HEALTH Tackling concussion

Health
Andrew O'Brien

It’s Rugby World Cup time. Once every four years I go into a trance of tackles and turnovers, lineouts and cut out passes. During the 2003 tournament, I worked as a physio by day and a video analyst for Australian Rugby at night. I would finish work in the hospital at 5, race to the rugby offices in time for kick-off, analyse a match until 2 or 3am, sleep on the office floor and be back in the hospital for 8am!
This time around, I’ll be watching with more concern for the participants. Injuries are part and parcel of any sport, particularly rugby, and all players accept that element of risk and play anyway. But over the last few years, talk of concussion and its impact has dominated rugby injury discussion.
Concussion is not new. Stories abound of players getting knocked cold and playing on. ‘It’s just a head knock, shake it off’ was the coach’s motto. Sadly, there are also tales of ex-footballers suffering with mood swings, depression and early dementia.
Ian Roberts, one of the hardest men in Australian Rugby League through the 1990s, recently underwent a series of tests for a television production that showed clear signs of Chronic Traumatic Encephalopathy, which leads to early dementia and only occurs as a result of repeated head trauma.
In America, the NFL settled a class action brought by former players for breach of duty of care in relation to concussion.
One of the scariest things I ever saw happened 20 years ago almost to this day. At school training, Tom Ward jumped and caught a lineout unopposed. He landed perfectly balanced on his feet, groaned, then his eyes rolled back in his head and he fell to the ground convulsing. Tom had been concussed two or three times earlier that season. It took months, but thankfully he returned to full health.
Vigilance, technique
Why is concussion such a big issue now, though? The answer comes in two parts.
The first part is vigilance. At all levels coaches, referees and medics are instructed to stop the game and remove a player if there is any concern. World Rugby guidelines state that any player who has a suspected concussion should be removed from the field immediately. At the professional level, players are required to pass a pitch-side Head Injury Assessment from a doctor before being allowed back on, whilst amateur and underage players must come off and stay off. Players at all levels are required to follow a graduated return to play protocol before playing again.
But what of the players who pass the protocols and get back to playing again, only to suffer further concussions? We have seen several instances in recent years of players retiring due to repeat injuries (former Leinster hookers Bernard Jackman and John Fogarty spring to mind)  and current players being forced to take time out in order to recover (Jonathan Sexton and George North the most high profile cases).
It’s hard not to fear for the long-term health of such players, but they do receive the best medical guidance. My bigger concern is for amateur players, where medical cover isn’t always available and players are left to their own devices.
The second issue is technique, specifically tackling technique. As juniors, players are taught to tackle from the waist down. Twenty years ago that was how the international players did it, but recently I heard John Fogarty say in an interview that he couldn’t teach a ten year old how to tackle. Herein lies the problem.
The professional game is power dominated. Tackling from the waist down cedes territory and gives the ball-carrier a chance to offload, so defenders tackle around the chest to keep the runner upright and stop them offloading, or smash them backwards in a highlight-reel hit.
Such tackles require perfect technique and timing. It could be a once-a-month incident, and yet players aim for it every time. Unfortunately, underage and club players see the professionals as the gold standard and copy them.
I wish I knew how to solve the problem, but I don’t. Rule changes thus far are designed to protect the player after an injury, but we need to reduce the risk of injury with better coaching at underage level, and possibly rule changes throughout. In the meantime, coaches, referees, parents and players themselves need to remember: If in doubt, sit it out. And while you’re sitting there, put on a Wallabies jersey!

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.