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Phil Clarke looks at the new concussion protocols in rugby league

Phil Clarke - Phil Clarke Posted 12th March 2014 view comments

Concussion in sport has recently become the hot topic for medics, administrators, players and even one or two lawyers.

Recent findings have brought to light that a bang to the head can be far more serious than we originally thought and the way that we now assess and treat this has radically changed.

Last week in London, I attended a Committee Hearing at the Houses of Parliament to discuss the implications for the major sports in the UK.

All head injuries must be properly assessed, says Phil

All head injuries must be properly assessed, says Phil

There were representatives from the FA, rugby union, boxing, rugby league, some recently retired players and the father of a young 14-year-old who tragically died after playing a rugby union game.

It was chaired by the Labour MP Chris Bryant, who was assisted by Baroness Grey-Thompson, Lord Addington and several other MPs.

The session began with a presentation from a leading expert in the field, Dr Willie Stewart. As a Consultant Neuropathologist, he explained how the latest research has taught us a great deal more about head injuries.

The days of a doctor or physio doing a 30-second assessment on the field are over. A proper pitch-side concussion assessment takes minutes not seconds.

Phil Clarke
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Most retired players, in both the professional and community game, will tell you stories about the time that they were concussed and played on. It used to be something that people laughed about, or wore as a badge of bravery.

That is no longer the case. The former Australian Test player, who had a brief stint at Wigan, Ian Roberts, has recently spoken about the brain damage that he believes he has suffered as a result of playing on with concussion.

Peter Robinson's tragic story about his son Ben, who died after staying on the field of play following a bang to the head, was a seminal moment in the meeting last week.

Consequences

It's one thing hearing stories of retired players who display signs of being 'punch drunk' when they're older (the medical term is CTE which you may come across, Chronic Traumatic Encephalopathy).

But the realisation that a player staying on the field of play after an initial heavy bang to the head can have fatal consequences made everyone in the room take note.

We now know more about what's called 'Second Impact Syndrome' a secondary bang or collision that causes a rapid swelling of the brain and can result in death or severe brain damage.

A player is far more susceptible after the first concussion during that 'window of vulnerability' and should be removed from the field of play.

Ben sustained his first concussion at the start of the second half but played for another 25 minutes and was involved in two further heavy collisions.

Tragically Ben's death could have been avoided had someone been able to recognised the signs of concussion and remove him from the field of play.

At the professional level, you are going to see this happen this season. The days of a doctor or physio doing a 30-second assessment on the field are over. A proper pitch-side concussion assessment takes minutes not seconds.

In junior and community games the player should be removed if there is any doubt that he may be concussed and unless there is an experienced and qualified medical person present, he/she should stay off the field for the rest of the match.

We know that children and adolescent athletes are more susceptible to concussion and can take longer to recover.

Fatal

There are two types of head injury, both of which are serious and potentially life threatening: concussion and structural brain injuries.

It's important that everyone involved in the game at junior, amateur and professional level understands head injuries and what action they should take when one occurs.

Concussion occurs when the brain is shaken inside the skull. It usually leads to a temporary impairment of the brain's function. If it's not treated properly it can lead to permanent brain damage and, in some cases, can be fatal.

It's important to remember that a player does not need to be knocked out to have a concussion. Less than 15% of concussion cases involve a player being knocked out. The message from the experts is clear and simple: "If in doubt, sit it out". No game of rugby is worth a person's life.

We're fortunate that severe head injuries are extremely rare in rugby league but concussion is a complex sports injury to assess, diagnose and manage because there's very little pain, other than perhaps a headache, for the player to complain about.

The player can only return to play when he has completed a Graduated Return to Play test. This is a system that slowly increases physical exercise when returning from concussion symptoms after each stage.

You may have read recently about the case involving Jamie Langley at Hull KR. He was stretchered from the field of play on a Sunday afternoon, was monitored and rested initially and then gradually returned to full training.

It's important to note that for the first 24 hours a player should rest both physically and mentally. They should abstain from alcohol, not watch TV or use a computer, and if they are young, possibly even stay home from school.

Minimum

There is a six-step process for the player to pass through, with Day 1 starting the day after the injury. Eventually at professional levels he will complete a Cogsport Test which assists in the decision on whether he is allowed to return to play. The first day that a player can return to play after a concussion is Day 6.

So a player concussed on a Sunday can't play the following Friday. The shortest possible turnabout would be for him to return to action on the Saturday but that's the minimum time, don't forget.

We know that it can take much longer than six days for younger players to recover and be able to return to play. The minimum recommended rest period for under 16-19s is seven days and 14 for those under 15.

So, what do we know about concussion in rugby league? Well, the former Head of Sport and Exercise Medicine at the RFL, Lisa Hodgson, has recently begun analysing the last eight season's Cogsport Data on concussion.

Her findings should be available in August and we will know if the issue is on the increase in the game. The RFL have also teamed up with Bolton University to look at all injuries in the 14 Super League clubs.

One of the things that will be discussed soon at a coaching meeting of Super League clubs is the possibility of allowing free interchange for suspected concussion.

This already exists in the NRL but some critics say that it will be abused by some coaches. I suppose that's one for Rod and Stevo to discuss during Back Chat.

Prevent

So what can be done to prevent players getting concussed?

Well, sometimes it's just a complete accident but high tackles, dangerous throws and spear tackles are clearly not conducive to a safe game, that's why we penalise them.

At junior level some parents think that wearing a head guard protects their son or daughter. The overwhelming view of experts is that they do not prevent brain injury, but may stop some cuts and scratches. They do not prevent concussion.

If you're involved in the game in anyway, please brush up on the information that's available. There are some simple pocket cards and tools available which might one day save a life.

If in doubt contact the RFL and get to know what you need to know now.

Comments (3)

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Steve Marshall says...

The bottom line is, we live in a world today that has more knowledge and technology to asses brain issues and injuries. We also know more about long term damage to the brain from sustained impacts. Concussion rule is a natural progress for any contact sport. This shouldn't be mistaken for banning contact sports however as some nannystate people constantly go on about. Children often learn from falling over, hurting themselves, getting back up and trying again and that is just in growing up. GoogyTooShoe peeps need to take a step back, let common sense prevail but also the old diehards of yesteryear understand we live in a modern world with modern views and perspectives. The point I really wanted to make however was, that with the concussion rule now in effect ( Good by the way ) we now need to start having extended benches so we can deal with loss of players more easily. How many sporting events have become a non contest because one team gets a couple of players in key positions injured and then don't have anyone to replace them. It can often spoil a game for every spectator and after all, all sports are driven by crowd numbers, both live and on TV. Next year I would like to see far larger benches than the current 4 players, that way every team can cover far more positions so to offset any old fart grumblings about the game going soft. It isn't going soft its adapting to an ever changing world that is constantly learning new things about human beings every day.

Posted 14:32 14th March 2014

Andy Bibby says...

Here's a radical idea. It one that happens at every game but only with officials.... Every team has a reserve player or two kitted up, warming up with the selection 17. He or both in extreme cases like in the 2013 Grand Final, where Warrington lost 2 players, which completely altered the outcome of the game to an extreme. They can only be used when an injury occurs and a player is in need of medical assistance. An independent medic has full say upon his condition and should he rule the player cannot return to the field then the reserve gets elevated to the bench...! actually the more I think into it the less radical it seems and more a case of why don't we already have this in place??

Posted 09:29 14th March 2014

Keith P says...

Very good article, this must be a topic where the 2 codes of rugby can work together 100%, sharing all data but not duplicating work and wasting time and effort.

Posted 14:18 13th March 2014

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