Rory lamont - 'I was forced to play while injured'

by **RDW** Sat 27 Jul 2013, 11:33 am

Damming and very concerning interview with Rory Lamont on the attitudes towards injuries in rugby in The Scotsman:

His left foot is in a medical boot used to aid recovery from ankle injuries, the Scotland internationalist having recently undergone what was his 16th operation during a ten-year professional rugby career. It proved to be one too many for the 30-year-old, who finally called time on rugby in May after deciding he no longer had the will to fight back from this latest setback after more than a year in rehab trying to make himself fit again.

There are some in Scottish rugby and further afield who will nod, and tell you it underlines their belief that Lamont was “a bit soft”; that he lacked the mental strength to deal with the harsh side of modern rugby union. Some qualified medical practitioners and highly-respected coaches will tell you ‘a lot of it was in his head’.

By the end of our interview, and a series of revelations of how he and other top names played for Scotland when seriously injured, and saying so, our concern is absolute at how aspects of modern rugby coaching and medical treatment remain in the dark ages.

Lamont is quick to state that he has enjoyed his rugby career and clutches the memories of playing for Northampton, Sale, Toulon, Glasgow and Scotland dearly. He is a phlegmatic character and, despite what he tells me of his career, has no trace of bitterness or regret. He refuses to say which coaches and medics mocked him or insisted that he play when he was insistent that his body was not up to it.

But this is a story that has to be taken seriously. Lamont retains good relationships in the game and does not wish to finish his career throwing criticism at individuals. Instead, he wants coaches to think twice and thrice when a player says he can’t play, and wants players, above all, to realise that they must stop the lies, the macho approach to hiding injury and simply accepting a coach’s demand to play when injured, and change the culture for the benefit of the players coming behind them.

It might sound grandiose, but once we get into Lamont’s examples of facing the All Blacks, having told the coaches he was not fit, the message begins to sink in.

“These are things I could not say when I was playing,” he began. “But this has to be spoken about because we are involved in a sport that is still only relatively new and where injuries are occurring frequently. Do we know how that is going to affect us as humans in later life? No, we don’t, because the first full-career pros have only just retired.

“It is important for me to say from the start that the game of rugby and the medical side of things have improved hugely in the past decade, and is far better and safer now in many ways, with better rehab, and prehab. I also want to make clear that I believe medics involved in sport and coaches have a very tough job, and you have to accept that mistakes happen to the very best, but the crucial part for me is that players are still not being listened to, and that is a major problem in the game.”

Lamont picks out Dr James Robson, the SRU’s head of medicine, as someone players retain huge faith in, not least because he will often back a player to the hilt in refusing a coach’s demand to play. Furthermore, he insists that the fact his career lasted until this year was down to excellent medical care and expertise from many in the game. But the examples where it was not is what needs addressed.

“This is the stuff that never gets spoken about and the public never get to hear,” he said. “But, in 2010, we played against the All Blacks. I had played against Stade Francais [for Toulon] ten days before and taken a huge hit to the quadricep, and had a massive bleed, haematoma, and could hardly run when I came over to join Scotland for training.

“I tried my best in training but, when I got to 60 percent of my speed, that was my limit. Five minutes into the team run the day before the game, I pulled up and said ‘this is no good’. The thigh went into spasm and I couldn’t run.

“I told them [medics and coaches] I couldn’t play and was looking at pulling myself out. I had done it once before, also against the All Blacks [in 2008], when I had a bad shoulder injury, but they disagreed and said it was in my head.

“So I had medics in one ear, coaches in the other. I want to play more than anyone and my body’s saying ‘no, no, no ...’ Next day, I’m doing the warm-up at Murrayfield and the quad’s stiff, my head is all over the place. I’m looking at the crowds and thinking I shouldn’t be here.

“I put it out of my mind and concentrate on my first job, to sprint from the kick-off and make the first tackle. The whistle goes, and I take off and, after about 15 metres, I feel something go ffffft in my thigh and the pain suddenly becomes excruciating.

“Two seconds into the game. I know if I go off now, this will screw the team, because we only had Nikki Walker covering the entire threequarter line, so we’d be short of cover, and we’re trying to beat the All Blacks for the first time.

“So, I get it treated, let it ease and stay on until half-time. I did my best but I played like Poopie. I never missed a tackle, because I couldn’t get near them. We lost four tries and Mike Blair to injury. I told them at half-time ‘I can’t stay on’, and they weren’t happy. But I stayed off. We lose heavily, a coach asks me after the game if I have a mental issue with playing the All Blacks. I just shake my head.

“The next day I return to France. I get it checked out and I’ve got a four-inch tear down my quad muscle – out of the game for another six weeks. Brilliant.

“I got hammered in the press for having a Poopie game. I tell the coach about the tear and there’s no apology or anything. Who cares?”

At club level, he recalls breaking his jaw in the first ten minutes of a game but being told to play on.

“My mouth is spitting blood, my jaw is in agony, I get treated and stay on the pitch. I come in at half-time and say ‘look, I need more painkillers; this is not good’. The response was ‘look, if you’re not interested in playing, we’ll replace you with someone who is’.

“I said ‘I do want to play’, so I get on with it, play the rest of the game, go home afterwards and don’t sleep at all. The next day, I phone the club doctor and say ‘I need to get to hospital now because I’m in agony’. We go, get x-rayed and it shows two pieces of my jaw are split, being held together only by muscle. Again, no apology from the doc or the coach.

“I had plenty of time in rehab but I broke my scaphoid [he points to obvious ugly scar down his wrist] once and played for eight months because every time I complained to the doc he’d say there was nothing serious. When it was finally diagnosed, the doc was ‘oh yes, it’s broken; should really have had that operated on straight away because now you run the risk of arthritis’. And I spent £5,000 of my own money to get the operation I was told I really needed.”

These incidents happened at various clubs in different countries. The issues are not of geography, but born of a culture still in rugby that is at odds with professionalism. It is not an easy issue for coaches, physios and doctors. Injuries are rarely black or white and diagnosis often an art, not a science. How many times do GPs and even specialists get it wrong, and some never see the severity of injuries in rugby which Dr Robson likens to those from car crashes?

Coaches, too, will invariably motivate players by pushing them through fears, when the pain was not as great as a player feared. But with 20-stone athletes crashing into each other, the game now has the potential to be more dangerous and errors of judgment more damaging.

There is a worrying acceptance among modern players that they will suffer serious injury at least once in their career, while a number of leading players have suffered from mis-diagnoses, had recovery periods doubled with changing opinions over the need for operations and been forced to retire through injury. Little is said.

So, Lamont’s testimony has to be welcomed. It comes from someone who knows plenty of pro rugby’s dark side. He says he has never suffered a recurrent problem and none of his 16 operations were for related injuries.

There has been a perception that he can be both brave and foolhardy, but, as one recalls his attempts to beat opponents to high balls, and clash mid-air, his leg once and ankle another time collapsing on landing, or taking a knee flush in the face as he desperately, and successfully, stopped a try by an England winger on the wet Murrayfield turf, many of Lamont’s daring efforts were also of the type that brought Scotland, and club supporters to their feet in raptures. And he was good, undoubtedly one of the best full-backs Scotland has produced in the professional era.

But the recollections above and incidents affecting fellow internationalists have led Lamont to believe in his own instincts. That manifested itself in defying medics and coaches, insisting on his own warm-ups and refusing to play with pain, and earned him a reputation for “having mental issues”.

A large problem in scale or small? It is impossible to tell. But it could be serious for every player affected and Lamont is hoping that by sharing his experiences he could help to effect change.

He added: “Ultimately, a player is responsible for his own body. But they also have to be listened to when they say they are injured or we’ll see more and more players being injured out of the game.”

Now any fan would say Rory played with bravery verging on recklessness - how could coaches think he was faking it?

Any thoughts on who the coaches he's not mentioned could be?

Very worrying read, and think it's fair to say this is a widespread problem in the game.

by ChequeredJersey Sat 27 Jul 2013, 12:16 pm

This is a disgrace, absolutely opposite to a doctor's role

by Hood83 Sat 27 Jul 2013, 12:51 pm

Really important perspective I think. My personal experiences with doctors for various non-rugby related injuries have been appalling. To any doctors on the boards, I'm sure you're stand up pros and top blokes, but of the huge collection I've met, the vast majority have been money-grubbing, arrogant, complacent bar stewards.

Anyway, important testimony I think, shines a light on the darker aspects of the game that surely must need to change if endemic.

by Hood83 Sat 27 Jul 2013, 12:54 pm

Would 2010 have been Andy Robinson? I actually have a lot of time for him as a forward's coach, but I could sort of imagine him adopting that attitude. Maybe that's unfair...

by **RDW** Sat 27 Jul 2013, 12:56 pm

Think it was Robinson, but it could have been one of thr assistant coaches.

Saying that I remember him on the 2001 lions tour screaming at james Robinson to keep a player on cause 've was fine!'

by GLove39 Sat 27 Jul 2013, 2:46 pm

Very interesting article by ramont, on an issue that needs addressing.
As for the coaches he's not mentioning. Well if we take his example do the NZ game, then it must be one of
Andy Robinson,
Gregor Townsend,
Graham Steadman,
Duncan Hodge,
Stevie Scott,
Neil Potts.

Personally I'd put my money on Robinson.

by GloriousEmpire Sat 27 Jul 2013, 4:54 pm

Hood83 wrote:Really important perspective I think. My personal experiences with doctors for various non-rugby related injuries have been appalling. To any doctors on the boards, I'm sure you're stand up pros and top blokes, but of the huge collection I've met, the vast majority have been money-grubbing, arrogant, complacent bar stewards.

Anyway, important testimony I think, shines a light on the darker aspects of the game that surely must need to change if endemic.

Yeah. Doctors are a breed at the moment. My GP lost my CT scan results and then forgot to schedule me another one four times. My girlfriend went to complain on my behalf (she's a bit feisty) and when he found out she's a modelling agent he gave her a stack of private phone number cards for discount Botox shots. All this paid for by the NHS.

It's an appalling state if Shiite right now and needs to be sorted out.

by **George Carlin** Sat 27 Jul 2013, 5:06 pm

That's very disturbing and at the same time completely believable. Just before the Lions tour O'Driscoll gave an interview saying that he hadn't played without some sort of pain in 4 years. But this is worse. This is acute, diagnosable injuries which the coaches are trying to will away. It's completely stupid to ask someone to play if they're not 100% - they will always be holding back and trying to protect themselves. These people are professional athletes, there because they love the sport - how likely is it really that they just lose interest in playing? Just idiotic.

I do know that James Robson has faced down previous Lions coaches and demanded that certain players come off the 'available' list. But you need to be that senior and that well respected to dig in like that.

Players need protected.

by ChequeredJersey Sat 27 Jul 2013, 5:08 pm

This thread is about doctors in rugby, please don't make it about gripes with the medical profession in general

by 123456789 Sat 27 Jul 2013, 5:32 pm

I expect it was Robinson you wouldn't phone an assistant coach to tell them you were injured. I was at that game and sat on Lamont's wing about two rows up and he didn't lay a finger on Hosea Gear so Robinson really didn't do himself any favours

by **Notch** Sat 27 Jul 2013, 6:17 pm

Andy Robinson and Gregor Townsend was the coaching ticket for that match.

How either could expect to beat the All Blacks with a winger on one leg 'marking' Hosea Gear is beyond me. Moronic.

by Guest Sun 28 Jul 2013, 12:30 am

What makes this a bit worse is some coaches get slated for using training performances as an excuse for selection (Sir Warren for one and I don't agree with the reasoning often), but surely somebody within that coaching team must be able to tell if a player is at "60%"?

Still, nothing will be sorted unless a stand is made against people coming back on after clearly being hurt. Last example I saw was George Smith coming back on after being wobbled badly in the third Lions test.

I do find it a bit hard to believe a coach would play Lamont at near half speed. If he did, that's total incompetence at your job. Also it might need a current player to publicly speak about it nearer when the incident occurred for action to be taken.

by ChequeredJersey Sun 28 Jul 2013, 12:58 am

Risca Rev wrote:What makes this a bit worse is some coaches get slated for using training performances as an excuse for selection (Sir Warren for one and I don't agree with the reasoning often), but surely somebody within that coaching team must be able to tell if a player is at "60%"?

Still, nothing will be sorted unless a stand is made against people coming back on after clearly being hurt. Last example I saw was George Smith coming back on after being wobbled badly in the third Lions test.

I do find it a bit hard to believe a coach would play Lamont at near half speed. If he did, that's total incompetence at your job. Also it might need a current player to publicly speak about it nearer when the incident occurred for action to be taken.

Fair enough. I have to say kudos to Gats for not picking a less than 100% Corbs, Phillips or Roberts

by Guest Sun 28 Jul 2013, 1:14 am

ChequeredJersey wrote:
Risca Rev wrote:What makes this a bit worse is some coaches get slated for using training performances as an excuse for selection (Sir Warren for one and I don't agree with the reasoning often), but surely somebody within that coaching team must be able to tell if a player is at "60%"?

Still, nothing will be sorted unless a stand is made against people coming back on after clearly being hurt. Last example I saw was George Smith coming back on after being wobbled badly in the third Lions test.

I do find it a bit hard to believe a coach would play Lamont at near half speed. If he did, that's total incompetence at your job. Also it might need a current player to publicly speak about it nearer when the incident occurred for action to be taken.

Fair enough. I have to say kudos to Gats for not picking a less than 100% Corbs, Phillips or Roberts

I thought it was obvious I had a slight pop at Sir Warren, when I mentioned selection based on "training performance" Also a near half pace player is somewhat more obvious.

Still, the three players you cared to mention all played a massive part in the third test and didn't get rushed back in per sé (at least two of them could probably have played in the second test, had it been necessary)

by Guest Sun 28 Jul 2013, 1:16 am

Or is that just another monkey on your shoulder about the Lions? Whistle

by doctor_grey Sun 28 Jul 2013, 1:40 am

So now one player is willing to go fully public with what we all surmise:
In fact, this is what all of us know goes on, but also is what many do not want to acknowledge. The injuries and the concussions.

Cheating concussion testing to be able to play
http://www.espnscrum.com/scotland/rugby/story/192179.html

From my point of view, real discussion about player welfare can finally begin.
Now.

by ChequeredJersey Sun 28 Jul 2013, 1:48 am

Risca Rev wrote:
ChequeredJersey wrote:
Risca Rev wrote:What makes this a bit worse is some coaches get slated for using training performances as an excuse for selection (Sir Warren for one and I don't agree with the reasoning often), but surely somebody within that coaching team must be able to tell if a player is at "60%"?

Still, nothing will be sorted unless a stand is made against people coming back on after clearly being hurt. Last example I saw was George Smith coming back on after being wobbled badly in the third Lions test.

I do find it a bit hard to believe a coach would play Lamont at near half speed. If he did, that's total incompetence at your job. Also it might need a current player to publicly speak about it nearer when the incident occurred for action to be taken.

Fair enough. I have to say kudos to Gats for not picking a less than 100% Corbs, Phillips or Roberts

I thought it was obvious I had a slight pop at Sir Warren, when I mentioned selection based on "training performance" Also a near half pace player is somewhat more obvious.

Still, the three players you cared to mention all played a massive part in the third test and didn't get rushed back in per sé (at least two of them could probably have played in the second test, had it been necessary)

...

I was being genuine

...

by ChequeredJersey Sun 28 Jul 2013, 1:51 am

Or am I not allowed to do that? That monkey on my shoulder is getting hungry. At least I have not had a go at Faletau for nthe first time ever ...

by **LondonTiger** Sun 28 Jul 2013, 7:27 am

ChequeredJersey wrote:
Risca Rev wrote:
ChequeredJersey wrote:

Fair enough. I have to say kudos to Gats for not picking a less than 100% Corbs, Phillips or Roberts

I thought it was obvious I had a slight pop at Sir Warren, when I mentioned selection based on "training performance" Also a near half pace player is somewhat more obvious.

Still, the three players you cared to mention all played a massive part in the third test and didn't get rushed back in per sé (at least two of them could probably have played in the second test, had it been necessary)

...

I was being genuine

...

Apparently the law now states that any non-welsh poster is not allowed to say anything complimentary about Warren Gatland. Should that appear to happen, all posters are to assume the comment was sarcastic.

by Hood83 Sun 28 Jul 2013, 11:05 am

GloriousEmpire wrote:
Hood83 wrote:Really important perspective I think. My personal experiences with doctors for various non-rugby related injuries have been appalling. To any doctors on the boards, I'm sure you're stand up pros and top blokes, but of the huge collection I've met, the vast majority have been money-grubbing, arrogant, complacent bar stewards.

Anyway, important testimony I think, shines a light on the darker aspects of the game that surely must need to change if endemic.

Yeah. Doctors are a breed at the moment. My GP lost my CT scan results and then forgot to schedule me another one four times. My girlfriend went to complain on my behalf (she's a bit feisty) and when he found out she's a modelling agent he gave her a stack of private phone number cards for discount Botox shots. All this paid for by the NHS.

It's an appalling state if Shiite right now and needs to be sorted out.

Blimey, really?!! You have my sympathies re CT scan GE. Had four years with a hip problem, MRI scans and everything showed nothing, they forced me to do lots of weight bearing 'physio' to strengthen it. I insisted on an MRA with the result being 'Oh, yes, it seems you have early stage arthritis and torn cartilage...don't know how we missed that, but stop all those exercises you've been doing for 3 years'...hip arthroscopy duly completed a couple of months ago and now 'Ah, well it turns out we fixed A problem...but it isn't THE problem that's been causing you the pain...'

Sorry, that was more of an insight into my medical history than you need. I'm an NHS supporter, but would love to know when I'm going to get the bit that's a 'national treasure'. Fed up hearing of doctors asking for more gold to be stuffed down their necks. Give it to the nurses if anyone.

Rant over, but I entirely agree! Doctors allowing players to play on injured at elite level is not surprising to me in the least.

by Hood83 Sun 28 Jul 2013, 11:07 am

Hood83 wrote:
GloriousEmpire wrote:
Hood83 wrote:Really important perspective I think. My personal experiences with doctors for various non-rugby related injuries have been appalling. To any doctors on the boards, I'm sure you're stand up pros and top blokes, but of the huge collection I've met, the vast majority have been money-grubbing, arrogant, complacent bar stewards.

Anyway, important testimony I think, shines a light on the darker aspects of the game that surely must need to change if endemic.

Yeah. Doctors are a breed at the moment. My GP lost my CT scan results and then forgot to schedule me another one four times. My girlfriend went to complain on my behalf (she's a bit feisty) and when he found out she's a modelling agent he gave her a stack of private phone number cards for discount Botox shots. All this paid for by the NHS.

It's an appalling state if Shiite right now and needs to be sorted out.

Blimey, really?!! You have my sympathies re CT scan GE. Had four years with a hip problem, MRI scans and everything showed nothing, they forced me to do lots of weight bearing 'physio' to strengthen it. I insisted on an MRA with the result being 'Oh, yes, it seems you have early stage arthritis and torn cartilage...don't know how we missed that, but stop all those exercises you've been doing for 3 years'...hip arthroscopy duly completed a couple of months ago and now 'Ah, well it turns out we fixed A problem...but it isn't THE problem that's been causing you the pain...'

Sorry, that was more of an insight into my medical history than you need. I'm an NHS supporter, but would love to know when I'm going to get the bit that's a 'national treasure'. Fed up hearing of doctors asking for more gold to be stuffed down their necks. Give it to the nurses if anyone.

Rant over, but I entirely agree! Doctors allowing players to play on injured at elite level is not surprising to me in the least.

Should say this was all punctuated with appointments not being scheduled, records not being passed across, rude staff etc. etc.

by doctor_grey Sun 28 Jul 2013, 12:10 pm

Hood83 wrote:
Hood83 wrote:
GloriousEmpire wrote:
Hood83 wrote:Really important perspective I think. My personal experiences with doctors for various non-rugby related injuries have been appalling. To any doctors on the boards, I'm sure you're stand up pros and top blokes, but of the huge collection I've met, the vast majority have been money-grubbing, arrogant, complacent bar stewards.

Anyway, important testimony I think, shines a light on the darker aspects of the game that surely must need to change if endemic.

Yeah. Doctors are a breed at the moment. My GP lost my CT scan results and then forgot to schedule me another one four times. My girlfriend went to complain on my behalf (she's a bit feisty) and when he found out she's a modelling agent he gave her a stack of private phone number cards for discount Botox shots. All this paid for by the NHS.

It's an appalling state if Shiite right now and needs to be sorted out.

Blimey, really?!! You have my sympathies re CT scan GE. Had four years with a hip problem, MRI scans and everything showed nothing, they forced me to do lots of weight bearing 'physio' to strengthen it. I insisted on an MRA with the result being 'Oh, yes, it seems you have early stage arthritis and torn cartilage...don't know how we missed that, but stop all those exercises you've been doing for 3 years'...hip arthroscopy duly completed a couple of months ago and now 'Ah, well it turns out we fixed A problem...but it isn't THE problem that's been causing you the pain...'

Sorry, that was more of an insight into my medical history than you need. I'm an NHS supporter, but would love to know when I'm going to get the bit that's a 'national treasure'. Fed up hearing of doctors asking for more gold to be stuffed down their necks. Give it to the nurses if anyone.

Rant over, but I entirely agree! Doctors allowing players to play on injured at elite level is not surprising to me in the least.

Should say this was all punctuated with appointments not being scheduled, records not being passed across, rude staff etc. etc.

Mate, I can't comment on the actions of others nor on your case, but you clearly highlight the problems with the NHS. It is completely unacceptable for scans to be lost, appointments to be mis-scheduled, and problems to be allowed to linger. I got out of the NHS years ago, partially because I had to travel a lot for other business, but also when I was somewhat affiliated with a staff which continually messed up records. To a point I felt it put my credibility (all a doc really has) seriously at risk. On the other hand, I have worked with fantastic committed people in the NHS too. And they never receive any praise because of all the public negativity. Shame, because I believe in the concept of the NHS, if not how it always works.

Regarding allowing athletes to play when still injured, the docs have limited authority and influence. If a player is 'healed' he might not be completely recovered. Many of these decisions are made by physios together with the coaching staff. Each team is different. I have treated top level athletes and sometimes have increased times for 'healing' to enable more 'recovery' time. Every doc does this.

I am not shocked by either article, either the injuries or the fudging the concussion baseline tests. I am a strong advocate for better handling (read: proper handling) of concussions. In my practise here, this is taken with grave consideration. And we treat NY area pros as well as colleges and high schools.

I would mention, though, the pressure at the top levels are extraordinarily intense. And has gone up a zillion fold since the advent of professionalism. The pressure on the players, coaches and the staff. The problem is that everyone has worked long and hard to get to the top level of pro sport. The docs too, and many consider it the pinnacle of a medical career (which in many cases it truly is). It takes a strong person to stand up to this pressure. What it really takes is an 'I don't care' attitude about whether one keeps their job at the highest level or not. I am excusing no one. But simply explaining.

What I have never understood is putting a player on the pitch who will not make the team better. Never have. Never will.

by **LondonTiger** Sun 28 Jul 2013, 4:28 pm

I cannot comment on GPs, but the hospital doctors I have met (and there are a load of those including my ex-wife) are amongst the hardest working, dedicated and underpaid professionals I have ever met (much as I may hate my ex for what she put me through, I include her in this). Despite what you may read in the Daily Fail, most hospital consultants are paid a lot less than you think and (due to contributing about 20% of their salary to it) had a pension fund that was in surplus and did not need changing.

My daughter would have died without such dedicated staff. There are always some bad eggs - but I will defend these guys with my dying breath. Gold diggers they are not.

My rant over.

by ChequeredJersey Sun 28 Jul 2013, 4:39 pm

I'm heavily biased I'll admit but whilst the NHS etc is flawed and there are some terrible doctors out there, in my experience they are the exception rather than the rule, and don't get me started on the media's portrayal of medicine which is nothing short of an utter disgrace

by **Notch** Sun 28 Jul 2013, 7:24 pm

We attack the NHS all the time. We live in a country where if you need rare, expensive medication/treatment to save your life you can get it for free. Think about what we'd be losing if we let them take it apart.

My family has benefited a lot from having access to medication which would cost us a literal fortune in insurance premiums in many other countries, but then any family in the country could need the same at any time. Life is never predictable.

Unfortunately, the problems in the NHS are very unlikely to be solved by a government intent on privatizing it as quickly as possible.

by MrsP Sun 28 Jul 2013, 9:39 pm

GE,

Really sorry to hear you have had a bad experience. It should not happen.

Might be worth remembering that it probably was not your GP who lost your CT Scan result. The result may well have gone astray but that does not mean he lost it. Even if the result got as far as him/her and he stuffed it in the bin in an effort to annoy you, the result would still be available in which ever centre had performed the scan. Could it be that the administrative system are the ones who have "lost" your scan result rather than your GP? Could he perhaps have been trying to have the result located for you so you didn't have to have it repeated and thereby protecting you from further radiation exposure?

Just a thought.

On the topic of players being forced to play when unfit. It should not happen. Anyone who doubts my feelings on the subject of players continuing when they have suffered a head injury can read this thread about concussion.

https://www.606v2.com/t22009-advice-on-when-to-return-to-play-after-a-concussion

However, the role of Sports Physician is slightly different to that of some other medical specialists. Most of us would encourage our patients to avoid risk factors for specific illnesses or injuries whereas sports medicine really deals with getting a person back so they can face those risks once again. Of course, that is no excuse for forcing players back before they are ready. My (fairly limited) experience of dealing with sportsmen is that it is they themselves who are the ones pushing to return to the action. We often need to protect the player from themselves.

It is great to hear someone come out and talk about the way the players get around some of the concussion tests. We all knew it was happening but it needs the players to start to wise up too.

by InjuredYetAgain Sun 28 Jul 2013, 10:12 pm

I'm going to play devil's advocate here for a second.
Ramont was rugby's equivalent of Darren Anderton in that the physio's table had the outline of his body on it as he spent so long there. There may come a point where a doctor sees a player so often that he eventually thinks that a player is "at it" and perhaps doesn't really want to play. Perhaps Doc G can shed any light on whether he thinks he would be able to see through a player who was making up symptoms-v- a guy who was telling them truth? I imagine that muscle tears must be relatively easy to spot but illnesses/back pain/even concussions etc must be a lot harder to be certain of.
Mrs P does make a very good point though in that we (ex) players are out own worst enemy some times and we don't get paid (much) let alone the rewards that the top players do.
I played a cup semi final a week after I had damaged my AC joint because we had an horrendous injury list. The physio spent ages putting all sorts of padding on my shoulder then put a tonne of strapping on it. She then had to help me on with my top as I couldn't lift my arm above shoulder height. When I threw my shoulder into one of the posts in the warm-up to simulate scrum-time, I almost barfed with the pain. Trying to take the ball in line out one-handed isn't too easy either. But, because there were no alternatives available, I played although, after about 3 scrums I had to move to playing right-hand wing forward as my right shoulder was totally Donald Ducked and I just couldn't push. I don't know if it was down to this alone but my shoulder now sub-luxes I think it is called (it pops out and back in on its own) and that, together with a shocking attitude to training, was one of the reasons I had to give up
I played with a guy who broke his thumb one week and was told he would be in plaster for 6 weeks. He got bored not playing so cut the plaster off himself and played after 2 weeks! I don't know what the hospital said to him when he went for his appointment to have ther thing officially removed
Who here can honestly say that they haven't played when they should have been sitting on the sidelines?

by **Notch** Sun 28 Jul 2013, 11:37 pm

InjuredYetAgain-

You win the award for most appropriate user name on the 606v2 rugby board. Congratulations! You must be very proud.

by InjuredYetAgain Mon 29 Jul 2013, 12:00 am

Proud, sore and wimp in equal measures, my friend

by doctor_grey Mon 29 Jul 2013, 12:41 am

InjuredYetAgain wrote:Proud, sore and wimp in equal measures, my friend

For some reason, I reckon not.

by Gibson Mon 29 Jul 2013, 1:00 am

That is disgraceful. It really hit the spot with me. Behind the scenes, as rugby gets more durty-pro and with more TV cash coming forth, its changing fast. And I dont like it. But hey, that's the way of it when you sell your soul to the Corporate Devil. Like Wendyball has.

As long as the Sheeple pay for it, they'll dish it up.

If it goes too far that way, I'm out Ted. I'll concentrate purely on following the Dutch girlie volleyball team around the World.

In a stalking way mind.

Back to the OP. It is despicable and it must be rooted out from the top down. Initiative from the hapless IRB? Allah give me strength.

I love this game. Love the people I meet through it. But that article really hurts.

by Gibson Mon 29 Jul 2013, 1:31 am

LondonTiger wrote:I cannot comment on GPs, but the hospital doctors I have met (and there are a load of those including my ex-wife) are amongst the hardest working, dedicated and underpaid professionals I have ever met (much as I may hate my ex for what she put me through, I include her in this). Despite what you may read in the Daily Fail, most hospital consultants are paid a lot less than you think and (due to contributing about 20% of their salary to it) had a pension fund that was in surplus and did not need changing.

My daughter would have died without such dedicated staff. There are always some bad eggs - but I will defend these guys with my dying breath. Gold diggers they are not.

My rant over.

Man. Real Life experience, speaks the Truth.

Good man Tiger. Tell it like it is.

by doctor_grey Mon 29 Jul 2013, 1:53 am

I think we should separate the concussion discussion from other injuries. I would consider a concussion amongst the ultimate soft tissue injuries. Proper diagnosis by trained medical professionals is critically needed. If not properly identified early and properly treated long term brain damage and impairment is likely. This is very different than breaking a finger and resetting by yourself and taping it at halftime. There are so many cases of concussions not being properly treated that we don't need to mention them. I include myself in this as I had a few whilst playing when younger then again on Army or foreign service (where there was no other doc available). I now suffer from nasty migraines a few times a year. And I consider myself lucky.

I don't think the right question is whether an athlete can fool a doc about concussions. The only time a player is removed from a match for concussion is if someone sees him/her get their bell rung. With that in mind. any behaviour afterwards, to me, should be almost irrelevant because they should not be allowed back on the pitch in probably 90% of the cases. A player can't hide looking woozy or wobbly. Then the proper long term diagnostics are needed. Please remember baseline testing is one tool amongst many. Over-reliance is dangerous. The George Smith case is obvious. One of my favourite players and I was happy to see him back with the Wallabies. But he should never have been allowed back on after the knock. The fact he played very well afterwards does not mean there was no bruising on the brain.

Other injuries are different. Something is clearly wrong and probable injury can be proposed. Accurate pitch-side diagnosis is usually correct 50% of the time. Once identified/validated by scan (X-Ray, MRI, CT) most injuries heal according to well known patterns and time frames. Any doc knows this and should be deaf to any claims of extraordinary healing. The problem with most injuries is the true stability and function of the injured area. It is frequently harder to determine which other tissues were damaged as well. And then it can take a long time for muscle function to be built back.

Let's take another of my favourite players, Ben Foden. I can't go into detail about his injury, but he clearly injured his ankle ligaments and he took a very long time to get back to his best form. Unfortunately that was at season's end. In hindsight, he clearly had additional damage to accompanying tissues, which is why he had trouble with making and accelerated into and out of his usual cuts when he came back. Straight ahead was functionally fine.

I apologise for going on, but this could end up as a medical paper about sports injuries. All players want to play. Truth from a player about injury is like truth from a politician. Trust at your own risk. But always always always verify. To answer the questions, some injuries are easy to see through the players. Some are harder. Concussions are very difficult. In my experience, it takes a lot of questioning, a lot of probing, and some good old fashioned intuition to know if a player is honest about injury or not.

by Gibson Mon 29 Jul 2013, 2:02 am

See, this is the kind of inside, experienced, knowledge, we all need to glean - before we bleat.

Awareness helps, one finds.

I stand a wee bit more educated. Cheers Doc. Wuv u Tiger.

by doctor_grey Mon 29 Jul 2013, 2:11 am

You're welcome mate.
But the most important paragraph is my last one. Players lie about injuries (as would I). Know your people and use your intuition.

by Gibson Mon 29 Jul 2013, 2:26 am

MrsP wrote:GE,

Really sorry to hear you have had a bad experience. It should not happen.

Might be worth remembering that it probably was not your GP who lost your CT Scan result. The result may well have gone astray but that does not mean he lost it. Even if the result got as far as him/her and he stuffed it in the bin in an effort to annoy you, the result would still be available in which ever centre had performed the scan. Could it be that the administrative system are the ones who have "lost" your scan result rather than your GP? Could he perhaps have been trying to have the result located for you so you didn't have to have it repeated and thereby protecting you from further radiation exposure?

Just a thought.

On the topic of players being forced to play when unfit. It should not happen. Anyone who doubts my feelings on the subject of players continuing when they have suffered a head injury can read this thread about concussion.

https://www.606v2.com/t22009-advice-on-when-to-return-to-play-after-a-concussion

However, the role of Sports Physician is slightly different to that of some other medical specialists. Most of us would encourage our patients to avoid risk factors for specific illnesses or injuries whereas sports medicine really deals with getting a person back so they can face those risks once again. Of course, that is no excuse for forcing players back before they are ready. My (fairly limited) experience of dealing with sportsmen is that it is they themselves who are the ones pushing to return to the action. We often need to protect the player from themselves.

It is great to hear someone come out and talk about the way the players get around some of the concussion tests. We all knew it was happening but it needs the players to start to wise up too.

by **George Carlin** Mon 29 Jul 2013, 7:07 am

Some great posts here - like my boy Gibson, I am grateful. I am reminded of American football where there is a huge pressure on agents to produce 'just one more' big money deal when players are in their late 20s because they know that their bodies are on the verge of breaking down over the next few years.

It must be extraordinary to rely on your body for a living. As a desk bound monkey, my body has only ever been a slightly knackered and increasingly flabby vessel for carrying around my brain. It's very difficult to imagine a life where you don't get paid if you cannot maintain a certain level of fitness and manage the pieces that can become broken at any time. The mental aspect of it is paramount. I remember reading a piece by Drew Mitchell who realised that he had to see a sports psychiatrist because he was unable to recall his horrendous ankle dislocation and break without re-living it. His body was good to play at least a month before his mind was. He had to make himself watch videos of it happening to him time and time again until he could look at it and come to terms with it.

by InjuredYetAgain Mon 29 Jul 2013, 7:22 am

I apologise if anyone thought I was being a bit flippant with my story. as the Doc points out as he seems to have a bit of first hand knowledge of some high profile injuries but obviously can't go into any sort of detail, but what we duffers on here can't appreciate is the physicality of collisions at the top.
The closest I got was at an Borders-v-Edinburgh game at Gala where you are literally 6 feet from the touch line. The sound of body on body when the scrums engaged was horrendous so god knows what damage these guys were doing to their necks, shoulders and spines.
I guess, though, that as long as we all talk lovingly about a big hit by Jerry Collins, Jason White etc and watch reruns of them on YouTube, we won't get away from the macho side of the game
Maybe we fans need to have a look at ourselves too?
I have snapped my Achilles and detached a retina playing but do I regret any of it? Not a chance. I have a good job and rugby was just an excuse to run around with friends and work up a thirst. When it is your job, it is a different matter. As George pointed out, the biggest injury risk I have is a paper cut or getting a staple under my thumbnail when trying to take it out of a wad of papersBecause I still have my faculties atop, but when guys are playing on with concussions that just adds an unacceptable risk.

by **RDW** Mon 29 Jul 2013, 7:23 am

The mental issue is a real one - I had a serious concussion in March 2012 that left me in hospital over night. I may have 'recovered' a month or so later but there's no way I would have been in the right mental state. Even when I came back playing in September I still had the head knock on the back of my mind.

These players might say they are fine after a concussion a few weeks later, but I can sure as hell tell you they won't be performing anywhere near their best.

by GunsGerms Mon 29 Jul 2013, 9:43 am

You should be grateful, in the UK you dont have to pay for a doctor apointment (its covered by NHS isnt it?) Here in Ireland I have to pay €55 for every apointment. I only get €25 back on that through health insurance. I cant afford to go anymore.

by MrsP Mon 29 Jul 2013, 9:51 am

GG,

The NHS is free at the point of use but we do pay for it in taxes.

I agree that charging to see a GP is very harsh on certain sections of society but it does have some advantages.

How much is 30 Euro in real terms? How much does a pack of ciggies cost?

by bluestonevedder Mon 29 Jul 2013, 10:25 am

This makes for terrible reading. Really provides a sneak peak into the dark depths of the rugby, and asserts the idea that as a fan sitting in the stands waiting for kickoff, you can never be sure that your prized players are in the best of health or being looked out for by the coaches. Pretty demoralising.

by doctor_grey Mon 29 Jul 2013, 11:35 am

bluestonevedder wrote:This makes for terrible reading. Really provides a sneak peak into the dark depths of the rugby, and asserts the idea that as a fan sitting in the stands waiting for kickoff, you can never be sure that your prized players are in the best of health or being looked out for by the coaches. Pretty demoralising.

It is terrible reading, and the reality spreads across the sport globally. Also, one needs to consider the players in the divisions just below top club level where players need to be on the pitch performing in order to move up to the top level. Again, I mention the pressure on everyone to perform is extraordinary.

Also, our players are all carrying injuries by the end of our too long season. One main reason NH teams play like their feet are in mud in the June Internationals is the physical toll taken by the season. The SH teams are now playing longer seasons too. Give a few more years of the current schedule and everyone will be beat up all year round. So we have a Global problem.

In my opinion, things are changing. And there is good reason for optimism.
Most good practise about injury is coming from the NFL. The American universities in their Football probably treated their players worse than any legit sport. There was a famous story of the Alabama coach in the 1960s making his players run and practise in full pads and helmets in August in 35C/95F heat. With no water breaks. He was "turning boys into men". It started to change when the NFL started complaining the universities were 'supplying' broken players. Initially the NFL was no better. But, then The NFL slowly at first started establishing benchmarks the universities were pressured into following. At that time there was no sports injury specialty and certainly no concussion understanding. The development of sport medicine comes from this event. And is spreading everywhere. And that sparked the huge growth of sports physios. These people go through uni training only a bit short of doctors, and are usually well trained. New standards are being established frequently. I find the pace of change amazing, though it appears slower than we would like. Most important is the acceptance of change.

Concussions are now taken very seriously in American football, and in fact in almost every American sport. This is happening for the good and right reasons, and also because of legal pressure. At the minimum everyone understands players can't play if they are not able to perform. The standards established here are moving around the world. There will always be old school types who were raised in the 'old world' of neanderthal sport and simply need to be pushed on.

What we need:
Global standards for injury identification throughout the sport
Global standards for recovery and return to play (concussion graduated return to play is a start)
Global limit on number of matches.

But, in many ways we are the problem. A final example is again my favourite test monkey - me. A few weeks ago I had surgery to repair a tendon in my left hand. I also have a herniated disc at C6C7, for which I have already had my three injections. Finally, I had just gotten over one of my migraines (due to concussions). My older son was playing in a 7s tournament on Saturday. There were also men's brackets. One team came running up asking if I had my kit in my car (dumb question, eh?) and could I fill in for a match or two. My body hurts when I wake up in the morning. So, seeing everyone playing everywhere and feeling the adrenaline rush I put on my kit and played two matches. I feel fine and played OK. The point is do what I say and not what I do. I simply love playing Rugby.
But, I am an idiot.
And need constant supervision.

by bluestonevedder Mon 29 Jul 2013, 11:46 am

Nice post Dr Grey, and agree with all your sentiments.

Like the NFL, I think rugby is changing too and is especially treating on-field concussions with greater importance. The introduction of the 10 minute interval for a concussion test is certainly a step in the right direction and will hopefully pave the way for further developments, without hindering the fluidity of the game too much.

However, I think particular attention needs to be paid to injuries that occur 'behind closed doors'. On-field incidents are obviously very public, so I think the exposure demands a reasonable level of treatment. Injuries from training or pre-existing problems are seemingly not as well treated (as Rory's account testifies too). There may well be problems in moving from a club to an international setup in terms of changing medical staff that might interfere with the fluidity of treatment.

Anyway, it's all speculation, but Rory's recent comments have certainly scratched the surface of what could be a deeply sinister issue.

by doctor_grey Mon 29 Jul 2013, 11:54 am

Openness about injuries is important, as you say. A lot are kept in the training room. Go to ESPN's US/global web site (or virtualy any US web site) and it is possible to read some detail about injuries about US athletes in most US sports. Then go to any Rugby web site and the injury information is usually vague. Applies to every team and nation. I think you are exactly right on about non-headline injuries. More openness will help with that. Unfortunately it takes a player who has to retire to speak up.

In my opinion, every sport is following the NFL. Rugby, I believe is willing and making attempts. Old school approaches die very hard and usually require a bit of force to make real change.

by **Notch** Mon 29 Jul 2013, 12:02 pm

It's an attitude pro rugby could get away with in the amateur era. Now, the game is so much more dangerous- the collisions are bigger, the risks are greater and the injury list is greater.

But I see this putting coaches under more pressure to play unfit players. If you're in a situation like Ulster last season when you have 50% of your squad on the injury list and no fit and available players in certain positions, coaches feel they have to play injured players- it's that or forfeit the game and the season. We had to play several guys carrying injuries in Rounds 5 and 6 of the Heineken Cup last year because if they weren't selected we would not have been able to field a full 15 from our senior squad.

Playing injured players makes the injury list that much worse, creating more pressure to play injured players. Vicious circle.

by GunsGerms Mon 29 Jul 2013, 12:05 pm

MrsP wrote:GG,

The NHS is free at the point of use but we do pay for it in taxes.

I agree that charging to see a GP is very harsh on certain sections of society but it does have some advantages.

How much is 30 Euro in real terms? How much does a pack of ciggies cost?

Dont smoke but think its around €9 according to this site:

http://www.numbeo.com/cost-of-living/city_result.jsp?country=Ireland&city=Dublin

by MrsP Mon 29 Jul 2013, 12:05 pm

But is the concussion Bin actually a step in the right direction or just an excuse to put concussed players back on the field because they managed to jump through a certain hoop despite the fact that they are clearly concussed?

by XR Mon 29 Jul 2013, 12:10 pm

This happens all the time and i would hazard a guess this is what happens with wales, players pick up injuries during a tournament and get dosed up to get through it and then have to sit out regional rugby for a month or 2 to recover.

You could see Roberts was injured, would be fit for the next match then after the 6N he'd be out for 6 weeks.

by Cyril Mon 29 Jul 2013, 2:36 pm

I was half-watching the rugby league semi-final yesterday and a player was taken off with double-vision.

He was then seen wandering (pretty dazed) along the touchline with the commentator saying (possibly half-jokingly) "he'll be walking up and down with that double-vision until it becomes single-vision again". I'm pretty sure he was back on again soon.

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