David Pocock checks on Ryan Crotty after another concussion (Photo by Mark Kolbe/Getty Images)

Rugby and concussions are a tragedy in the making

Concussions are a problem rugby has never really reckoned with, and they have the power to truly change how we view the game. Madeleine Chapman investigates.

It’s a long-running narrative that some of the best All Blacks in history have been those able to get knocked down and get back up again, both figuratively and literally. The ability (courage, bravery) to play through injury and pain will cement a player in rugby lore for years to come. Richie McCaw played with a broken foot. Buck Shelford played on after having three teeth knocked loose. Colin Meads played on with a fractured arm. And in a feat that will surely never be topped, Buck Shelford played on with one of his testicles hanging outside of his scrotum.

Usually included in this list is Dean Lonergan, who was knocked unconscious and suffered convulsions on the field during a Kiwis rugby league test in 1991. He was taken off to be seen by medics but soon returned to the field and played out the rest of the game. Watching footage of that match now, even knowing he recovered, is like watching an amateur walk a tightrope. Tragedy is always one misstep away.

That’s the tough man mentality, and one that almost every competitive athlete can relate to. When you’re in the middle of battle (it helps to think of sports as combat, rather than entertainment), pain is so easy to ignore. Very few boxers have themselves thrown in the towel because that’s not their job. It’s the trainer’s job to know when their athlete shouldn’t go on. Because even in boxing, where the aim is literally to knock the other person out, there’s a limit.

And yet, just last year, Alan Wyn Jones of the British and Irish Lions was sent back out on the field 20 minutes after being knocked unconscious by Jerome Kaino’s swinging arm.

As many purists will cry, rugby is a contact sport. Always has been, always will be. But while rugby stays the same, medicine evolves. A recent study conducted by Auckland University of Technology found that 85% of the elite rugby player participants had suffered at least one concussion, and those players performed worse on tests that measured cognitive flexibility and information processing. This is weeks, months, and years after the initial incident. Muscle sprains and broken bones may have a general recovery timeline but the effects of concussion can stay with a person forever.

Perhaps the lack of physical symptoms makes it easy to downplay the severity of a concussion. “Concussion is a challenging thing to diagnose because there’s nothing we can see on conventional scans,” says Dr Mark Fulcher, team medic for the Football Ferns. “A concussion is essentially a functional thing. The brain gets shook around inside the head and stops working properly. We know there’s some damage there but we can’t structurally see it.” Not only is there no bleeding or structural damage, there can often be very few symptoms at all. “They might just not be their normal self. They might be more irritable. Those symptoms will typically happen shortly after the injury but sometimes they’ll become more evident over the next 24-48 hours.”

Even the language helps to soften the impact. ‘Head knock’, ‘head clash’, ‘collision’. They’re all euphemisms for what is, in reality, a mild traumatic brain injury, but are used so much that even the official term concussion has become synonymous with ‘bumped heads’.

Like most injuries or illnesses, concussion will affect different people in different ways. So for someone like Ryan Crotty who suffered his sixth (or was it seventh?) concussion in fifteen months last weekend, recovery is apparently quick and full. “I think for some patients, they would appear to be able to sustain multiple concussions and don’t seem to have an ongoing problem. But it’s very hard to know because we don’t typically follow these patients up for 50 or 60 years. And if you look at the research, none of the studies have done that either.”

And that’s where the danger lies. Everything is fine until it’s not. For Eden Rugby Premiers captain Stuart Ta’avao, everything was fine until the last game of the season when he suffered his fifth concussion. That was a month ago and he’s still experiencing symptoms. “I don’t know what happened, really, but I had a blow to the back of the head and had blurred vision and pins and needles running down my back.” Much like Crotty, Ta’avao typically recovered from his concussions in a few days, a week tops. But heading into his fifth week, he still feels “like I’m hungover all the time, always forgetting things I should remember.” Everything’s fine until it’s not.

Asked if he’ll be returning to the field next season, Ta’avao, a lifelong rugby fanatic, doesn’t hesitate in saying no. “For me, at my age especially, it’s a lot easier to say I probably won’t go back to play.” But he knows it’s not so easy for other players, particularly All Blacks. “If that was my bread and butter and that was feeding my family, it might be a different decision.”

Buck Shelford was tough with a capital T

When playing a game that could impair you for life, it helps to get paid. Which brings into question the responsibilities of the people who employ rugby players. According to the Worksafe criteria, the New Zealand Rugby Union, as well as the Super Rugby franchises, are PCBUs (person – or organisation – conducting a business or undertaking). A PCBU’s primary duty of care is to “ensure, so far as is reasonably practicable, the health and safety of workers, and that other people are not put at risk by its work.” Injuries are simply an occupational hazard in any sport. But an employer must manage risk. At what point does sending an employee back to a workspace where they have suffered multiple, and regular, mild traumatic brain injuries constitute a failing on the part of the employer.

One player at least has decided that point has already past. Former Irish age group international Cillian Willis is suing his former club Sale Sharks for ‘clinical negligence’ after they allowed him to play on despite receiving a concussion and then another head knock in a club game. Willis, 28, hasn’t played rugby since and never will. The case won’t be heard until next year but will be a watershed moment, if only as a harsh reminder to clubs and national organisations of the lives they’re ultimately responsible for.

It’s a grey area. It could set a dangerous precedent for an organisation or club to force resignation or retirement on a player. But at the same time, asking a player to make big decisions soon after receiving a brain injury that’s known to impair cognitive functions is ironic at best. Mils Muliaina, an All Blacks test centurion, knows that there’s no easy solution. But longer rest periods is a good start. “I understand that’s sometimes difficult to do because there’s so much external pressure with having to get back on the field, sponsorship, the game, also the pressure of the player saying he’s alright. But there has to be something that the high honchos have to come up with and put their brains together that works for everyone and keeps players safe.”

Stuart Ta’avao has a brother playing rugby professionally and knows the difference between recreational rugby and career rugby. Saying no to your livelihood to protect your brain is a harder decision than many would appreciate. But after speaking for fifteen minutes about his concussion, his playing career, and the symptoms he still experiences five weeks on, Ta’avao seemed to reach a new conclusion.

“If I played rugby again and it would affect my ability to function, would I still do it? That’s an easy decision for me now. Actually even if I was a professional, that would be an easy decision.”

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