Concussion in sport
By Jack Kelly (Deputy Sports Editor)
The RFU announced it would change its rule on the height of tackles in junior games next season as part of long-term player-protection plans to reduce concussions in the sport. The move has been unanimously approved by Rugby Football Union Council members in an attempt to support player welfare, notably reducing head impact exposure across the community game - clubs, schools, colleges and universities at both age-grade and adult levels - covering the National One division and below in the men's game and Championship One and below in the women's game.
However, arguments have been made that this rule change is fundamentally flawed with Irish Captain Johnny Sexton being a notably vocal opponent to the amendment. When asked whether it would make a difference he said: "Not at all. Definitely not. You can get a knee in the head. You can get a hip in the head. Most concussions, they come from those. There was a study done a few years ago and there were a lot of red cards given for high tackles and 100 per cent we need to get them out the game but none of them resulted in concussions, whereas a lot of them came from knees to the head and hips to the head. I am not sure who puts these rules in place but I don't agree with them, especially for a taller man like myself who likes to tackle hard."
Sexton does make a coherent argument that does make sense. But with endless hours of Six Nations on our screens at the moment, we are enthralled by the savage hits dished out by these 100+ kg athletes. It is somewhat gladiatorial and simply compelling. However, surviving these brutal hits over the eighty minutes of a rugby match has been described as ‘like surviving a car crash 50 times a game.’ For reference, a car crash at 40 mph will produce forces of around 40 G’s. The highest force ever recorded on a rugby pitch? 205 G’s.
In an interview with ‘The Sportsman’, Dr. Lorenzo Masci, a Consultant Sports Physician at the Institute of Sport, Exercise and Health, spoke about the severity of tackling in rugby. ‘They are getting so big we are often seeing injuries that we only see in motor vehicle accidents. I saw an injury of a player who had sustained a sternal fracture, the bone at the front of the chest wall where the ribs come in. You don’t see those injuries unless you have been in a major motor accident.’ Why is this? Undeniably attributable has been the accelerated development of sport science over the last twenty years breeding a new type of sportsperson; freak athletes.
Research carried out by CNN found that the average All Black back is four inches taller and 14 kg heavier than they were in 1974. A remarkable development bridging on being frankly frightening. This growth far exceeds any other sports. Of course, this athleticism has coincided with professionalism being ushered in in 1995 and has brought the game to new heights. Naturally, as humans it goes without saying that there is a primal element within our psyche that endears us as viewers to the strongest and fastest athletes our population has to offer repeatedly running into each other. If you haven’t watched international rugby yet, do, it’s great!
As great as it is from the safety of the stands, the ferocity of the tackle has generally been accepted as an occupational hazard within the game but there remains the risk of serious head and neck injury. Furthermore, the link between concussion and dementia is a major concern.
According to TheBlitzDefence, between 2006 and 2009 there were only two rugby union players who retired due to concussions or brain injuries. Contrast this with the numbers of retirements due to the same reasons between 2016 and 2019 increasing to 35. Either awareness of the seriousness of these injuries has grown or players are feeling the full effect of the new level of what was already an attritional game and getting out while the going is still good.
As mentioned, the potential long-term neurological effects of concussions and other knocks to the head in professional sport have attracted significant attention and research interest over recent years. Confirmation in 2014 that former England footballer Jeff Astle died as a result of chronic traumatic encephalopathy (a form of dementia) — and that it was caused by regularly heading the ball — ignited a furore on the risks of this practice in particular.
New guidelines introduced this year limit the number of “higher force headers” professional English footballers are allowed to make each week in training to 10. These are usually headers following a long pass (more than 35 metres) or from crosses, corners or free kicks.Similar guidelines had already been adopted across all children’s football leagues in the UK. But the question remains: do headers really cause dementia?
Recent work carried out at the University of Glasgow by neuropathologist William Stewart and his team analysed the death certificates of Scottish men. They found higher rates of dementia among former professional footballers compared to the general population, with ex-footballers about 3.5 times more likely to die from a neurodegenerative disease, such as that which causes dementia, than men who didn’t play football professionally.
Stewart’s group also showed that dementia deaths in former professional footballers were greater among those who had played in positions where heading tended to be more frequent, like central defenders, for example.
In the world of American football, the NFL had to pay out $765 million due to concussion related injuries to over 20,000 retired players. Controversy regarding concussion has loomed over the NFL for quite some time due to their outdated concussion protocol, the list of players who have died due to CTE and their denial of any link between their antiquated protocol and its effects.
David Webner and Grant L. Iverson conducted a study titled ‘Suicide in professional American football players in the past 95 years’ and found that most of the men suffered from multiple life stressors prior to their deaths, such as retirement from sport, loss of steady income, divorce, failed business ventures, estrangement from family members and medical, psychiatric and/or substance abuse problems. An inextricable link was drawn between those who suffered from head injuries causing substance abuse, failed relationships etc. thus leading to suicide.
There are a wide range of examples to back this up. Most famously the case of Aaron Hernandez. April 19th, 2017, at approximately 3 a.m. the former New England Patriots tight end was found hanging from a bed sheet in his prison cell in Shirley, Massachusetts. Hernandez had recently been found not guilty of a 2012 double homicide, so one can imagine that his suicide came as a complete shock. A postmortem brain scan would later reveal that Hernandez had been suffering from CTE. The scan was performed by Ann McKee, PhD, lead researcher of the CTE Center at Boston University, showed evidence of brain atrophy, damage to the frontal lobe, and large portions of black spots created by tau proteins. “We’ve never seen this in our 468 brains, except in individuals some 20 years older,” said Dr. McKee.
Similarly, the posthumous brain examination of Phillip Adams, a 32-year-old retired journeyman N.F.L. player who shot and killed six people before dying by suicide in April, revealed that he had an “unusually severe” form of C.T.E., a degenerative brain disease found in athletes and others with a history of repeated hits to the head.
By their nature, contact sports will lead to injuries. That goes without saying but the goal for all organisations should be to create conditions that safeguard players from 1. Being concussed or suffering neck injuries 2. Having suitable protocols (in-game and return to play) that protect players should they be unlucky enough to suffer a head or neck injury 3. The bottom line is that player welfare should be the priority and not telling a player to get on with it for the team's sake. Athletes are getting bigger, stronger and faster. All contact sports make for phenomenal viewing due to this athleticism and preserving this physicality is key to sports popularity but the evidence points to a need for a review of the protocols to prevent head injuries.
