Concussion - New Rules, Part 2

Part One was written just after the Ireland-France match. In that game, Brian O'Driscoll and Luke Marshall both got concussed. Marshall then got concussed again in the Italy-Ireland game.

Given the track record of what happens when something is noted on this blog, I'm becoming very tempted to pay special attention to Harlequins in the first week of April, running up the game against Munster in the Stoop.

However, glib comments aside, concussion is back in the news. And a particular feature of the discussion has been people asking how O'Driscoll or Marshall were left play again.

It's that feature I want to touch on in this post, and look at the idea of contributory negligence.

There's been a fair bit on this blog about the duty of care owed by officials and coaches to players, a duty not to expose them to a foreseeable risk of harm. There's also a duty on players not to expose themselves.

This isn't about ducking out of tackles or not playing the game as hard as possible; far from it. The idea that a brain injury, which is what concussion is, is somehow not a "real" injury, or that it's somehow an indication of weakness if you have put yourself in a place where you are hit so hard your brain function is affected, is one that bedevils this area and one that needs to be removed from rugby as fast as possible. Praising a player who keeps going when clearly concussed is nonsense; the player might be an animal, but if playing concussed, then he's doing his best to turn himself into a vegetable.

Players will be injured playing the game, and that is accepted; as one case put it, anyone playing must accept their fair share of bruises, injuries and minor fractures. We all do, and it's well worth it to play the game. But players have a duty to be honest about those injuries, and not to expose themselves to the risk of further injury. If they do, then they have, of their own choice, placed themselves in a situation where they have voluntarily assumed a foreseeable risk of harm to themselves. Like driving a car without a seatbelt, they have chosen to make things more dangerous for themselves. As a result, they are at least partly to blame if they do get hurt, and must take the consequences.

This, with concussion, is where the real issue comes in. The Graduated Return to Play Protocol - the means whereby it is seen if players can safely return to the game - requires players to be symptom-free at each stage. The problem is, so many of the symptoms of concussion, for example feeling "fuzzy", or headaches, are ones that don't have external, objective symptoms; if someone chooses to keep quiet about them, they won't turn up. The same is true of baseline psychometric tests; if one choses, one can "game" the test, slowing down one's reactions so that if tested later, one can always match or beat the baseline.

The problem is, of course, that in so doing, a player who wants to play and who covers up his symptoms exposes himself to a clear risk of not just the same injury, but a worse one by being concussed again while still symptomatic. That it's foreseeable is, to be honest, now a question of stating the obvious; when it's been in the news, when the RFU announces in an injury survey released today that concussion is now the most common form of match injury in elite rugby in England and one whose incidence is not dropping, then anyone in the game is well aware that multiple concussions are a major risk.

So, then, what does this mean in practice? Well, let's return to that analogy with the seatbelt. If you are in a road-traffic accident, suffer injury because you're not wearing a seatbelt, and sue the other driver for causing you the injury, the other driver will point out that a lot, if not all, of your injury is down to your own negligence in not wearing your seatbelt. A judge hearing your case will then knock off a considerable amount of any damages you might get - 25-50% would not be uncommon - because so much of it is your fault.

In like fashion, a player who isn't honest with the team doctor, says he's asymptomatic when he's not and plays when he's still fuzzy - something O'Driscoll stated on the Off The Ball radio show that he has done - would be contributing to any subsequent injury he may suffer as a result of concussion. The IRB itself states as a basic principle in its concussion management guidelines: Players must be honest with themselves and medical staff for their protection. I stress we don't know if it happened in these cases, but an interesting comparison, in the same 13 jersey, is with Conrad Smith - a practising solicitor - who was recently suspected of concussion, left the pitch after failing a pitch-side assessment and, while frustrated, accepted entirely that it was right and necessary that this should be the case. 

The problem with concussion, of course, is that it can take years, even decades for the effects of multiple concussions, suffered when the player was hiding previous ones, to show up. By which stage, it's too late for the player.

Therefore, it's clear that there is a duty on coaches and team doctors not to put players unnecessarily in harm's way; but if they are making their assessments honestly, capably, following the GRTP and based on the information given to them by the player as to what his or her symptoms are, can it reasonably be said they have failed in that duty? And can not the finger of blame for the injuries sustained outside the framework aimed to protect players be pointed at the player who wasn't honest about his symptoms?

And all this, let us remember, when you still have the unanswerable question: if you train so hard to be able to make the right decisions, not make mistakes and not leave down your teammates, how are you helping them when you can't think straight at all?

It's time for honesty. Concussion is a brain injury, it is a risk in the game, and players need to be honest about it - with their doctors, with their teammates and with themselves.

Concussion - New Rules

A very short post, as much as a heads-up as anything else (if I might be pardoned the phrase) that the new Zurich Consensus has been published.

You can read it HERE.

This is now the standard to be followed in dealing with concussion. The Pocket SCAT2 has been tweaked, and is now the Pocket Concussion Recognition Tool, the CRT.

I'll go through it in more detail, teasing out the details, but, given the manner in which we saw both Ireland's centres concussed in the game against France this weekend just gone, concussion in rugby is once again - alas - a live issue. And it is one on which knowledge is not so much power as safety. Hence my appeal to anyone reading this to please read the new Zurich Consensus, familiarise yourself with it and apply it, every single time concussion crops up in a game.

Transfer Fees

The day can't be far off when you could play an over-30's version of the Rugby Championship in France. It's not quite that the T14 is the Dunrucking Retirement Home for Aged Southern Hemisphere Rugby Players, but, dear Lord, how the likes of Toulon are buying up players.

Of course, one of the latest, and one of the most expensive, acquisitions is Jonathan Sexton, moving to Racing Metro for the reported figure of €600,000 per annum. The strip-mining of Welsh talent has reached a pitch that is uncomfortably reminiscent of how League denuded Wales of players in the late '80s and early '90s. And still it continues, with Rocky Elsom now going to Toulon. There is a lot of money in French rugby, as THIS infographic from Green & Gold Rugby shows.

It is, in many respects, very like the manner in which the English Premiership in soccer has cornered the market. One must also wonder about the sustainability of it all, even given the strict financial rules that the Top14 imposes (and it must be said, the T14 is very transparent on this).

It's in this light that recent moves by the European Commission are interesting. Sport is an area over which the European Union has some oversight - it's a European competence, in the jargon - and decisions such as Bosman and Kolpak highlight this (on which this blog has touched in the past). Some of the work on the subject is excellent - I thoroughly recommend the European Parliament's document on the European dimension in sport, drawn up by the man who opened up Croke Park to rugby games which you can read HERE (it's long, but genuinely worth taking the time to read and reread at leisure). - and when the Commission turns its attention to sport and the insane money sloshing around some sports, then it's worth paying attention.

You can read the original document HERE and a good precis of it from the Guardian HERE. In essence; money, and beserk inflation of transfer fees, is destroying competition in European football and creating a de-facto closed shop. It has a raft of concrete proposals, largely aimed at rebalancing the effect of this closed shop and going some way to addressing the issues raised in the original Bosman case about protecting player development. Even the Premiership in soccer is now starting to take these issues of sustainability seriously as you can see in THIS piece from the Guardian (although the numbers involved are still eye-watering).

It will, of course, also affect rugby. And it's interesting to reflect on how this would work. Already, the president of Aviron Bayonnais has been speaking about a similar division between the haves and have-nots developing in the T14 to the extent of floating the idea of a union between the two Basque rivals to stay competitive (and to get an idea of that rivalry, Google "Imanol Harinordoquy father"). and we are now in the position where French clubs are outbidding national unions who develop the players. It has an effect on French rugby, too; while the T14 isooming, French coach Philippe Saint-André has been in the press bemoaning the dearth of French out-halves, and - in a sentence I never thought I would see - France are currently bottom of the Six Nations table, winless, after three games (although grim familarity with what it's like supporting Irish rugby leads me to just know that come the game against Ireland, they'll turn back into the sort of French team that can cut the All Blacks to ribbons).

It also seems to be affecting the international game. The issue of player release for the Lions this summer has been a touchy subject, and the (French) President of the IRB, Bernard Lapasset has been speaking on the subject of how money is now causing problems for the test game and player release - HERE. It is interesting to note that the European Parliament document referred to above also notes the problem and emphasises clubs should release players for tests.

It has not yet reached the point where legislation on the subject has come in. But it is as well to flag the issue, because it is one of the major factors in rugby as a professional game, and it is not going to go away soon. And the steps taken to deal with the dysfunctional elements in other sports will certainly hit rugby, too. Best we know what's coming down the tracks before it hits us.