Health

Concussion debate in rugby heating up

LONDON (AP) — It's been nearly three years since Peter Robinson received the kind of phone call that every parent dreads.

His 14-year-old son, Ben, had collapsed and been hospitalized. He had a 1 percent chance of survival, and even then would be in a vegetative state. Ben died two days later. But his death should have been avoided.

During a school rugby union match in Northern Ireland, Ben sustained a concussion at the start of the second half but was allowed to play on despite showing signs of head trauma. His coach checked Ben for concussion on three occasions but Ben continued playing until collapsing with one minute remaining, his mother looking on on the sidelines.

"If Ben had been removed after that first concussion," Peter Robinson told the Associated Press in a phone interview, "he'd be here with us today." Ben's death, in January 2011, was the first confirmed case of "Second Impact Syndrome" in Britain and is one of a handful of cases used by critics to demonstrate that rugby needs to wise up regarding its rules and guidelines over concussion.

Medical chiefs, neurosurgeons, players' union representatives, coaches and former players attended a Professional Rugby Concussion Forum at Twickenham — the home of English rugby — on Thursday. The conference was set up to test the temperature in the rugby fraternity for what is proving to be an increasingly hot topic across the globe.

And one of the central themes of the whole issue is the International Rugby Board's new, to some controversial, concussion protocol for dealing with head injuries during matches. The Pitch-Side Concussion Assessment, first trialed last year, allows players to return to the field of play five minutes after a head injury as long as they have been cleared of concussion by medics. To do so, they must answer a number of questions — without getting any wrong — and pass a balance test, otherwise they are removed.

Previously, players had had to take three weeks off — a period later reduced to one week — if they suffered suspected concussion. According to IRB statistics, under the new protocol the percentage of players with a post-match confirmed concussion who stay on the field after a suspected concussion has dropped from 56 to 13.

But not everyone is happy. Barry O'Driscoll, a former Ireland international, used to sit on the IRB's medical board but resigned 18 months ago when the PSCA was introduced. He thinks rugby bosses are failing to place enough importance to the subject of concussion.

"Players are being sent back on with brain damage, there's absolutely no doubt about it," O'Driscoll said on the sidelines of the concussion forum. O'Driscoll shakes his head in disbelief when he sees some incidents of players returning to the field, obviously concussed. Two stick in his mind.

During the third and deciding test between the British and Irish Lions and Australia in July — a match of huge global interest — Australia flanker George Smith was wiped out after clashing heads with Lions hooker Richard Hibbard in a horrific-looking collision.

Smith wobbled off the pitch, held up on both sides by doctors, and he later admitted himself that he had "snake-danced" to the sidelines. Remarkably, he was allowed to take the PSCA, passed it and returned to play.

Months earlier, Ireland great Brian O'Driscoll — the nephew of Barry — was also knocked sideways by a hit from France prop Vincent Debaty in the Six Nations. O'Driscoll was unsteady on his feet — an undisputed sign of concussion — and was also being held up by medics. He was back in action within three minutes.

Barry O'Driscoll believes rugby will soon be open to the kind of lawsuit that hit the NFL, which agreed to a settlement of more than three-quarters of a billion dollars to settle lawsuits from about 4,500 former players who developed dementia or other concussion-related brain disorders they say were caused by the on-field violence.

"I think the lawyers are licking their lips, I really do," O'Driscoll said. "I think it's just waiting to happen." The IRB aren't so downbeat. Despite acknowledging there is much still to learn about a confusing, complex issue, the world governing body believes major progress is being made. And they appear to be warming to the idea of mandatory education for players and coaches, perhaps in time for the start of next season.

"Rugby's approach is founded on evidence-based research and not individual opinion, has been driven by area experts, has the full support of the International Rugby Players Association and national unions and is putting the welfare of players at all levels first," the IRB said. "The IRB has been proactive in taking the recommended measures as science evolves."

They don't have an easy job. There are major commercial pressures to have the best players on the pitch all the time, education on concussion is still in its infancy for many, while players will usually do anything to stay on the pitch. They have teammates to help out, wages to earn, and 'hard man' images to maintain.

An alarming incident in the English Premier League this weekend has moved the issue further under the microscope, and was even discussed by British politicians on Thursday. Tottenham goalkeeper Hugo Lloris was allowed to play on during a match against Everton on Sunday despite being knocked unconscious when his head collided with an opponent's knee.

"Can we have an urgent debate as soon as possible on the dangers of concussion in sport so that we can provide a lead?" Labour MP Chris Bryant said in the House of Commons. "There is real evidence that people, when they are forced to play again after being concussed, can all too easily end up suffering from premature dementia."

As quickly happened in the United States, the topic of concussion is generating more and more interest, driven largely by campaigning by British newspaper Mail on Sunday. And Robinson is among those thankful for that. He is calling for governments in Britain to introduce mandatory concussion education to prevent the tragedy that befell Ben ever happening again.

"I would love concussion awareness to be taught in the school curriculum," he said. "This could happen in the school yard, in any sport. Recognise and remove."

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