The Big Interview: Éanna Falvey

Stephen Barry chats to the Irish Rugby Team Doctor about concussion in sport.There are few greater signs of how en vogue discussion on concussion is on these shores than the person sitting in front of me on the bus, as I transcribe quotes from a conversation only hours earlier with Irish Rugby Team Doctor Éanna Falvey.She attacks academic papers with green and pink highlighters, passing headlines including ‘The NFL’s Concussion Culture’ and ‘A knockout blow for concussion?’The latter piece is headed by an image which has become the face of the debate in many papers – Irish flanker Sean O’Brien, disoriented and stumbling around the field after a concussive blow against England.O’Brien seems unaware of the man behind him, holding his arm back but the photo perfectly captures Falvey restraining the ‘Tullow Tank’, preventing the oddly frail-looking player from doing any further damage.Falvey certainly doesn’t seek the limelight, though; in fact he believes limelight is the wrong word altogether: “I’d rather you never saw me at all,” he contends. “If I’m coming to attention in and around the game, it’d be a bad sign of that particular game.”Falvey can be spotted during each game on the sideline, tracking players rather than the ball-watching: “What you’re trying to do is watch behind the play. The reality is you come off the pitch after the game and sometimes you don’t even remember what’s happened. When there’s a ruck you’re watching who gets up or who doesn’t get up; you’re not watching what happens to the play.“When you’re on the ground trying to spot stuff, that can be really difficult, because at pitch-level you don’t really see it, but the more eyes you have and the more aware you are, the better you can deal with it.”That is a lesson his Welsh counterparts had to learn the hard way after being embarrassed by the image of winger George North caught on camera with his lights out, something that has already triggered the introduction of medics in the Cardiff stand following the game on TV monitors.Such a move was already taken in Dublin last August, since which Falvey has had a role in withdrawing the likes of Conor Murray, Johnny Sexton, Gordon D’Arcy and Rob Kearney, with all four undergoing Head Injury Assessments during a tit-for-tat autumn bout against Australia.Second Impact Syndrome is the key danger in such cases and, despite the watching world, Falvey has always felt that authority to remove players, having withdrawn a Munster player for three weeks in 2003, in only his second outing as Team Doctor.

“The issue is that there isn’t a lot of evidence out there, but the protocols are as good as are available."

However concussion is an evolving field and one in which substantial debate is taking place over concussion protocols. Barry O’Driscoll, an uncle of Brian’s, has argued that the protocols aren’t sufficiently cautious since his resignation as World Rugby Medical Advisor.He believes that the ‘five-minute rule’ on suspected concussions, after which players may return to the field if they pass a short sideline assessment, is “totally discredited.”However Falvey frequently references the ‘evidence-base’, something he feels a critical mass of data has not yet been obtained for: “The issue is that there isn’t a lot of evidence out there, but the protocols are as good as are available. You must remember that the vast majority of people who are anti-‘the protocols’ haven’t offered any other kind of a solution instead. It’s very easily to say ‘oh, the protocols are terrible.’ Well, tell us something better and I’ll gladly use it.”Falvey also disputes the validity of evidence that concussion rates are rising, noting that a study of the 2007 Rugby World Cup revealed that concussion was being underreported by 50%.So while the protocols are, Falvey admits, far from perfect, the ‘Recognise and Remove’ principle is having its positive effects, leading to incidents being reported properly, “because there’s a proper mechanism now of what to do and when to do it.”

“The same facilities aren’t available for Junior rugby or Junior B football in West Cork."

“If people who are suffering from concussion are honest, if the people looking after them are educated the best way possible for dealing with that and if there’s a protocol which is evidence-based and up to date in terms of management, then that’s the best you can do.”He also sees the growth in player body profiles as an overly simplistic way of explaining the prominence of concussion, although the average weight gain of 10kg per player since the game turned professional in the mid-nineties is a “scary figure to see.” Still, it is an issue too multifaceted for simplistic analysis with the evolution of the game also playing its part. Defences are now more organised and centres are so well-versed in defensive duties that “collisions need to happen to make some holes.”Even criticisms of protein supplements don’t hold enough water on current evidence, with Falvey considering them, as the name suggests, supplementary to the major emphasis on strength and conditioning plans.It’s a part of the reason why the Sports Surgery Clinic, where Falvey is Director of Sports and Exercise Medicine, employs nine researchers, all seeking to expand that evidence-base for fashionable treatments.But while the professional player is now well looked after, the same resources and knowledge have yet to drip down to the grassroots. “The same facilities aren’t available for Junior rugby or Junior B football in West Cork. It’s about educating players, parents and coaches around the dangers of things like concussion, which is why the profile these injuries are getting is a good thing.”Although he is uncomfortable at times releasing too much information on players’ medical histories (“Would you like somebody telling the press corps about the colonoscopy you had last week?”), he is currently enjoying the fact that the preparations for the concluding weekend of the 6 Nations feature few injury headaches.He knows who will and won’t make it by the Tuesday before a game, scoffing at the notion of last minute fitness tests: “I’m from a GAA background and you get guys doing fitness tests on the morning of a match – that’s daft. You can’t prepare a team like that. In a team sport like rugby everybody has to be in around the game plan, know who’s going to be executing the game plan and what their role in the game plan is going to be. So you can’t have any uncertainty after a Tuesday with regard to injury.”It will be an arduous year too, with autumn’s Rugby World Cup meaning that he will be away from home 22 weeks of the year. However the former Irish champion boxer is at home in the competitive environment, having always known the high and lows, the demands and sacrifices.Yet the carrot of huge rewards remains, with Saturday’s 6 Nations decider potentially the first in a line of milestones.