As the Six Nations championship takes its mid-term break, rugby enthusiasts may wish to reflect on how concerns about the effects of concussion are continuing to multiply. Though Ireland out half Johnny Sexton, who has sustained four documented concussions in recent years, has been central to the discussion, the issue is bigger than any individual player and raises grave questions for the sport at all levels.
Noting how repeated concussive knocks are becoming more damaging more frequently, respected rugby medic Dr Barry O’Driscoll believes that players who suffer three or more concussions should “seriously think about their future”.
The word concussion comes from the Latin concutere, meaning "to shake violently". Made of soft tissue, the brain is cushioned by spinal fluid and encased in the protective shell of the skull.
Despite this bony protection, the brain can still be shaken and stretched by pressure waves following an impact. The resulting traumatic brain injury can cause bruising, damage to blood vessels and injury to the nerves.
An audit by the English Rugby Football Union found a significant year-on-year increase in the rate of reported concussion which now stands at 10.5 concussions occurring every 1,000 player hours.
In the US, the National Football League (NFL) has paid out close to a billion dollars to some 4,000 former American football players with neurodegenerative conditions linked to multiple concussions. Chronic traumatic encephalopathy, a progressive degenerative brain disease, was recently diagnosed in 87 of 91 deceased NFL players.
In rugby, there is a clear need – at the least – to carry out baseline cognitive testing at the beginning of a player’s career. And to remember that concussion is an issue at every level of the game – from schools through to club and professional.
Those at high risk with a history of concussions must be managed proactively; sadly this may mean premature retirement. This will mean difficult decisions but player welfare must trump all other factors; competitive and financial.