Medical Director’s Blog – Concussion: It’s not a rugby injury

By Dr Sam Barke

2018 is here, and with its arrival we find ourselves moving into the final months of the rugby season.  School fixture lists will now be dominated by hockey and it won’t be long until we start to see the outfields being mown for the start of cricket.  I can almost hear the sigh of relief from some of the staff I have regular contact with as the anticipated reduction in numbers on the “off games” list soon starts to show.  But is rugby’s reputation fair?

 

Rugby has led the way

Outside of America, where American Football has been the main driver for advancing the knowledge on concussions, the rugby community has been at the forefront of research, education and implementing change in the way we deal with concussions.  World Rugby and the national bodies below it, such as the RFU, have led the way in raising awareness of the injury and advising on how it should be managed.  It is right that they have – rugby clearly carries a risk of concussion – but by being so they have also inadvertently taken ownership of the injury and dominated the headlines to the point where it would be easy to think it is only rugby which has a problem. I expect there are sports which are quite happy for rugby to take the negative press!

 

But does concussion happen in other sports?

Of course.  Concussion happens outside of sport – tripping in the playground, walking into a door, falling out of bed – so it makes sense that there is a risk of it happening in sport too.  All “major” sports governing bodies in England – RFU, ECB, RFL, FA, England Hockey –  have adopted concussion management guidelines, acknowledging that there is a risk of sustaining the injury playing their sport. Last week, an article published in the Daily Telegraph (“Cricket is failing to do enough to protect players with concussion”)  called for more to be done to protect cricketers from the risks of concussion.  A few days later it was announced that concussion substitutions will be allowed in the English domestic cricket league from this year.  A big step in acknowledging the importance of the dealing with the injury appropriately and raising awareness among the community and school game.

 

What does the Return2Play data show?

Between September and December 2017, we saw 223 concussions.  Of these, 181 (81%) were sustained playing rugby (both training and matches).  It needs to be remembered, these were injuries sustained during the peak of the rugby season in schools where the main sport last term was rugby, so it is not at all surprising that rugby sits at the top of the league table at this point in the year.  After rugby, the second most common cause of injury were concussions sustained outside of sport, in joint third place were football and hockey. It will be interesting to see is how this will change over the course of the rest of the academic year.

 

“But surely rugby has a far higher risk than other sports?”

This is where it gets tricky. My usual answer is “how can we know?”.  Being able to collect data on the number of concussions occurring in sports relies on all of those sports understanding the injury and being able to recognise it. There is no doubt that understanding is high in the rugby community – with thanks to the RFU’s Headcase campaign but can the same be said across other sports?  On Saturday I was chatting to a hockey coach who had only seen a handful of concussions over their career. They were shocked to learn that you didn’t have to be knocked out to have sustained a concussion and suddenly appreciated they’d seen far more than they’d realised.

 

 

As ever, education is key

We need to move away from thinking of concussions as rugby’s problem.  Stop putting in place policy that requires only rugby players and rugby coaches to undertake concussion education.  At schools all staff and all pupils – whether involved in sport or not – should be aware of the injury and how it should be managed.  Only then will we be able to start making a fair comparison between sports.

To read the other blogs in the concussion series, please follow the links below.

Concussion: Back to Basics

Concussion: There’s no recovery fast track

Concussion: Teachers have an important role to play