Medical Director’s Blog – Concussion: It’s not a rugby injury
Updated January 2020
A new year is here, and with it’s 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 summer, Steve Smith’s high profile concussion while playing cricket for Australia in The Ashes led to the first use of a concussion substitution in international cricket (see my article in The Times here – The Ashes: Steve Smith likely to feel concussion symptoms for at least a week). 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?
In 2019, our doctors undertook over 1000 “concussion assessments”. Of these, 70% were sustained playing rugby (both training and matches). After rugby, the second most common cause of injury were concussions sustained outside of sport (12%) in joint third place were football and hockey (5% each). The rest of were made up of injuries in sports as diverse as swimming, netball, cycling, skiing and basketball (plus 8 more). It is, of course, worth noting that the majority of our clients are large rugby playing schools and rugby clubs so we would expect the numbers to be skewed towards that sport
“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.