Advice on when to return to play after a concussion.

First topic message reminder :

Folks, in the light of a few rugby-related concussions I've become aware of recently, including one to RDW_Scotland I figure it's worth having the IRB quidelines available as a ready reference, so I'm resurrecting MrsP's thread (below) and making it a "sticky". -KRD


http://irbplayerwelfare.com/concussion



This is a subject very close to my heart and a chat on another thread has just lead me to ask.

How many players/coaches/parents are aware of the most recent guidelines?

This is about protecting not just your rugby career but your quality of life and even, for youngsters, your life itself.

Summary Principles

Concussion must be taken extremely seriously to safeguard the long term welfare of Players.

Players suspected of having concussion must be removed from play and must not resume play in the match.

Players suspected of having concussion must be medically assessed.

Players suspected of having concussion or diagnosed with concussion must go through a graduated return to play protocol (GRTP).

Players must receive medical clearance before returning to play.

The new Guidelines are summarised below.

The IRB Recognise and Remove message incorporates 6 Rs[size=38]

Recognise -

Learn the signs and symptoms of a concussion so you understand when an athlete might have a suspected concussion.


Remove -

If an athlete has a concussion or even a suspected concussion he or she must be removed from play immediately.


Refer -

Once removed from play, the player should be referred immediately to a qualified healthcare professional who is trained in evaluating and treating concussions.


Rest -

Players must rest from exercise until symptom-free and then start a Graduated Return to Play. The IRB recommends a more conservative return to play for children and adolescents.


Recover -

Full recovery from the concussion is required before return to play is authorized. This includes being symptom-free. Rest and specific treatment options are critical for the health of the injured participant.


Return -

In order for safe return to play in Rugby, the athlete must be symptom-free and cleared in writing by a qualified healthcare professional who is trained in evaluating and treating concussions. The athlete completes the GRTP (Graduated Return to Play) protocol.[/size]


Who has read them or been made aware of their contents?


For anyone who has suffered a recent head injury, here is some excellent advice c/o Doctor Grey.


http://www.morrisrugby.org/images/pdf/2010parent-head-injury-instructions.pdf

And another video (about 10 mins) this time from the NFL giving some general advice about concussion.

http://www.nata.org/health-issues/concussion



For anyone who may be unaware of the extent or severity of the problem, this is an interesting Aussie TV program on the subject which aired just last week or so.

http://www.abc.net.au/4corners/stories/2012/05/10/3499950.htm

And this is why I am so animated about concussion!

http://www.theguardian.com/sport/2013/dec/13/death-of-a-schoolboy-ben-robinson-concussion-rugby-union

on now - http://www.bbc.co.uk/programmes/b04pj7z3

I don't know if this was on the IRB website but

http://irbplayerwelfare.com/concussion

Edit: just noticed a link in the original post but that link doesn't work anymore.

Thanks Hammer.

I have updated the link in the article now.

It is interesting/worrying that the "must not return to play in the match" bit is no longer there.

Just watching the build up to the Sarries v Irish game and the Saracens players are all wearing sensors on their heads (behind the ear) that are there to measure the level of impact. Not sure if they're to be used when taking players off or as part of a study (hopefully).

Up on BBC now

http://www.bbc.co.uk/sport/0/rugby-union/30671380

Read about it in the Sunday Times. A really good thing Saracens are trying out - not that most on here believe that they can ever do anything good.

Yeah. I wonder if they intend to use the data in real time to decide whether to take a player off for concusion checks or if they will look at the data retrospectively?

Either way it is an interesting approach.

Well done Sarries.

A couple more articles on concussion.

A report brought to my attention by Sin e from Neil Francis on his own experience,

http://www.independent.ie/sport/rugby/neil-francis-serious-injury-no-longer-seen-a-chance-to-test-manhood-30880134.html

And one from Rugby Fan about a very young CTE sufferer who was severely effected despite no reported concussions and having only played High School football.

http://www.vox.com/2015/1/5/7463363/football-cte-high-school

Thank you for flagging these up lads.

Keep them coming.

Not just about concussion, but more criticism of schools rugby:

http://www.telegraph.co.uk/education/educationnews/11331343/Gladiatorial-culture-of-school-rugby-is-too-violent-for-small-children-warns-surgeon.html

Bloody doctors with their anecdotal evidence If you think there's a problem look at it properly. Either with the RFU (to make sure they do it properly) or independently. Is 20 youngsters a lot? How does it compare as a percentage of participants when compared to other sports, including cricket and football, which are not contact sports?

But, classing players by weight seems sensible (and the kiwi's supposedly do it so it must be good). Everyone playing touch rugby, with contact being separate and optional, seems a good idea.

HammerofThunor wrote:Bloody doctors with their anecdotal evidence If you think there's a problem look at it properly. Either with the RFU (to make sure they do it properly) or independently. Is 20 youngsters a lot? How does it compare as a percentage of participants when compared to other sports, including cricket and football, which are not contact sports?

But, classing players by weight seems sensible (and the kiwi's supposedly do it so it must be good). Everyone playing touch rugby, with contact being separate and optional, seems a good idea.

But that is where studies begin, with someone seeing a potential problem/solution anecdotally and then investigating it. Or stimulating someone else to investigate it. This was a letter in the BMJ, not a study. Asking questions, not necessarily suggesting they had the answers.





And 20 youngsters needing the care of a neurosurgeon is too many. It doesn't much matter if cricket is better or worse.

I agree that we need to think about weight categories rather than just age but we need to change the culture of rugby which seems to assume that admitting you are injured is a form of weakness.

Well that depends. There were 20 case that were "rugby related". Does that mean they played rugby? That it happened after a rugby match? That is was caused by the rugby? None of that is specified. If they were directly related to rugby was it an accidental in the air (e.g. Payne against Saracens) or another type of accident like that as a one off. Or was it a case of repeated blows to the head on an extended period?

It's bad yes, but how relevant is it to this case?

It's more a gripe about the media who generally publish anecdotal things more readily than any proper studies, and when they bring up studies they give no care to the quality, etc of it.

If this leads to proper studies, great. If it doesn't then it's a waste of time. It's also on the unions to have a continuous review of injuries, especially in schools. According to him the unions say there is no evidence of risk to kids (or whatever he said). Is that right? Have they done a study on it? Is it published? Do we have any faith in our media that if two conflicting studies were publish they could actually give a fair account of the quality of each? I don't, so I'd have to read them myself.

We're supposed to be one of the world leaders in science and our general media science reporting is horseshit. But that's a difference personal gripe with isn't hugely related

Posted this on the other concussion thread too.

Don't know if peple saw the Bath match?

But Anthony Watson was knocked clean out for at least 30's by a knee to the head, he went off for a "test" but was allowed back on to play again. Later in the game he was knocked out again by a grab to the face, which to my mind proves he was never ok to go back on the field.

Now that second knock out could cause him real issues but I don't think it was even mentioned by the commentators. And Watson's only 20(?).

yappysnap wrote: And Watson's only 20(?).

And is in the England squad with no mention of concussion. Agree with you mate, it's a worry.

And North tonight. Clearly KO'd but back on the pitch after tests that were never intended to be used in that set of circumstances.

Then apparently played on again after a further KO? I didn't get to see the whole match.

When are they going to take those responsible for these incidents to task?

Did Ben Robinson's death really change nothing?

Another retirement because of repeated concussions.

http://www.bbc.co.uk/sport/0/rugby-union/31508482

Another retirement because of concussion.

http://www.bbc.co.uk/sport/0/rugby-union/32338677

Mike Brown still suffering concussion issues, and may now be ruled out for rest of the season

Programme on the beeb tonight. Should be worth a watch.

Panorama: Rugby and the Brain - Tackling the Truth - will be broadcast on BBC One on Monday 21 September, at 20:30, and afterwards on the BBC iPlayer.

http://www.bbc.co.uk/news/uk-34311525

http://www.bbc.co.uk/news/uk-scotland-34249189

Maybe it's time to stop using the term concussion and start calling a spade, a spade.
It's a brain injury.

Different sport but this was in the local news

http://www.hulldailymail.co.uk/8216-Pray-little-Robin-8217-Connor-Lynes-Hull/story-26218511-detail/story.html

Blood clot after a tackle in league, kid was in a coma. Apparently he was walking again recently which is good news. His mum is campaigning for kids to wear scrum caps. They had a head specialist from the university of Birmingham on saying that he didn't think scrum caps were the answer as good studies tend to show they don't protect the brain and can lead to false confidence (and therefore more force in collisions).

http://www.bbc.co.uk/news/uk-england-devon-35040216

I was just about to put the link. Tragic.

http://www.sportsintegrityinitiative.com/concussion-sport-and-the-law/

Still happening!

Seriously?

http://www.bbc.co.uk/sport/rugby-union/38227807

It really is a shambles and once again Northampton haven't handled this well IMO.

They first said that he DEFINITELY wasn't knocked out then quickly changed their tune to say that they didn't have enough replays to see that he was lying face down in the turf not moving - implying that they now accept that he was knocked out.

And I really don't buy the lack of replays excuse - the only way they wouldn't have seen that is if there had been no replay at all for them to view, as any camera angle would  have shown it given that he was instantaneously out cold when he landed. Also, the medic was on the pitch very quickly and would surely have seen that he was face first on the ground not moving.

What I really don't understand is why they didn't just keep him off - the only reason this has blown up is because they let him back on.

Here's the incident



https://www.youtube.com/watch?v=8q78YPBDv78

Shambles is one way to describe it.

Anyone watching, even in real time, should have had serious concerns about any player landing on his head from that height. Add to that the clear appearance of North's LOC should have meant he was not allowed back on the pitch.

Given this was North, who has not only a pretty scary head injury history but also a history of somehow being able to pass HIAs despite significant head injury, how on earth was he sent back on to the pitch?

BT have strongly questioned Northampton's assertions that they were not able to access the footage.

I'm just waiting for them to say that none of the medics or coaches saw the incident happen - it's not like he was in the middle of a ruck or off the ball, he was chasing a high ball. The entire stadium would have been looking at them!

Given the current headlines about concussion in sport and threats of legal action I just can't fathom why they sent him back on. The excuse of 'well he passed his HIA so we were within the guidelines' really doesn't wash with me either, although it probably covers them from a legal point of view and directs attention towards those who made HIAs the way of assessing whether a player is fit to carry on (World Rugby I'm assuming)

missing one point though!

World Rugby's own rules state that if a player is unconscious then they are to be removed from the game. Regardless on if they can pass a HIA or not!

Not quite.

The HIA is not intended to be used on any player with a clear head injury. It is supposed to be used where an incident has occurred which could lead to a concussive head injury but there are no clear signs on the pitch.

If a clear or suspected head injury has occurred the player must be removed and not allowed to return. They are then assessed as part of the GRTP protocols.

"A concussion review group has now been formed to investigate the handling of the case and RFU boss Ritchie said: "They will come to a conclusion by the end of the week and we should learn lessons from that, where there are ones to learn.

"Concussion is definitely a big challenge. We have to address it head on."



Did he really just say that? Was he trying to be funny?

http://www.bbc.co.uk/sport/rugby-union/38403463

Pete C (Kiwireddevil) wrote:Here's a news feature that screened in Australia NZ recently. Ex-AB Steve Devine seems to be really suffering as a result of his concussions
http://www.abc.net.au/4corners/stories/2012/05/10/3499950.htm

This is still one of the most worrisome documentaries about concussion I have ever seen on tv.

http://www.stuff.co.nz/sport/rugby/93767917/new-zealand-rugby-players-to-participate-in-international-concussion-study