Wales centre Jamie Roberts has been concussed four times on a rugby field, including fracturing his skull in a clash with Australia’s Stirling Mortlock back in 2008 after which he still played on for 15 minutes.
The British and Irish Lions stalwart is also a qualified doctor so knows better than most of the potential dangers of concussion, arguably rugby’s hottest and most sensitive topic currently. Roberts, who at the start of this season was appointed an ambassador for a concussion drive in Wales rugby, said: “I think it’s one of those where we don’t want to be in a position where someone has to learn the hard way before something is done about it.
“It’s important to understand concussion, as less than 10 per cent of all concussion results in a loss of consciousness. So, being knocked out isn’t always an indicator.
“Having been knocked out four times on the rugby field, it’s a topic I’m obviously interested in. But it’s a subject causing serious debate.”
Initial research has indicated that the sort of blows to the head sustained by rugby players repeatedly can lead to the early onset of dementia. Dr Willie Stewart is a neuropathologist who was brought in by the International Rugby Board, now World Rugby, to advise it on concussion protocols.
So what are the long-term effects of concussion in rugby? “These are the questions we’re still trying to answer,” says Stewart. “Concussion is brain injury, but to what extent? In some people does that become a grain of sand in an oyster that becomes a pearl? We don’t really know these things.”
Stewart, who is based in Glasgow, Scotland, has worked in brain injury for over a decade and has been trying slowly but surely to warn of its potential perils in a sporting context.
“I think concussion in sport and brain injury just used to be seen as a boxer’s problem,” he says. “You would think that boxing is the worst for it but I sometimes wonder if boxing is actually any better or worse. Of course, they set out in boxing to injure each other’s brains but, with the medical back-up and set-up, it’s actually well controlled.
“Take boxing and rugby as a comparison. In rugby after a concussion, you get 10 minutes to be assessed. In boxing, it’s just 10 seconds – the count – and if you’re not ok, you’re removed straight away.”
In the past, concussion was almost seen as a badge of honour in rugby, that the hard men played on despite the obvious blow to the head. Former England captain Lewis Moody admits he treated concussion “as a joke” but now takes the subject so seriously he has already pledged to donate his brain to research after his death.
Northampton full-back Ben Foden is bidding to force his way back into the England set-up for the current Six Nations but considers himself one of the lucky ones not to have been on the receiving end of as many concussions as his peers 11 years into his professional career.
“I did have one concussion about three years ago and I remember begging to be put into the side and was told I’d only be put in if I passed the concussion test. I didn’t and I had to watch from the sidelines but had a scan the next day and was given the all clear.”
In some ways, Foden’s remark highlights the fact players need to be protected from themselves by the game’s authorities and he, for one, believes that is happening.
“Things go wrong if you’re not fully equipped in anything in life,” he argues. “We have to rely on the powers that be that they’re doing the right thing.”
For Foden, the issue of concussion and more broadly that of increasing injuries across the board is only going to get worse. “The problem is you’ve got kids coming out of school that are 17 or 18 and run the 100 metres in 11 seconds while weighing 105kg, and players are only going to get bigger.”
"I sometimes wonder if boxing is actually any better or worse (than rugby)" – Stewart
The statistics back it up. Research by the Rugby Players’ Association in England showed that in 1994 – at the onset of the professional game – the average weight of the England rugby team was 90kg while the team for their last autumn international against Australia weighed in at 12.7 kgs heavier on average per person.
Over the past 15 years in the global game, player weight has risen by 10 per cent , while the average sprint time over 10 metres has dropped by five per cent. In addition, players are tackling and being tackled more – the tackle count having risen from 160 tackles per game to 220. In the English game at elite level in concussion terms, there are 6.7 concussions every 1,000 player hours – one concussion every four matches – compared to an average of 4.6 for the previous decade.
Stewart, who was first brought in by rugby’s governing body to assist 18 months ago, argues some of that figure could be down to the fact there has been greater reporting of concussions recently, but the majority of the figures are down to a genuine increase. Fresh injury statistics are expected from the Rugby Football Union in its audit next month, in which Stewart says: “I fully expect to see another rise”.
English Premiership side Saracens have been trying to tackle the issue with their players wearing patches behind their ears both in training and matches to measure the impact each player’s body undergoes in a session or match.
Known as the x-Patch, something similar was used by the company in mouth guards as a trial with a New Zealand amateur rugby side during 19 matches in 2013. The results showed that the team incurred 20,687 impacts to the head of 10g (the equivalent of a light punch) or more. But most tellingly, it showed 181 impacts of 95g or more, a gargantuan force to be taking to the head.
Quite what Saracens’ trial will find, is unclear. As performance director Philip Morrow explains: “This is more a search and find mission. We don’t know what we’re going to find, but we want to find out as much as possible about it.”
Other changes afoot in the wider game is an online module put together by World Rugby that must now be completed by every professional rugby player in England.
Stewart used to be one of the harshest critics of rugby’s hierarchy and failures to do enough in combating the issue of concussion. But rugby officials have since followed the lead taken by the NFL, where there have been a litany of lawsuits over concussion cases.
As things stand, Stewart says: “Rugby has come an incredibly long way in just a couple of years. I feel it’s moving in the right direction but it needs to keep moving forward. There’s no point resting on its laurels. Rugby has to be a beacon for improvement.”
Stewart was personally more obsessed with the amateur level to try to raise awareness at a level where the medical back-up and understanding is at a minimum. In that area, he believes the message is beginning to get through.
But at the elite level, he argues more can be done by following the NFL’s lead, which cut contact sessions in training and the game’s so-called ‘flying wedge’ without affecting the game as a whole. Stewart would like to see reduced contact in rugby training sessions and to address the issue of receiving the ball in mid-air.
“I don’t think it adds anything to the game. Do people watch the game for that? No. So, it’s a case that still more can be done.”
