RUGBY:An independent survey by the IRUPA has revealed an alarming drop in medical care as well as some other worrying trends, writes GERRY THORNLEY

A SURVEY amongst the 150-strong Irish Rugby Union Players Association has revealed a slightly alarming drop in medical care, with a relatively high percentage (over 40 per cent) of players revealing they had been pressurised into playing while injured. Over half the players also believed they had been misdiagnosed or wrongly treated.

Furthermore, nearly one in four players also expressed unhappiness with a surgeon or specialist they had been referred to, with the added feeling that the leading players were given preferential treatment. Although a degree of dissatisfaction was to be expected, some of the responses alarmed the IRUPA chief executive Niall Woods.

The survey is given added credibility due to the high response, almost 75 per cent, of the 150 or so members of IRUPA on either international, provincial or development contracts (academy players were not included). Furthermore, the confidential survey was conducted independently by BDO consultants in Limerick (part of a global chain of chartered accountants), throughout all four provinces in May last year.

“The most striking area where there were problems, which I had been receiving calls on anecdotally throughout last season was the medical area, and the drop in standard of care that the players felt there had been,” explains Woods. “This was backed up then by the stats in the survey.

“What I had been hearing anecdotally from players calling me was that players were getting pressured to play while injured. Whilst on the one hand players will always play with some form of injury, it was more (a case of) serious injury, and the most worrying part was who was responsible for the pressure being put on them to play.”

Over 40 per cent claimed they had been pressurised to play while injured, and while most of the pressure, predictably, came from the coaching team (almost 64 per cent), almost 28 per cent of players felt that the pressure came from the medical team.

“That is a worrying stat,” admits Woods. “That says to us that the primary care of the player, in this case the patient, wasn’t being catered for. So the alarm bells were ringing when we were looking at those stats.”

The survey also asked whether players felt they had been pressurised to remain on the pitch after suffering injury or concussion and, in light of recent events such as the revelations post-retirement from John Fogarty and Bernard Jackman about the effects of concussion, 19.1 per cent of the players felt that they had been.

Wood feared that the figure may have been higher and accepts that “the player is also partly to blame, because they also want to play. When you get a concussion you don’t know where you are, which is why I think the onus should be on an independent medical person on the pitch, not the team doctor, so that there is no undue pressure coming from coaches”.

This would be expensive? “Yes, but from our point of view, we’re looking to try and promote the care of the player, so that there are no longer term issues down the road. So we would feel it is a small price to pay.

“Having been at the IRB medical conference in November there is a huge concern around the concussion issue, and the influence of coaches. Certain coaches feel pressure too. They’re human, they’re there to win, they’re paid to win, and some of them obviously go to extra lengths. And I feel sorry for the medics as well because it’s a very hard job to be independent when you’re probably being paid by the team.

“You go back to Bloodgate at Harlequins,” says Woods, citing the case of Tom Williams feigning injury with a blood capsule. “The doctor and the physio were bullied by the coach, and probably in hindsight it was a good thing that happened, especially as it didn’t involve a bad injury.”

Continuing this theme, there was what Woods calls a “worrying” response when players were asked where they felt the allegiance of the team physiotherapist lay with. Almost 43 per cent of responses said to the players, but over 57 per cent (ie almost six out of every 10 players) said the physios allegiance was with management. “That needs to come right down.”

As for the team doctor, almost 35 per cent of players felt that their allegiance lay first with management. “Again, if you go back to Bloodgate, that’s what happens. The management have too much influence on the doctor and the physio. But you also have to have sympathy because how can they totally dedicate themselves to the player when they’re paid by the employer?

“I’ve seen the pressures myself from playing, and it’s nine years since I played, and I hear it on a regular basis in Ireland and the UK. There was also a real macho thing with one coach, who simply didn’t want any player in the physio’s room. That it was a sign of weakness, so you felt like you should be out training even with injuries, and that’s just the way the sport is. In American Football there’s probably the same attitude, and maybe 10 times worse.”

Nearly one in four players also expressed unhappiness with a surgeon or specialist they had been referred to. You’d wonder if that wouldn’t be a normal response, and Woods accepts that is probably the case, “but this is elite sport and you should be striving to get it down as low as possible. You want your top players being sent to the top specialists. And the feedback was that the top guys were getting the best service, and the provincial player wasn’t”.

Another worrying response concerned a misdiagnosis or inappropriate treatment, with 57.3 per cent of players feeling this had been the case at some point(s) in their career. Woods cites certain examples of misread scans as well as misdiagnosis, and hence rehab programmes which made the injuries worse. Mightn’t players be wrong in believing they had been misdiagnosed? “There could be an element of that, but 57 per cent is quite high. If it was 20 per cent you mightn’t be as concerned, but again the aim is to get that down.”

According to Woods, part of the problem here is the geographical logistics of sending players to certain specialists. “If, say, Munster send someone to Dublin, medics in Cork and Limerick are getting pissed off as to why they were sent there. Where they are based is a problem. Like, if the best hip surgeon is based in Belfast, everyone should be going to Belfast, no matter if you’re playing in Galway, Limerick, Cork or Dublin, whereas it tends to be done locally. And it’s about equitable treatment for all players. That is aspirational, and I’m not naïve in thinking that’s going to happen overnight.

“That’s the way of things, not just in sport. The higher up you go, the better treatment you get. But our aim is to improve the welfare of the players as much as possible, not only when they are playing but when they are finished.”

IRUPA’s previous survey, in 2006, revealed that 40 per cent of players retired through injury, and that 47 per cent of them could not play rugby of any sort ever again, while 72 per cent of them are in regular pain or discomfort. That equates to one in five retired players.

To the IRFU’s credit, that survey prompted them to agree to an independent exit medical, unique to Irish rugby, with private medical insurance to cover any operations on rugby injuries in the 12 months after retirement, even if the ‘independent’ part of the examination has since been taken away.

While virtually every player maintains he is ‘drug free’ encouragingly only one claimed to have been pressurized into taking a performance enhancing drug. Asked if he believed it, Woods said: “Yes. In New Zealand it was 10 per cent in their survey, and that was amongst 700 or 800 players surveyed, so that’s 70 or 80 players (who had been pressurised into taking performance-enhancing drugs, as opposed to actually taking them).”

Invariably, there will be an element of shoot-the-messenger here. However, Woods said that on foot of presenting the survey’s results to the IRFU last June, the Union have responded positively if slowly, by conducting a review of their own medical committee, with a mooted independent chairman.

“There are changes being made to the IRFU medical committee,” says Woods. “We’re appointing an IRUPA medical advisor to be available to all the players and we’re confident that our medical advisor will be on the committee.”

Ultimately, the whole point of this survey was to improve the medical care of Irish-based players. “And the quicker we can get it done the better,” says Woods.

“Unfortunately that is out of our hands, but things like the survey help to focus the attention, and the provinces have seen their individual reports and they accept them and are trying to improve their situations as well.”

Woods also presented much of the survey’s results to the IRB medical conference in November. “While some of the medics there said it was not ideal to see some of the stats it’s good that they know it, and they need to be told.”

Woods and IRUPA have done the IRFU, the players and the Irish game a favour. Encouragingly, there have already been less complaints this season. As the IRUPA CEO puts it: “There’s probably a perception that the IRFU medical care has been top of the range, and it has been, but it just seems to have slipped a little bit and things like this survey are there to get it back up to the level it was at.”

IRUPA SURVEY

Have you been pressurised to play while injured?

Yes: 40.4%. No: 57.3%. Non response: 2.2%.

If yes, pressurised by who?

Medical team: 27.8%. Coaching team: 63.9%. Others: 8.3%.

Pressurised to stay on the field after suffering injury/concussion?

Yes: 19.1%. No: 78.7%.

Allegiance of the team physiotherapist is with? Players: 42.7%. Management: 57.3%.

Allegiance of team doctor is with?

(With) Players: 65.2%. (With) Management: 34.8%.

Ever been unhappy with a surgeon or specialist you have been sent to?

Yes: 23.6%. No: 75.3%.

Ever had a problem with misdiagnosis or inappropriate treatment?

Yes: 57.3%. No: 42.7%.

I understand my responsibility and

what it means to be a drug free athlete in rugby?

Yes: 97.8%. No: 0%. Non response: 2.2%.

I have been pressurised into taking performance enhancing drugs during my career?

Yes: 1.1%. No: 97.8%. Non response: 1.1%