use to determine if a player has sustained a concussion. It has its flaws.

Last week, Conor Murray, the Ireland scrum-half, was knocked out against England but according to Joe Schmidt claimed he passed the HIA even though he did not return to the field.

Barry O’Driscoll, uncle of Irish icon Brian, is one of the system’s most trenchant critics and resigned his position as International Rugby Board medical adviser in protest at the protocols.

“The HIA is absolutely meaningless,” he said.

“I have no doubt that World Rugby instructs the independent doctors to keep them off whether they pass the test or not because otherwise they are heading for the most frightening potential scenario.”

When the brain sustains a concussion, it remains in a parlous state for some time when another impact could have catastrophic consequences. Tragically in 2011, 14-year-old schoolboy Ben Robinson, died from second-impact syndrome.

The safeguards of an independent specialist and video technology are a huge step in the right direction, but the International Rugby Players’ Association is calling for them to be rolled out across all of professional rugby.

As Dr John York, chairman of the NFL’s Health and Safety Committee, notes: “It has been over five years since we missed an NFL player laying on the field who was semi-conscious due to a head injury. The cost [of the technology] is an inconsequential expense.”

The long-term risks are equally frightening. In Boston, Chris Nowinski, founder of the Concussion Legacy Foundation, has access to the brains of 91 deceased NFL players. Of those, 87 have been diagnosed with chronic traumatic encephalopathy (CTE), a neurodegenerative disease previously known as ‘punch drunk syndrome’.

“All the evidence we have indicates that brain trauma or repetitive brain trauma causes CTE,” Nowinski said.

“There is no one who has ever been diagnosed with CTE who has not had a history of brain trauma.”

This is big news in the United States. The research undertaken by the Concussion Legacy Foundation underpinned the $1 billion settle-ment by the NFL of concussion lawsuits.

Hollywood also got in on the act with Will Smith starring in a new film as Dr Bennet Omalu, the neuropathologist who discovered the very first cases of CTE in American footballers.

After years of denial, the NFL now expects 6,000 of its nearly 20,000 retired players to suffer from Alzheimer’s or moderate dementia.

All of which has troubling implications for rugby, which has a higher rate of concussion and a much longer season than the NFL.

In July, World Rugby released its own findings into a long-term study of 485 men including 131 former professional rugby players claiming there was no definitive link between rugby and long-term cognitive health problems. This was immediately disputed by the study’s lead researcher, Professor Patria Hume, who called such a claim “irresponsible”.

As Nowinski argues “the reality is with human brain studies, it will take a lifetime to find proof of a definitive link”.

What there is, according to Dr Alice Theadom, another of the study’s researchers, is strong evidence.

“The findings of this study did show that regardless of sport, those who experienced four or more concussions did show a reduced ability to think and react quickly,” she said.

The question is how rugby grapples with this impeding problem. It can retreat into its shell or remain proactive and upfront about the risks.

Rob Nichol, the chief executive of the IRPA, accepts that the majority of his members need protecting from themselves and their determination to remain in the field.

He is optimistic that the impact sensors, such as those Saracens are trialling, will be rolled out across rugby within three years providing an additional objective marker.

“I think we are on the brink of a culture change,” he said. “Concussion and the risk of concussion affects every sport but what rugby can really do now is lead.”


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