Luke Marshall’s fifth concussion a major cause of concern

The match was just four minutes old for Ulster centre Luke Marshall when he ran a preplanned line and took possession six metres from the opposition line.

With Rhys Patchell hanging on to him, Marshall's head made contact with the arm of Scarlets flanker James Davies and he went down.

It didn’t look like much but the 25-year-old was turned by medics and remained still on the ground for three minutes before being assisted from the pitch.

It was later confirmed that the Ulster and Ireland centre had suffered what is officially his fifth concussion.

Marshall and Ulster won't enjoy the speculation from observers who are not privy to his medical records. Not long ago the player wrote a letter of complaint to the Sunday Independent following comments made after his fourth head injury.

It is a serious and nuanced subject. But if this was Marshall’s fifth cruciate ligament injury, there would be similar speculation about the future of his career.

Eminent concussion experts such as Mickey Collins, who sees 20,000 cases of concussion yearly in his Pittsburgh clinic and who was interviewed by this newspaper in 2013, says there is no number that can be put on concussion injuries at which point you must say enough. It is, he says, an individualised process.

However Collins also says: “When you get an injury and you get hit again and again and again, you are going down a very dangerous road.”

Head injuries

Marshall knows this. Ulster know this. But other more conservative doctors do put a limit on the number of head injuries when they advise people to stop playing. Cognitive neurologist

Harry Kerasidis

believes three concussions carry with them a higher risk of long term neuro-cognitive deficit.

Marshall's history is that he has had four concussive episodes between March 9th, 2013 and February 28th, 2014 and, as Johnny Sexton did, stepped away from the game for several months to recover. Since then he had been concussion-free and enjoyed an impressive spell with the Irish team in South Africa this summer until last weekend's incident.

In their weekly injury update Ulster didn’t enlighten anyone about their player’s condition other than what was already evident from the weekend collision.

“Luke Marshall suffered a concussive injury in the same [Scarlets] game. He will not play against Glasgow but will continue to be assessed this week and will follow the return to play guidelines,” they said yesterday.

Public concern

What they could have said is that it’s his fifth concussion and that they are aware of the frequency and the public concern surrounding the injury.

They could have elaborated on the general condition of his health or the severity of the brain injury and they could have allayed fears and speculation that his career may or may not be in jeopardy. But that has not happened.

Marshall did say something encouraging in June before the South African tour.

“You hear of players suffering from headaches and having to go home and sit in a dark room, or can’t concentrate and all sorts of things like that. I was never at a stage like that at all,” he said.

Two-year deal

If he feels that way today, then good. But Ulster will balance the frequency and severity of his head injuries with their duty of care, which they did when Ulster and Ireland prop

Declan Fitzpatrick

retired last year, when Leinster’s

John Fogarty

and

Bernard Jackman

retired in 2010 and when centre

David Quinlan

stopped playing in 2007, all because of head injuries.

For Marshall, who signed a two-year deal with Ulster this year, which will keep him at Kingspan Stadium until 2018, his fifth head trauma remains the most concerning injury the talented young centre could have had.